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Abstract
Objectives
To report the results of new designed dual growing rods system for progressive pediatric spinal deformity.
Summary of Literature Review
The current expandable spinal implant system appears effective in controlling progressive pediatric spinal deformity, allowing for spinal growth. However, there was no report concerning the growing rod in Korea.
Materials and Methods
Between 2010 and 2011, seven pediatric patients, who had a minimum of 1year follow-up, had undergone surgery for spinal deformity correction with a dual growing rods technique. We analyzed the demographic and radiologic data, including height, weight, age at surgery, diagnosis, number of lengthening, Cobb's angle of the major curve, thoracic kyphosis angle, lumbar lordosis angle, T1-S1 length, instrumented segment length, and complications, from the preoperative period to the last follow up period.
Results
Four male and three female patients with 5 neuromuscular scoliosis, 1 idiopathic juvenile osteoporosis and 1 spondyloepiphyseal dysplasia had underwent corrective surgery with dual growing rods. The mean age at the initial surgery was 11.6 years (7-13.8). The mean follow-up duration was 19.3 months (12-24), and the mean lengthening procedure time was 2.8 (2-4) for every patient. Cobb's angle of scoliosis curve was corrected from preoperative 80.2°(55-136) to 37.6° (15-81) on the last follow-up. Thoracic kyphosis angle and lumbar lordosis angle were changed from preoperative 48.7°(12-101) and 38.3°(9-72) to 44.5°(12-75) and 18.8°(1- 46) on the last follow-up, respectively. Growth length during the follow-up period was measured as instrumented segment is 46 mm (33- 59) and T1-S1 segment is 82 mm (66-98). Complications, such as breakage of rod in 3 cases and soft tissue infection in 1 case, occurred during the follow-up period.
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Fig. 1.
This diagram shows three parts compositions of growing rods system. (A) conventional rod for lumbar contouring, (B) Growing tube, (C) Growing rod for thoraco-lumbar contouring.
Fig. 2.
This clinical photo shows that there were two separated incisions for pedicle screw insertion and intramuscular rod placement.
Fig. 3.
Serial radiographs of 7 years male patients with neuromuscular scoliosis due to lipomeningocele. (A) Preoperative whole spine PA view. (B) Whole spine PA view after primary surgery. (C) Whole spine PA view after first lengthening procedure for growing rods. (D) Whole spine PA view shows last follow up after fourth lengthening procedure.
Fig. 4.
Serial radiographs of 10 years 9 month male patients with spondyloepiphyseal dysplasia. (A) Preoperative whole spine Lateral view. (B) Whole spine lateral view after primary surgery. (C) Whole spine lateral view after first lengthening procedure for growing rods. (D) Whole spine lateral view after second lengthening procedure for growing rods. (E) Whole spine PA view shows rod breakage of left distal lumbar rod(arrow) during follow up after second lengthening procedure for growing rods.
Table 1.
Demographics and Surgical Data for All Patients
| No. | Sex | Age at surgery (yr) | No. of lengthenings | Average lengthening interval (mo) | No. of total surgeries | Diagnosis | Instrumented levels |
|---|---|---|---|---|---|---|---|
| 1 | M | 12.9 | 4 | 5.7 | 6 | NM∗ | T1-L2 |
| 2 | F | 10.8 | 2 | 4 | 3 | IJO† | T4-ilium |
| 3 | M | 10.7 | 4 | 5.7 | 7 | SED‡ | T4-ilium |
| 4 | M | 13.6 | 2 | 5.5 | 3 | NM | T1-L2 |
| 5 | M | 7 | 4 | 5.3 | 5 | NM | T2-ilium |
| 6 | F | 12.3 | 2 | 6.5 | 3 | NM | T1-ilium |
| 7 | F | 13.8 | 2 | 6 | 4 | NM | T1-L5 |
Table 2.
Clinical and Radiologic Data for All patients
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