Advances in Clinical and Experimental Medicine

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Advances in Clinical and Experimental Medicine

2019, vol. 28, nr 8, August, p. 1073–1077

doi: 10.17219/acem/102269

Publication type: original article

Language: English

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Creative Commons BY-NC-ND 3.0 Open Access

The titanium-made growth-guidance technique for early-onset scoliosis at minimum 2-year follow-up: A prospective multicenter study

Grzegorz Miękisiak1,2,A,B,C,D,E,F, Krzysztof Kołtowski3,4,A,B,E,F, Piotr Menartowicz4,A,B,F, Zygmunt Oleksik5,B,C,F, Dariusz Kotulski5,A,B,C,F, Tomasz Potaczek6,A,B,C,E,F, Martin Repko7,A,B,E,F, Milan Filipovič7,A,B,E,F, Anna Danielewicz8,A,C,E,F, Marek Fatyga8,A,B,E,F, Michał Latalski8,A,B,C,D,E,F

1 Department of Neurosurgery, University Hospital in Opole, Poland

2 Institute of Medicine, Opole University, Poland

3 Department of Pediatric Surgery and Urology, Wroclaw Medical University, Poland

4 St. Hedwig of Silesia Hospital, Trzebnica, Poland

5 Department of Orthopedics, University Children’s Hospital of Kraków, Poland

6 Department of Orthopedics and Rehabilitation, Jagiellonian University Medical College, Kraków, Poland

7 Orthopedic Department of University Hospital Brno, Czech Republic

8 Department of Pediatric Orthopedics, Medical University of Lublin, Poland

Abstract

Background. The management of early-onset scoliosis (EOS) remains a serious challenge in pediatric orthopedics. The growth-guidance system (GGS) is a surgical option that allows continuous growth along a rod, averting the need for repeated operative lengthening.
Objectives. The objective of this study was to evaluate the outcomes of the GGS in the treatment of EOS.
Material and Methods. A prospective study, including 81 patients from 4 departments treated with this method from 2013 to 2015, was conducted with a minimum follow-up period of 24 months. The follow-up data of 57 patients was available, thus the drop-out rate was 29.63%. There were 44 girls with a mean age of 10.03 years and 13 boys with a mean age of 8.04 years.
Results. The mean preoperative Cobb angle was 65.3° (range 36°–139°) was corrected to 23.7° (2°–94°), and at the end of the 2-year follow-up increased to 30.7° (8°–93°). The predominant proximal level of instrumentation was T5 and the distal was L1. The combined length of T1–T12 and T12–S1 increased on average by 33.19 mm in 24 months. The overall rate of serious complications was 43.86%. The most prevalent device-related complications were: the dislodgement of top screws because of the short length of the rod (14 cases), the implant failure (11 cases) and loss of correction (9 cases).
Conclusion. The results show that the GGS used in this study allows for a good and stable correction while preserving the ability of the spine to grow in at least a 2-year follow-up. The complication rate is acceptable and comparable with other growth-friendly techniques. To date, this is the largest successful study on the use of titanium-made GGSs.

Key words

early-onset scoliosis, scoliosis, spine, titanium

References (27)

