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

Slides:

Advertisements

Similar presentations

Thoracogenic Spinal Deformity: A Rare Cause of Early Onset Scoliosis International Congress on Early Onset Scoliosis November 19 & 20, 2015 A. Noelle Larson,

Advertisements

Sagittal balance in thoracolumbar or lumbar congenital kyphoscoliosis and kyphosis at a minimum of 10 years after surgery : A case series Sagittal balance.

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

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.

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.

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

K O B E U N I V E R S I T Y O R T H O P E D I C S A K O B E U N I V E R S I T Y O R T H O P E D I C S A Nippon Steel Hirohata Hospital Nippon Steel Hirohata.

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.

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.

The National Burden of Revision Spinal Fusion: A Focus on Patient Characteristics and Complications Sean S. Rajaee MS Linda E. A. Kanim MA Hyun W. Bae.

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

POSTERIOR SUBTOTAL VERTEBRECTOMY FOR THE TREATMENT OF THORACIC OSTEOMYELITIS IN ELDERLY PATIENTS Meric ENERCAN, MD Cagatay OZTURK, MD Mehmet AYDOGAN, MD.

Xingye Li, Jianxiong Shen, M.D.

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

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

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,

VEPTR Implantation for Children with congenital scoliosis under Age 3

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

Early Treatment of Scoliosis in Spinal Muscular Atrophy

Children’s National Health System ICEOS 2016 – Utrecht, Holland

EOS Patients from A Retrospective database

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

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

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

Early Experience of Frequent Small Increments Lengthening of Magnetic Spinal Growing Rods in Children with Severe Early Onset Scoliosis Joseph Ivan Krajbich.

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,

Top 3 Articles That Changed My Approach to EOS

Analysis of Percentile Weight Changes in Failure To Thrive Children undergoing Growing Rod Insertion. ICEOS 2012 Walsh A, Lui DF, Kelly M, O'Neill F, McDevitt.

Can Infection Associated with Rib Distraction Instrumentation be Managed without Implant Removal? A Multi-Center Study John T. Smith, MD* Patrick Cahill,

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

REALLY? WAS THIS SUPPOSED TO BE A DEBATE?

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

Complications of Anchors in the Growing Rod Technique

Garrido E†, Bermejo F†, Tucker SK†‡, Noordeen HNN†‡, Morley TR‡

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

Behrooz A. Akbarnia Nima Kabirian Jeff Pawelek Milad Alam

Is Vertical Expandable Prosthetic Titanium Rib (VEPTR) Application a Sufficient Method to Provide Expected Spinal Growth in Congenital Scoliosis? M. Bulent.

John A Heflin, MD John T. Smith, MD

1st International Congress on Early Onset Scoliosis &

Long-term results in surgical management of congenital scoliosis (CS): A minimum 10 years follow-up study Debnath UK Harshavardhana NS Hegarty J Grevitt.

Myth vs. Truth: Screws are Always Superior to Hooks for GR Foundations

Classification of EOS Treatment

Sumeet Garg, MD The Children’s Hospital, Colorado

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

Is fusion surgery always the end point?

Modeling Thoracic Volume To predict Pulmonary Function in Scoliosis

HAZEM B ELSEBAIE FRCS, MD

Suken A. Shah, MD Jon Oda, MD William Mackenzie, MD

ICEOS 2009, Istanbul Natural History of Spine in Patients with Esophageal Atresia -A Long-Term Population-Based Follow-up Study Ilkka Helenius, Saara J.

Scoliosis surgery with hybrid system in osteogenesis imperfecta (OI)

ARTHROGRYPOSIS AND VEPTR

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:

Dual Rods and Submuscular Rod Placement Reduce Complications and Unplanned Surgeries in the Growing Spine: Analysis of 910 Surgeries in 143 Patients Shay Bess, Behrooz Akbarnia, George Thompson, Paul Sponseller, David Skaggs, Suken Shah, Hazem Elsabaie, Oheneba Boachie-Adjei, Sarah Canale, Connie Poe-Kocher and the Growing Spine Study Group 2nd International Congress Early Onset Scoliosis and Growing Spine Montreal November 2008

