Z. Deniz Olgun, Houman Ahmadiadli, Muharrem Yazici

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Vertebral Body Growth During Growing Rod Instrumentation: Growth preservation or stimulation? Z. Deniz Olgun, Houman Ahmadiadli, Muharrem Yazici Hacettepe University, Ankara H a c e t t e p e Orthopaedics Spine Unit

Background Hueter-Volkmann principle Appendicular skeleton Growth stimulation with distraction Growth inhibition with compression Spine

Background Growing rod instrumentation and vertebral body growth. A radiological investigation in immature pigs Guney Yilmaz, Gokhan Demirkiran, Cenk Ozkan, Kenan Daglioglu, Gazi Huri, Muharrem Yazici Spine, In press Index Preop 3rd L2 L3

Background Growing rod series Akbarnia et al., 2005 Annual T1-S1 growth 1.21cm/yr Normal vertebral growth Dimeglio During growing rod treatment, growth potential of vertebrae is preserved.

Background Growing rod series Akbarnia et al., 2008 Annual T1-S1 growth Lengthening every 6 mo or less 1.8cm/yr Lengthening later than every 6 mo 1.0cm/yr Growth stimulation instead of just preservation?

Questions Does routine lengthening every six months using the growing rod technique stimulate vertebral growth? Is growth different between vertebral segments outside the instrumentation and vertebral segments that are spanned by the instrumentation rods but not instrumented themselves?

Material and Methods Near normal vertebral anatomy Instrumentation to L3-L4 A minimum of 5 lengthening procedures undergone All lengthenings every six months regularly Only x-ray data which has appropriate scale information and clear digital images of these Radiologic measurements Heights of selected vertebrae within instrumentation (WIL) and vertebral segments outside instrumentation (OIL) Post-index and final follow-up Difference in height

Results 17 patients Age @ index operation # of lengthenings 72.6 months (38-105) # of lengthenings 6.6 (5-9) Measured levels: WIL: L1 (6), T12(4), T11 (3), T7, T9, T11 OIL: L4 (9), L2 and L3 (3 each), L5 (2)

Results Statistics Post-index Final FU  WIL 15.6(10.0-21.1) 20.8(15-26.6) 5.22.3 OIL 17.8(13.5-22) 22.5(14.0-28.8) 4.72.0 Statistics Post vs. FU, p<0.01 ∆, p=0.480

Melike Yalcin 7yo F, congenital scoliosis, after 7 lengthenings

Kubra Birler, 6yo F, arthrogryposis multiplex, after 4 lengthenings

Conclusion Normal growth Study group Dimeglio A, in Growing Spine , eds Akbarnia, Yazici, Thompson Lumbar vertebrae grow faster than thoracic 2 mm/year Lumbar vertebra and disc 1 mm/year Thoracic vertebra and disc Study group Thoracic (distracted) vertebrae appear to have grown faster than lumbar (control) vertebrae!

Conclusion Growth preservation Growth stimulation Definitely YES Growth stimulation Probably YES Could not be proven with basic statistics BUT needs appropriate coefficient Need longer follow-up and a larger cohort