ICEOS 2016 Pelvic obliquity correction in distraction based growing spine constructs Mathew Schur BA1, Lindsay M Andras MD1, Nicholas R Gonsalves MD1,

Slides:

Advertisements

Similar presentations

Mechanisms and Risk Factors of Brachial Plexus Injury in the Treatment of Early-Onset Scoliosis with Distraction- Based Growing Implants by Elizabeth R.A.

Advertisements

Comparison of the Volume of Scoliosis Surgery Between Spine and Pediatric Orthopaedic Fellowship-Trained Surgeons in New York and California by Mark A.

A Comparison of Patients Treated with Shilla Growing Rods for Early Onset Scoliosis 9 th International Congress on Early Onset Scoliosis November 19-20,

Patients without intraoperative neuromonitoring (IONM) alerts during implantation of rib based growing constructs did not sustain neurologic injury during.

Growth Preserving Spinal Surgery for Scoliosis in Children with Osteogenesis Imperfecta Lawrence Karlin, MD, Amer Samdani, MD, Anna McClung, BSN, RN, Michael.

In the first 5 years of Treatment, the Charges for Guided Growth Constructs are 30% less than Growing Rods Lindsay M. Andras MD 1, Liam Harris BS 1, Scott.

Comparison of deformity correction and complications with VEPTR and early primary posterior spinal fusion in young children with idiopathic scoliosis:

Short Term Health Related Quality of Life and Family Burden after Surgical or Casting Treatment Hiroko Matsumoto, Nicholas Feinberg, Julie Yoshimachi,

A minimum of 2 year follow up of 22 EOS patients who were treated with 2 nd generation MCGR Karsten Ridderbusch, Christian Hagemann, Ralf Stücker Childrens.

Intra-wound Vancomycin Powder Significantly Reduces the Risk of Infection in Growth-friendly Surgery John T. Smith, MD Justin Haller, MD Angela Presson,

John T. Wilkinson m. d. , Chad E. Songy m. d. , Frances l

The Use of MAGEC Growing Rods as a temporary distraction rod in Severe Kyphoscoliosis: A Case Report. John T. Smith, MD Mary Scowcroft Perry Presidential.

Authors: Pooria Hosseini MD, Jeff Pawelek BS, Gregory Mundis MD, Burt Yazsay MD, John Ferguson MD, Ilkka Helenius MD, Kenneth Cheung MD, Gokhan Demirkiran.

ICEOS 2015 Comparison of Weight Percentile Gain with Growth-Friendly Constructs in Early Onset Scoliosis Liam Harris BS1, Lindsay M Andras MD1, Paul D.

Incidence of Proximal junctional kyphosis with Magnetic Expansion Control Rods in early onset scoliosis P Inaparthy, JC Queruz, C Thakar, D Rolton, C Nnadi.

The Rib Construct (RC) has provided secure proximal fixation for management of patients with EOS and severe thoracic hyperkyphosis Alaa Azmi Ahmad – MD.

Final Fusion in Patients Treated with Rib Based Distraction: A Review of Peri- operative Results THE UNIVERSITY OF UTAH Department of Orthopaedic Surgery.

The Safety and Efficacy of Isola-Galveston Instrumentation and Arthrodesis in the Treatment of Neuromuscular Spinal Deformities*† by Muharrem Yazici, Marc.

Burt Yaszay, MD Jeff B. Pawelek, BS John Emans, MD Patrick Cahill, MD Bo Robertson Gregory M. Mundis, MD Behrooz A. Akbarnia, MD Children’s Spine Study.

Authors: Pooria Hosseini MD MSc, Jeff Pawelek BS, Stacie Nguyen MPH, George H. Thompson MD, Suken A. Shah MD, John M. Flynn MD, John P. Dormans MD, Behrooz.

Temporary Internal Distraction as an Aid to Correction of Severe Scoliosis by Jacob M. Buchowski, David L. Skaggs, and Paul D. Sponseller JBJS Essent Surg.

Complications of Growing Rods - has the Magec Rod overcome all of it ?

Xingye Li, Jianxiong Shen, M.D.

