Temporary treatment with magnetically controlled growing rod for surgical correction of severe adolescent idiopathic thoracic scoliosis greater than 100°

Koller, Heiko; Mayer, Michaël; Koller, Juliane; Ferraris, Luis; Wiedenhöfer, Bernd; Hitzl, Wolfgang; Hempfing, Axel

doi:10.1007/s00586-020-06709-9

Cited by 7 publications

(14 citation statements)

References 29 publications

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“…The correction rate achieved via the Hi-PoAD technique was comparable to that of staged procedures based on traction (both internal and external) (65.0% vs 51.3–67.4% [ 4 – 8 , 10 , 11 ]), but without the need of prolonged challenging traction periods, multiple procedures and high health- and hardware-related costs. The rationale of staged procedures is to obtain a gradual distraction resulting in adequate correction minimizing stresses over the spinal cord.…”

Section: Discussionmentioning

confidence: 80%

“…These techniques, although effective, are really demanding for the patients and lead to significant health-related costs, considering the prolonged period of hospitalization and the multiple surgical procedures required. To offer a better tolerated alternative to these patients, a temporary internal distraction with magnetically controlled growing rods (MCGR) [ 10 , 11 ] has been proposed; however, increased concerns about its cost-effectiveness may arise due to the addition of high hardware costs. One-staged correction using aggressive tricolumnar osteotomies (3COs) such as vertebral column resection (VCR [ 12 – 14 ] represents an effective alternative, but at a cost of high technical complexity, alongside an high complications rate.…”

Section: Introductionmentioning

confidence: 99%

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One stage correction via the Hi-PoAD technique for the management of severe, stiff, adolescent idiopathic scoliosis curves > 90°

et al. 2023

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Study design Retrospective cohort study. Purpose to assess the efficacy and safety of Hi-PoAD technique in patients with a major thoracic curve > 90°, < 25% of flexibility and deformity spread over more than five vertebral levels. Methods retrospective review of AIS patients with a major thoracic curve (Lenke 1–2–3) > 90°, with < 25% of flexibility and deformity spread over more than five vertebral levels. All were treated via the Hi-PoAD technique. Radiographic and clinical score data were collected pre-operatively, operatively, at 1 year, 2 years and at last follow-up (2 years minimum). Results 19 patients were enrolled. A 65.0% correction rate of the main curve was achieved, from 101.9° to 35.7° (p < 0.001). The AVR reduced from 3.3 to 1.3. The C7PL/CSVL reduced from 1.5 to 0.9 cm (p = 0.013). Trunk Height increased from 31.1 to 37.0 cm (p < 0.001). At the final follow-up no significant changes, except from an improvement in C7PL/CSVL (from 0.9 cm to 0.6 cm; p = 0.017). SRS-22 increased in all patients, from 2.1 to 3.9 at 1 year of follow-up (p < 0.001). 3 patients had a transient drop of MEP and SEP during maneuver and were managed with temporary rods and a second surgery after 5 days. 2 of these 3 cases (66.7%) had a Total-Deformity Angular Ratio (T-DAR) > 25; conversely, among patients who had a one-stage procedure, only 1 (6.2%) had a T-DAR > 25 (p = 0.008). Conclusions The Hi-PoAD technique proved to be a valid alternative for the treatment of severe, rigid AIS involving more than 5 vertebral bodies. Study design Retrospective comparative cohort study. Level of evidence III.

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Section: Discussionmentioning

confidence: 80%

Section: Introductionmentioning

confidence: 99%

One stage correction via the Hi-PoAD technique for the management of severe, stiff, adolescent idiopathic scoliosis curves > 90°

et al. 2023

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“…Compared with VCR or anterior release and posterior spinal fusion in the treatment of severe spinal deformities, apical region correction and global balance with 3 rods showed shorter operation time and less blood loss [ 22 ]. Since only partially or fully resect the bilateral facet joints, the height of the chest is increased, which may improve patients’ pulmonary function [ 33 ]. As for LIV, we chose the last touching vertebra of the CSVL on the 3D reconstruction of the spine CT as the LIV to maximize motion segments.…”

Section: Discussionmentioning

confidence: 99%

Apical region correction and global balance: a 3-rods surgical strategy for the treatment of severe and rigid scoliosis