  1. Pehrsson K, Larsson S, Oden A, Nachemson A. Long-term follow-up of patients with untreated scoliosis: A study of mortality, causes of death, and symptoms. Spine (Phila Pa 1976). 1992;17(9):1091–1096.
  2. Goldberg CJ, Gillic I, Connaughton O, et al. Respiratory function and cosmesis at maturity in infantile-onset scoliosis. Spine (Phila Pa 1976). 2003;28(20):2397–2406.
  3. Fernandes P, Weinstein SL. Natural history of early onset scoliosis. J Bone Joint Surg Am. 2007;89(Suppl 1):21–33.
  4. Hasler CC. Early-onset scoliosis: Contemporary decision-making and treatment options. J Pediatr Orthop. 2018;38(Suppl 1):S13–S20.
  5. Tis JE, Karlin LI, Akbarnia BA, et al; Growing Spine Committee of the Scoliosis Research Society. Early onset scoliosis. J Pediatr Orthop. 2012;32(7):647–657.
  6. Vitale MG, Matsumoto H, Bye MR, et al. A retrospective cohort study of pulmonary function, radiographic measures, and quality of life in children with congenital scoliosis: An evaluation of patient outcomes after early spinal fusion. Spine (Phila Pa 1976). 2008;33(11):1242–1249.
  7. Karol LA, Johnston C, Mladenov K, Schochet P, Walters P, Browne RH. Pulmonary function following early thoracic fusion in non-neuromuscular scoliosis. J Bone Joint Surg Am. 2008;90(6):1272–1281.
  8. Campbell RM, Smith MD, Mayes TC, et al. The characteristics of thoracic insufficiency syndrome associated with fused ribs and congenital scoliosis. J Bone Joint Surg Am. 2003;85-A(3):399–408.
  9. Luque ER. Paralytic scoliosis in growing children. Clin Orthop Relat Res. 1982;(163):202–209.
  10. McCarthy RE, Sucato D, Turner JL, Zhang H, Henson MAW, McCarthy K. Shilla Growing rods in a caprine animal model: A pilot study. Clin Orthop Relat Res. 2010;468(3):705–710.
  11. McCarthy RE, Luhmann S, Lenke L, McCullough FL. The Shilla growth guidance technique for early-onset spinal deformities at 2-year follow-up. J Pediatr Orthop. 2014;34(1):1–7.
  12. Nash CL, Moe JH. A study of vertebral rotation. J Bone Joint Surg Am. 1969;51(2):223–229.
  13. Smith JT, Johnston C, Skaggs D, Flynn J, Vitale M. A new classification system to report complications in growing spine surgery: A multicenter consensus study. J Pediatr Orthop. 2015;35(8):798–803
  14. Fletcher ND, Bruce RW. Early onset scoliosis: Current concepts and controversies. Curr Rev Musculoskelet Med. 2012;5(2):102–110.
  15. Mardjetko SM, Hammerberg KW, Lubicky JP, Fister JS. The Luque trolley revisited. Review of nine cases requiring revision. Spine (Phila Pa 1976). 1992;17(5):582–589.
  16. Skaggs DL, Akbarnia BA, Flynn JM, Myung KS, Sponseller PD, Vitale MG; Chest Wall and Spine Deformity Study Group; Growing Spine Study Group; Pediatric Orthopaedic Society of North America; Scoliosis Research Society Growing Spine Study Committee. A classification of growth friendly spine implants. J Pediatr Orthop. 2014;34(3):260–274.
  17. Luque E, Cardoso A. Treatment of scoliosis without arthrodesis or external support: Preliminary report. Orthop Trans. 1977;119;276.
  18. Pratt RK, Webb JK, Burwell RG, Cummings SL. Luque trolley and convex epiphysiodesis in the management of infantile and juvenile idiopathic scoliosis. Spine (Phila Pa 1976). 1999;24(15):1538–1547.
  19. McCarthy RE, McCullough F, Luhmann SJ LL. Greater than two years follow-up Shilla growth enhancing system for the treatment of scoliosis in children. In: 2nd Annual International Conference on Early Onset Scoliosis (ICEOS). Montreal, Canada; 2008.
  20. Yang JH, Ham CH, Hwang YG, Suh SW. Metallosis: A complication in the guided growing rod system used in treatment of scoliosis. Indian J Orthop. 2017;51(6):714–718.
  21. Neumann DRP, Thaler C, Hitzl W, Huber M, Hofstädter T, Dorn U. Long-term results of a contemporary metal-on-metal total hip arthroplasty: A 10-year follow-up study. J Arthroplasty. 2010;25(5):700–708.
  22. Merritt K, Rodrigo JJ. Immune response to synthetic materials. Sensitization of patients receiving orthopaedic implants. Clin Orthop Relat Res. 1996;(326):71–79.
  23. Latalski M, Fatyga M, Kołtowski K, Menartowicz P, Repko M, Filipovič M. Guided-growth implants in the treatment of early onset scoliosis. A pilot study. Ortop Traumatol Rehabil. 2013;15(1):23–29.
  24. Dimeglio A, Canavese F. The growing spine: How spinal deformities influence normal spine and thoracic cage growth. Eur Spine J. 2012;21(1):64–70.
  25. Hickey BA, Towriss C, Baxter G, et al. Early experience of MAGEC magnetic growing rods in the treatment of early onset scoliosis. Eur Spine J. 2014;23(Suppl 1):S61–65.
  26. Phillips JH, Knapp DR, Herrera-Soto J. Mortality and morbidity in early-onset scoliosis surgery. Spine (Phila Pa 1976). 2013;38(4):324–327.
  27. Teoh KH, Winson DMG, James SH, et al. Do magnetic growing rods have lower complication rates compared with conventional growing rods? Spine J. 2016;16(Suppl 4):S40–S44.