Olson EM, Sturm PF, Jain VV, Schultz LR, Glos DL, Bylski-Austrow DI

Adam Margalit, BS Paul D. Sponseller, MD Richard McCarthy, MD

ICEOS 2016 Utrecht, November 2016

ICEOS 2016 Comparison of Weight Percentile Gain with Growth-Friendly Constructs in Early Onset Scoliosis Liam Harris BS1, Lindsay M Andras MD1, Paul D.

How is definitive treatment effective in early onset scoliosis treated with Growing implants? Review of one centre series Tiziana Greggi, Elena Maredi,

DISCREPANCY BETWEEN PROGRAMMED AND OBSERVED DISTRACTIONS IN MAGNETICALLY-CONTROLLED GROWING ROD TREATED PATIENTS María del Mar Pozo-Balado, PhD; Noelia.

Retrospective Review of Shoulder Balance Comparing Adolescent Idiopathic Scoliosis (AIS) to Early Onset Scoliosis (EOS) Patrick J. Cahill William Lavelle.

Traditional Growing Rod Instrumentation: Risk-Benefit Analysis of Surgical Intervention Christopher Migdal, BS,1,2 Eric Klineberg, MD,1,2 Joel Lerman,

Sumeet Garg, MD Jack Flynn, MD Nicole Michael, BA

Growth Friendly Surgery is Effective at Treating Scoliosis Associated with Goldenhar Syndrome Braydon Connell, Jonathan Oore, Joshua Pahys, George Thompson,

John A. Heydemann, MD; Oussama Abousamra, MD;

Nicole Michael, BA John Smith, MD Tricia St. Hilaire, MPH

Surgical treatment of severe scoliosis in young children using magnetically controlled growing rods – initial experience in a prospective cohort Benny.

Clinical correlation of SRS-Schwab Classification with HRQOL measures in a prospective non-US cohort of ASD patients Dennis H. Nielsen, MD; Lars V. Hansen,

PELVIC OBLIQUITY CONTROL IN CHILDREN WITH NEUROMUSCULAR EARLY ONSET SCOLIOSIS TREATED WITH MAGNETICALLY-CONTROLLED GROWING RODS María del Mar Pozo-Balado,

Distraction-to-stall ensures spinal growth in Magnetically Controlled Growing Rods Benny Dahl1), Casper Dragsted2), Søren Ohrt-Nissen2), Thomas Andersen2),

Richard Schwend, MD Robert Tung, BS Division of Orthopedic Surgery

Brian Yang BA, Jill Larson MD, Michael Glotzbecker MD

John T. Smith, MD Jessica V. Morgan John A. Heflin, MD

Distraction-Based Surgeries Increase Spine Length for Patients with Non-Idiopathic EOS - 5 Year Follow up Yehia ElBromboly, Jennifer Hurry, Kedar Padhye,

Michael J. Elliott,MD; Jesua Law, DO

The Use of MAGEC Growing Rods as a temporary distraction rod in Severe Kyphoscoliosis: 2 Case Reports. John T. Smith, MD Mary Scowcroft Perry Presidential.

Hospital Universitario La Paz, Madrid, Spain

Does rod orientation and use of cross connector affect spinal height in magnetically controlled growing rod patients? Pooria Hosseini, Behrooz A. Akbarnia,

Evaluation of Pulse Oximetry in Pre- and Post Casting

Magnetically Controlled Growing Rods: Sagittal Plane Analysis and the Risk of Proximal Junctional Kyphosis Purnendu Gupta, Felix Brassard, Jennifer Schottler,

Sara K. Fuhrhop, BS Mark J. McElroy, MS Harry C. Dietz, MD

Outcome Measures in Early Onset Scoliosis

DEBATE Fusion vs non-fusion options

Charles E. Johnston, MD Anna McClung BSN, RN Scott Paradise

Complications of Anchors in the Growing Rod Technique

A New Classification System to Report Complications in Growing Spine Surgery: A Multicenter Consensus Study John T. Smith, MD, Charles Johnston,

Dual Rods and Submuscular Rod Placement Reduce Complications and Unplanned Surgeries in the Growing Spine: Analysis of 910 Surgeries in 143 Patients Shay.

