How is definitive treatment effective in early onset scoliosis treated with Growing implants? Review of one centre series Tiziana Greggi, Elena Maredi, Francesco Lolli, Mario Di Silvestre, Konstantinos Martikos, Francesco Vommaro, Andrea Baioni, Stefano Giacomini Rizzoli Orthopaedic Institute – Bologna Italy Spinal Deformity Surgery Department 1

BACKROUND Dual Growing Rod (GR), Veptr-like systems (Veptr-L) and Magnetically controlled growing rods (MCGR) are Gold Standard for the treatment of early onset scoliosis for every ages of patients under 10 years old and every etiology . Our study is focused on results of final fusion in patients treated with Growing Implants (GI) in general. Is the correction acceptable? (177 complications in association with 897 procedures). However, because surgical lengthening procedures are required frequently when growing rods are used, the risk of a complication increases during the treatment period. This phenomenon was demonstrated by the Kaplan-Meyer analysis that showed patients treated with growing rods had an increasing risk of incurring a complication with an increasing number of surgical Procedures. Submuscular placement of the growing rod likely reduced wound complications A dual-rod construct likely dissipates the amount of mechanical stress Complications of growing-rod treatment for early-onset scoliosis: analysis of one hundred and forty patients. Bess S, Akbarnia BA, Thompson GH, Sponseller PD, Shah SA, El Sebaie H, Boachie-Adjei O, Karlin LI, Canale S, Poe-Kochert C, Skaggs DL. J Bone Joint Surg Am. 2010 Nov 3;92(15):2533-43. doi: 10.2106/JBJS.I.01471. Epub 2010 Oct 1. Complications incidence in the treatment of early onset scoliosis with growing spinal implants. Greggi T, Lolli F, Di Silvestre M, Martikos K, Vommaro F, Maredi E, Giacomini S, Baioni A, Cioni A. Stud Health Technol Inform. 2012;176:334-7. 2 2

Is the correction acceptable? AIM OF THE STUDY Is the correction acceptable? Complications of growing-rod treatment for early-onset scoliosis: analysis of one hundred and forty patients. Bess S, Akbarnia BA, Thompson GH, Sponseller PD, Shah SA, El Sebaie H, Boachie-Adjei O, Karlin LI, Canale S, Poe-Kochert C, Skaggs DL. J Bone Joint Surg Am. 2010 Nov 3;92(15):2533-43. doi: 10.2106/JBJS.I.01471. Epub 2010 Oct 1. Complications incidence in the treatment of early onset scoliosis with growing spinal implants. Greggi T, Lolli F, Di Silvestre M, Martikos K, Vommaro F, Maredi E, Giacomini S, Baioni A, Cioni A. Stud Health Technol Inform. 2012;176:334-7. 3

MATERIALS AND METHOD We retrospectively reviewed 44 patients, affected by early onset scoliosis and surgically treated with Growing Implants from 2007 to 2012 (minimum follow up 4 year); 10 of them (23%) are finally treated: 8 with final spinal fusion and 2 with fusion without instrumentation. The growing treatment before are: 6 with GR, 4 with Veptr-L. They are 6 females and 5 males. The age at first surgey was 8.7 yy (7-12). The age at final treatment was 13.4 (12-18). The range of lengthening was: from 2 to 6 for each patient treated with mechanical GI. The etiology was different. 4

RESULTS The main thoracic curve went to 71.7 in the first preoperative to 47,6 after the first implant of GI. At the follow up, before the final surgery it was 74,7 with a loss of correction, and went to 51,4 after the final surgery. First correction between preoperative and first growing implant was 30,2%; Final correction between final lengthening procedures and final treatment was 30.5%. Final lengh preop Final post 5

COMPLICATIONS We had 5 complication: a neurological late complication, a patient with 2 rod fractures and hooks mobilization, a patient with hook mobilization, a patient with rib fracture and hook mobilization, a patient with distal screw mobilization. 6

CONCLUSIONS the main thoracic curve during the treatment with growing implant has a fluctuated way. The first implant is the most corrective, then there is a loss of correction during the lengthening. The final surgery has more or less the same correction of the first one. Thanks to this data we can say that growing implant don’t stop the scoliosis worsening, but they can only limit it, thanks to the first correction. Final lengh preop Final post 7

CONCLUSIONS The aim of GI is to grant a “normal” growth of the spine during the lengthening-time and to arrive at the final surgery as soon as possible. In addition to this the correction with final fusion is inferior then the literature review of posterior instrumentation alone for AIS (more or less 50%). Of course other studies are necessary.

GRAZIE Rizzoli Orthopaedic Institute – Bologna Italy Spinal Deformity Surgery Department Dr.ssa Tiziana Greggi www.ior.it 9 9 9