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European Spine Journal

, Volume 27, Issue 9, pp 2203–2212 | Cite as

Staged insertion of growing rods in severe scoliosis

  • Sebastiaan Schelfaut
  • Jennifer A. Dermott
  • Reinhard Zeller
Original Article

Abstract

Purpose

The objective of this retrospective chart and radiographic review was to present the clinical outcomes and complication rate of a staged approach to modern dual growing-rod (GR) surgery when treating children with severe early onset scoliosis.

Methods

Fifteen patients received a 6-mm dual GR system. During Stage 1, pairs of end vertebra were exposed in a subperiosteal fashion, instrumented, grafted, and fused. Stage 2 was performed, on average, 5 months later (range 8–35 weeks) and the fused foundations were connected with two growing rods under skull-femoral traction. Clinical and operative notes were reviewed and all complications were recorded. Radiographic measurements were assessed at pre-index, with intraoperative traction during Stage 1, post-Stage 2 and at most recent follow-up. Statistical analyses were performed to evaluate change in scoliosis and kyphosis.

Results

At initial surgery, the average age was 8.17 ± 1.5 years. The mean Cobb angle was 88.1° ± 14.0°, corrected to 60.3° ± 8.7° (p < 0.001) with intraoperative traction in Stage 1, preserved after Stage 2 instrumentation (59.5° ± 9.6°, p = 0.69), and maintained with subsequent lengthenings (60.6° ± 12.8°, p = 0.73). Hyperkyphosis (11/15 patients) improved from 70.8° ± 15.7° to 46.6° ± 9.7° (p < 0.001). At minimum 2-year follow-up (range 24–80 months, mean 49.5), the complication rate was 14 (0.93 complications/patient), including 6 rod breakages, 6 superficial infections, and 2 deep infections. No anchor migration or pull-out was noted. Seven patients have undergone definitive posterior spinal fusion.

Conclusions

Staged insertion of dual GR systems permits strong distraction, with acceptable correction of severe deformities and minimal complications.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.

Keywords

Early onset scoliosis Dual growing rod Staged approach Fusionless growth preservation Anchors 

Notes

Compliance with ethical standards

Conflict of interest

Dr. Zeller receives royalties from Spinevision (excluding personal use) and is an unpaid consultant for Paradigm Spine. None of the authors has received any grant or financial support for the present study.

Supplementary material

586_2018_5552_MOESM1_ESM.pptx (225 kb)
Supplementary material 1 (PPTX 225 kb)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Sebastiaan Schelfaut
    • 1
  • Jennifer A. Dermott
    • 2
  • Reinhard Zeller
    • 2
  1. 1.Universitair Ziekenhuis LeuvenLouvainBelgium
  2. 2.Hospital for Sick ChildrenTorontoCanada

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