Behrooz A. Akbarnia Nima Kabirian Jeff Pawelek Milad Alam

Preliminary Results using Shilla guided growing rods with sublaminar fixation in Early Onset Scoliosis Samuel R. Rosenfeld, M.D. Benjamin T. Smith, D.O.

John A Heflin, MD John T. Smith, MD

1st International Congress on Early Onset Scoliosis &

M. Bulent Balioglu, Y. Emre Akman, Yunus Atici,

Classification of EOS Treatment

Nicholas D. Fletcher, MD¹ Charles E. Johnston III, MD²

HAZEM B ELSEBAIE FRCS, MD

Scoliosis surgery with hybrid system in osteogenesis imperfecta (OI)

The Classification for Early-Onset Scoliosis (C-EOS) Predicts Timing of VEPTR Anchor Failure Michael G. Vitale, MD MPH Associate Chief, Division of.

Amer F. Samdani, MD Tricia St. Hilaire John Emans, MD John Smith, MD

Simultaneous Vertebral Column Resection (VCR) and Growing Rods (GR) or Shilla for Severe Early Onset Spinal Deformity (EOS) John Emans, MD; Ashley Goldthwait,

Management of Implant Related Infections:

Presentation transcript:

ICEOS 2016 Pelvic obliquity correction in distraction based growing spine constructs Mathew Schur BA1, Lindsay M Andras MD1, Nicholas R Gonsalves MD1, Paul D Sponseller MD MBA2, John B Emans MD3, Michael G Vitale MD MPH4, David L Skaggs MD MMM1, Growing Spine Study Group, Children’s Spine Study Group 1.Children's Orthopaedic Center, Children's Hospital Los Angeles; 2.Department of Orthopaedic Surgery, Johns Hopkins Children’s Hospital, Johns Hopkins University; 3.Department of Orthopaedic Surgery, Boston Children’s Hospital, Harvard Medical School; 4. Department of Orthopaedic Surgery , New York-Presbyterian Morgan Stanley Children’s Hospital, Columbia University Medical Center

Disclosures Mathew Schur BA – None Grants/Research Support Consultant Stock/Shareholder Speakers’ Bureau Other Financial Support Board/Committee member Mathew Schur BA – None Lindsay M. Andras MD – Eli Lilly (c); Biomet & Medtronic (d); SRS, POSNA, JPO (e); Orthobullets (f); Nicholas R. Gonsalves MD - None Paul D. Sponseller MD, MBA –DePuy (a, b, f); Globus Medical (f); Journal of Bone and Joint Surgery (e); Journal of Bone and Joint Surgery Oakstone Medical (f); SRS (e) John Emans MD – Journal of Children’s Orthopedics (e); Medtronic (b); Synthes (b, f) Michael G Vitale MD, MPH – Biomet (a, b & e); Children’s Spine Foundation (a & f); DePuy, A Johnson & Johnson Company (e); FOX, Children’s Spine Foundation (e); IPOS (f); Medtronic (e); OMEGA (e); OREF (a); POSNA (a & f); SRS (a); OSRF (a); Stryker (b); Synthes (e); Wellinks (b) David L. Skaggs MD MMM – Ellipse, POSNA (a), GSSG & GSF (e); SRS (a, e); ZimmerBiomet (b, d, e); Medtronic (b, d, e); Zipline Medical, Inc. (b, c); Orthobullets (b, c); Grand Rounds (b); Green Sun Medical (b, c); Johnson & Johnson (d); Wolters Kluwer Health - Lippincott Williams & Wilkins; Biomet Spine (e)

Background The use of pelvic fixation in growing spine constructs allows for improvement of the significant pelvic obliquity that can occur in patients with early-onset scoliosis (EOS) Multiple options exist to provide this fixation and little comparative data is available

(Iliac screws/Sacral Alar Iliac Screws) Objective To determine if there is a difference in the correction of pelvic obliquity by different types of pelvic fixation Screw group (Iliac screws/Sacral Alar Iliac Screws) S Hooks

