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

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Presentation transcript:

John T. Smith, MD Jessica V. Morgan John A. Heflin, MD Conversion of Rib-Based Distraction Constructs to Luque-Trolleys to Manage Severe Proximal Junctional Kyphosis: A report of 4 cases. John T. Smith, MD Jessica V. Morgan John A. Heflin, MD

Disclosures Smith: Consultant: DepuySynthes, Globus, Biomet, Spineguard. Royalties: VEPTR 2 device; Board of Directors: Children’s Spine Foundation Heflin: Consultant: Globus, Medtronic Morgan: Nothing to disclose

Background: Proximal Junctional Kyphosis (PJK) Common after growth-friendly rib-based or spine-based distraction Prominent implants Skin problems Cosmetic issues Growth-friendly salvage options are limited

Luque Trolley’s Potentially allow for continued growth Very low profile Reduce need for repetitive surgery This study presents 4 cases where LT’s were used as a salvage procedure for PJK

Technique Remove upper rib hooks Contour rod to match or improve existing kyphosis Pass a minimum of 2 sub-laminar wires at proximal end Leave adequate length for growth

Case Example 1 10 y/o male with congenital kyphosis managed with rib-based distraction since age 3 Multiple wound dehisences, prominent instrumentation and PJK

Case Example 2 8 y/o male with scoliosis and NF1 Significant PJK and prominent instrumentation Converted to a Luque Trolley

Results 4 Patients Diagnosis varied: Age Initial implantation: 3.3 years Age at conversion to LT: 9.1 years Length of follow-up: 1.8 years Pre conversion kyphosis: 84 degrees Post conversion kyphosis: 77 degrees 3 of 4 patients had wound problems prior to conversion All patients showed continued spinal growth after LT conversion

Discussion Luque Trolley’s offer an option for salvage of growth-friendly distraction constructs where PJK occurs and implants are prominent Longer follow-up is needed to determine if continued growth will occur

Thank you