Jiao

Tan

Feng

et al. 2022

BMC Musculoskelet Disord

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Background The treatment of severe and rigid scoliosis is challenging. We developed a surgical strategy for severe and rigid scoliosis since 2014. This study aimed to retrospectively analyze the safety and efficacy of apical region correction and global balance with 3 rods as a surgical strategy for the treatment of severe and rigid scoliosis. Methods A retrospective study was performed for patients with severe and rigid scoliosis who underwent one-stage posterior corrective operation using the apical region correction and global balance with 3 rods surgical strategy between February 2014 and April 2020. The inclusion criteria were as follows: [1] Cobb angle > 90°; [2] flexibility < 30%; [3] a minimum 2-year follow-up. Patients were excluded if they had a history of traction or spinal surgery. Coronal and sagittal parameters, including Cobb angle, flexibility, apex vertebra translation, trunk shift (TS), thoracic kyphosis, lumbar lordosis, and sagittal vertical axis (SVA) were measured preoperatively, postoperatively and at the final follow-up. The Scoliosis Research Society 22-item questionnaire was administered preoperatively and at the final follow-up. During the operation, one slightly-bent short rod was placed into the concave side of apical region and correction was achieved by rod-rotation and distraction. Two pre-bent long rods were placed into both sides of the scoliosis and global balance was improved by leveling the proximal thoracic vertebrae and distal lumbar vertebrae. Results A total of 41 patients were included, with an average age of 20 years (range, 12–49 years) and follow-up of 34 months (range, 24–58 months). Postoperative correction rate was 53% for scoliosis. There were 14 patients with normal kyphosis before surgery, and 28 patients with normal kyphosis at the last follow-up. 88% of the patients (23/26) with preoperative coronal imbalance (TS > 20 mm) restored coronal balance at the final follow-up. 87% of the patients (14/16) with preoperative sagittal imbalance (SVA > 40 mm) restored sagittal balance at the final follow-up. The mean operation time and blood loss were 286 min and 941 mL, respectively. No patients had neurological complications or implant failure. Conclusion The surgical strategy of apical region correction and global balance with 3 rods is a safe and effective alternative for the surgical treatment of severe and rigid scoliosis.

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“…[ 9 10 ] Some authors have also used preoperative traction or internal distraction as a part of a staged correction, in order to achieve better correction and shorter fusion. [ 11 12 13 14 15 16 17 ] However, preoperative traction implies an increased risk of perioperative complications such as pin loosening, pin tract infection, and cranial nerve palsies. [ 11 12 13 14 15 16 17 ] Combined anterior and posterior or all-posterior vertebral column resection has also been used to treat severe and rigid scoliosis, but this demanding procedure is affected by a considerably high rate of perioperative complications.…”

Section: Introductionmentioning

confidence: 99%

“…[ 11 12 13 14 15 16 17 ] However, preoperative traction implies an increased risk of perioperative complications such as pin loosening, pin tract infection, and cranial nerve palsies. [ 11 12 13 14 15 16 17 ] Combined anterior and posterior or all-posterior vertebral column resection has also been used to treat severe and rigid scoliosis, but this demanding procedure is affected by a considerably high rate of perioperative complications. [ 18 19 20 ] Then, the introduction of all pedicle screws constructs allowed the all-posterior procedures to gradually gain popularity due to the high reliability of three-columnar fixation systems.…”

Section: Introductionmentioning

confidence: 99%

Surgical treatment of severe adolescent idiopathic scoliosis through one-stage posterior-only approach

Traversari

Ruffilli

Barile

et al. 2022

Journal of Craniovertebral Junction and Spine

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The aim of this meta-analysis was to analyze the results of one-stage all-posterior spinal fusion for severe adolescent idiopathic scoliosis (AIS). A systematic search of articles about one-stage posterior spinal fusion for severe AIS was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data about population, pre-and postoperative radiographical data, surgical procedure details, and complications were extracted. Meta-analyses were performed when possible. Fourteen studies (640 patients) were included. The mean Cobb angle of the major curve varied from 80.0 ± 7.3 to 110.8 ± 12.1. The meta analysis showed a comprehensive coronal correction rate of the major curve of 58.6%, a comprehensive operative time of 274.5 min, and a comprehensive estimated intraoperative blood loss of 866.5 mL (95% confidence interval: 659.3–1073.6, I 2 ≈ 0%). A total of 48 complications (5.4%) were reported. Overall, the meta-analysis showed a major complication rate of 4%. In seven cases, revision surgery was needed. Posterior-only approach is effective enough to correct severe curves and can spare the patient possible adverse events due to anterior approach. However, when choosing this approach for severe AIS, screw density needs to be high and posterior column osteotomies may need to be planned to mobilize the spine and maximize correction.

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Temporary treatment with magnetically controlled growing rod for surgical correction of severe adolescent idiopathic thoracic scoliosis greater than 100°

Cited by 7 publications

References 29 publications

One stage correction via the Hi-PoAD technique for the management of severe, stiff, adolescent idiopathic scoliosis curves > 90°

One stage correction via the Hi-PoAD technique for the management of severe, stiff, adolescent idiopathic scoliosis curves > 90°

Apical region correction and global balance: a 3-rods surgical strategy for the treatment of severe and rigid scoliosis

Surgical treatment of severe adolescent idiopathic scoliosis through one-stage posterior-only approach

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