Methods Neuromuscular, syndromic, and congenital EOS patients treated with distraction based implants with pelvic fixation from 1990 to 2013 were reviewed from two EOS multicenter databases Patients were divided into groups by type of pelvic fixation: Screw group (SAI/Iliac screw) vs S hook group Patients with less than 2 year follow-up or index instrumentation at ≥ 10 years of age were excluded Statistical significance analyzed via t-test

154 patients met the inclusion criteria: Results 154 patients met the inclusion criteria: Screw group=41 patients (Iliac screws=29;Sacral-alar-iliac (SAI) screws=12) S hook fixation=113 patients

Results Better Pelvic obliquity correction observed in the screw group than the S hook group Type of pelvic fixation Mean preoperative pelvic obliquity (degrees) Mean postoperative pelvic obliquity (degrees) Mean pelvic obliquity correction (degrees) Percent correction (%) P-value Iliac/SAI screws 34.2 ± 11.9 8.2 ± 5.7 26.1 ± 11.9 74 0.039* S hooks 31.3 ± 9.2 14.0 ± 9.5 17.3 ± 9.2 57

No difference in change in T1-S1 or Cobb correction Type of pelvic fixation Mean preoperative T1-S1 length (mm) Mean postoperative T1-S1 length (mm) Mean T1-S1 length change (mm) P-value Iliac/SAI screws 261.4 301.8 40.4 0.90 S hooks 238.3 277.8 39.5 Type of pelvic fixation Mean preoperative Cobb angle (degrees) Mean postoperative Cobb angle (degrees) Mean Cobb angle correction (degrees) Percent correction (%) P-value Iliac/SAI screws 80.9 49.6 31.2 33% 0.13 S hooks 72.7 48.6 24.1 31%

Results A trend toward more complications observed in S hook group than screw group but this did not reach statistical significance Type of pelvic fixation Complications P-value Iliac/SAI screws 14.6% (6/41) 0.21 S hooks 25.7% (29/113)

Discussion Screws (iliac/SAI screws) achieved better correction of pelvic obliquity than S hooks (p= 0.039) No difference was found in the increase in T1-S1 length (p=0.90) or Cobb angle correction (p=0.13) between the groups Rate of complications for the S hook group was greater than the screw group, although not statistically significant

Conclusion In distraction based growing spine constructs, pelvic fixation with screws achieved better correction of pelvic obliquity than S hooks

References Moe JH, Kharrat K, Winter RB, et al. Harrington instrumentation without fusion plus external orthotic support for the treatment of difficult curvature problems in young children. Clin Orthop Relat Res 1984;185:35–45. Akbarnia BA, Breakwell LM, Marks DS, et al. Dual growing rod technique followed for three to eleven years until final fusion: the effect of frequency of lengthening. Spine 2008;33:984–90. Muharrem Y, and Olgun ZD. Growing rod concepts: state of the art. Eur Spine J. March 2013; 22(Suppl 2): 118-130. Sponseller P, Yang, JS, Thompson GH, McCarthy RE, Emans JB, Skaggs DL, Asher MA, Yazici M, Poe-Kochert C, Kostial P, Akbarnia BA. Pelvic fixation of growing rods: Comparison of constructs. Spine. July 15 2009; 34(16): 1706-1710. Brooks JT, Jain A, Perez-Grueso FS, Skaggs D, Thompson GH, Akbarnia BA, Sponseller PD. Paper #35: Pelvic anchor outcomes in growing rod constructs: An analysis of patients with a minimum of 4 years of postoperative follow-up. Spine Deformity. November 2014; 2(6): 512. Protopsaltis T, Schwab F, Bronsard N, Smith JS, Klineberg E, Mundis G, Ryan DJ, Hostin R, Hart R, Burton D, Ames C, Shaffrey C, Bess S, Errico T, Lafage V. The T1 Pelvic Angle, a Novel Radiographic Measure of Global Sagittal Deformity, Accounts for Both Spinal Inclination and Pelvic Tilt and Correlates with Health-Related Quality of Life. J Bone Joint Surg Am. October 01 2014; 96(19): 1631-1640. Thompson GH, Akbarnia BA, Campbell Jr. RM. Growing rod techniques in early-onset scoliosis. Journal of Pediatric Orthopaedics. April/May 2007; 27(3): 354-361.