ICEOS 2nd Annual Meeting Authors Disclosure Information Presenter Shay Bess Nuvasive (e), Pioneer (b), Alphatec (b), Stryker (d) Co-Authors Behrooz Akbarnia DePuy; A Johnson & Johnson Company (a,b,d,e),K2M (b,d,e), Nuvasive (a,b,c,d), Stryker (d),Ellipse Technologies,Inc (b), Allez Spine (c),Medtronic Sofamor Danek (a) George Thompson DePuy ,A Johnson & Johnson Company (b,d),Synthes (b,d), Medtronic Sofamor Danek (a) ,Zimmer (a) Paul Sponseller DePuy ,A Johnson & Johnson Company (a,b,d), Globus Medical (e) David Skaggs DePuy Spine (d), Stryker (b,d), Medtronic (a,b,d) Suken Shah DePuy Spine (a,b,e) Hazem Elsabaie No Relationships Oheneba Boachie-Adjei DePuy Spine (a,d,e), Osteotech (a,b),K2M(a,b,e) Axial biotech (a) Sarah Canale No Relationships Connie Poe-Kocher No Relationships (a) Grants/Research Support (b) Consultant (c) Stock/Shareholder (d) Speakers’ Bureau (e) Other Financial Support

Introduction Treatment Scoliosis Growing Spine= Challenging Observation Curve progression Arrest pulmonary development Cast treatment Skin breakdown Inhibit chest wall development Early Fusion Inhibit trunk and thoracic development Fusionless Technology Allow thoracic and pulmonary development Growing Rod Technique (GR) Unacceptably high complication rates? Used with permission from Children's Hospital Los Angeles, Inc

Purpose: Materials and Methods Evaluate Complications GR Treatment Clinical Radiographic Minimum 2 yr F/U Initial GR implant Multi-center, Retrospective Treatment Groups Construct type Single Rod (SI) Dual rod (DU) Implant placement Subcutaneous (SQ) Submuscular (MU) Used with permission from Children's Hospital Los Angeles, Inc

Materials and Methods Complications Wound (superficial, deep infection, etc) Implant (rod/fixation failure, prominence, etc) Alignment (curve progression, PJK, DJK, etc) Medical/Other (GI, pulmonary, etc) Surgical procedures Planned (PLAN = anticipated surgery due to routine GR treatment) Unplanned (UNPLAN= surgery due to complications)

Results: Demographics & Treatment Groups 143 patients (1987-2005) Avg. age =6.1 years (range, 1.6-12 yrs) 910 GR surgeries 13.3 levels (7-18) 6.4 procedures/ pt (2-15) 4.5 lengthening/ pt (0-13) Final fusion=53 pts (37%) Follow up=59.4 mo. (24-166 mo.) Treatment groups Construct type (NS) SI; n=73 DU; n=70 Subgroups (*=p<0.05) SI SQ; n=17* SI MU; n=55 DU SQ; n=35 DU MU; n=35

Results: Diagnosis

Results: Total Procedures and Complications Single vs. Dual Rod SI (n=73) DU (n=70) p value Total (n=143) Total Surgeries; avg (range) 447; 6.1 (3-13) 463; 6.6 (2-15) NS 910; 6.4 (2-15) Total complications 94 83 177 Total pts with complication 43 38 81 Percent pts with complication 59% 54% 57% Complications per patient (range) 1.3 (0-7) 1.2 (0-7) Complications per surgery 0.21 0.18 0.19 Total UNPLAN 42 32 74 Total PLAN 405 431 836 Ratio PLAN to UNPLAN 9.6:1 13.5:1 11.3:1 Complications leading to UNPLAN 45% 38% 42%

Results: Wound Complications SI (n=73) DU (n=70) Total (n=143) Total Wound Complications (pts;total;avg) 8;9;0.12 15;21;0.3 23;30;0.21 % Wound Complication 11% 21% 16% Superficial; Deep Infections 0*; 6 6*; 8 6; 14 UNPLAN (pts;total) 7;10 9;19 16;29 Ratio Wound Problem: UNPLAN <1 1.1 1.03 SI-SQ (n=17) SI-MU (n=55) DU-SQ (n=35) DU-MU (n=35) Total Wound Complications (pts;total;avg) 2;2;0.12 5;6;0.11 11*;16;0.5 4*;5;0.1 % Wound Complication 11% 9% 31%* 11%* Superficial; Deep Infections 0;1 0; 4 4; 6 2; 3 UNPLAN (pts/total) 1;1 5;8 5;12 4;7 Ratio Wound Problem: UNPLAN 2 <1 1.3 *=p<0.05

