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

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Presentation transcript:

Myth vs. Truth: Screws are Always Superior to Hooks for GR Foundations ICEOS 2009 Istanbul Jack Flynn, MD Associate Chief of Orthopaedic Surgery Children’s Hospital of Philadelphia Associate Professor of Orthopaedic Surgery University of Pennsylvania School of Medicine 1

Anchors for GRs Introduction Pedicle screws for growing rod anchors Avoids implants in the canal Strongest construct Useful when laminae or TPs missing

Anchors for GRs Introduction Pedicle screws for growing rod anchors Problems: Can plow into nerve root with distraction Risk to cord proximally with pullout Screw fracture Screw can become too short as vertebral body grows

Anchors for GRs Introduction Hooks for growing rod anchors No risk to anterior structures (esophagus, aorta) Saves screw site for final fusion Placement without imaging Hooks don’t break

Anchors for GRs Introduction Hooks for growing rod anchors Problems: Plow through laminae requiring revision Hook sites may be absent or very weak

Anchors for GRs Study results Maher, Akbarnia et al Spine 2008 8 porcine spines Hook-hook, hook-screw, screw-screw  with crosslink Screw-screw without crosslink Biomechanical pullout test Screws had better pullout strength Crosslink did not significantly enhance strength

Anchors for GRs Distal anchors Most are using 4 pedicle screws for the distal anchor Risk of pull out is generally low Risk of plowing also low Theoretically root is at risk Rare with 2 level fixation

Anchors for GRs Proximal anchors 4-6 screws Hook screw combinations Risk of catastrophic pull-out AP distance is small in toddlers. Can be out anterior 3 level proximal thoracic fusion (trying to avoid proximal thoracic spine fusions) Hook screw combinations

Anchors for GRs Proximal anchors 4 hooks Supralaminar (canal volume) Transverse process (weaker) 4 hooks with sublaminar cable augmentation Authors preferred method Best risk benefit profile

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

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

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

Thank you