Results: Wound Complications

Results: Implant Complications SI (n=73) DU (n=70) Total (n=143) Total Implant Complications (pts;total;avg) 34;64;0.88 29;42;0.6 63;106;0.74 % Pts Implant Complication 46% 41% 44% Hook Loss; Screw Loss; Rod Fracture; Prominence; (total) 27*; 0; 30; 2 10*; 5; 22; 4 37; 5; 52; 6 UNPLAN (pts;total;avg) 19*;28*;0.4* 7*;10*;0.15* 26;38;.28 Ratio Implant Problem: UNPLAN 2.3 4.2 2.8 SI-SQ (n=17) SI-MU (n=55) DU-SQ (n=35) DU-MU Total Implant Complications (pts;total;avg) 9;18;1.1 24;25;0.8 15;27;0.8 14;15;0.4 % Pts Implant Complication 53% 44% 43% 40% Hook Loss; Screw Loss; Rod Fracture; Prominence; (total) 8; 0; 7; 1 19; 0; 22; 1 6; 5; 11; 4* 4; 0; 11; 0* UNPLAN (pts;total;avg) 6;9;0.5 12;19;0.4 6*;9*;0.3* 1*;1*;0.03* Ratio Implant Problem: UNPLAN 2 1.3 3 15* *=p<0.05

Results: Implant Complications

Results: Alignment Complications SI (n=73) DU (n=70) Total (n=143) Total Alignment Complications (pts;total;avg;range) 4; 4; 0.05; 0-1 6; 7; 0.1; 0-2 10; 11; 0.08; 0-2 % Pts with Alignment Complication 6% 9% 7% Junctional Kyphosis; Curve Progression; Other; (total) 1; 0; 3 2; 4; 0 3; 4; 3 UNPLAN (pts;total;avg;range) 3; 3; 0.04; 0-1 2; 3; 0.04; 0-2 5; 6; 0.04; 0-2 Ratio Implant Problem: UNPLAN 1.3 2.3 1.8 *=p<0.05 SI-SQ (n=17) SI-MU (n=55) DU-SQ (n=35) DU-MU Total Alignment Complications (pts;total;avg;range) 2;2; 0.12; 0-1 1;1; 0.02; 0-1 3;3; 0.09; 0-1 3;4; 0.1; 0-2 % Pts with Alignment Complication 12% 2% 8% Junctional Kyphosis; Curve Progression; Other; (total) 0; 0; 2 1; 0; 0 1; 1; 1 1; 3; 0 UNPLAN (pts;total;avg;range) 1; 1; 0.03; 0-1 1; 2; 0.06; 0-2 Ratio Implant Problem: UNPLAN 1 NA 3 *=p<0.05

Results: Medical and Other Complications SI (n=73) DU (n=70) Total (n=143) Total Medical & Other Complications (pts;total;avg;range) 11; 15; 0.21; 0-2 6; 7; 0.1; 0-3 17; 22; 0.15; 0-3 % Pts with Medical Complication 15% 8% 12% Pulmonary 8 2 10 Dural Tear 3 1 4 Other (hematoma, GI, EBL) UNPLAN Ratio Implant Problem: UNPLAN NA

Results Kaplan-Meier Survival Analysis Total complications vs. Procedures 50% survivorship at 7 surgeries Wound Complications vs. Procedures 90% survivorship at 7 surgeries 40% survivorship at 13 surgeries Odds Ratio: Complication vs. Procedure 24% increased complication risk each additional procedure (Odds Ratio=1.24, 95% Confidence Interval: 1.07, 1.44, p=0.005) Odds Ratio: Complication vs. Age 13% decrease complication risk each year increased age initial surgery (Odds Ratio=0.87, 95% Confidence Interval: 0.75, 1.00, p=0.057).

Conclusions Growing Rod Complications Procedure vs. Treatment Acceptable complication rate per procedure? Comparable to AIS (Carreon et al JBJS 2007) 19% vs. 15.4% Complication rate correlates with number procedures Anticipate complication Council parents

Conclusions Complications ≠ Surgery Complications manageable by PLAN Steps to minimize Complications UNPLAN Dual Rods Reduce implant complications Reduce implant UNPLAN Submuscular Rods Reduce wound complications

ICEOS 2nd Annual Meeting Thank You ICEOS 2nd Annual Meeting Montreal November 2008