HAZEM B ELSEBAIE FRCS, MD

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Presentation transcript:

HAZEM B ELSEBAIE FRCS, MD Single growing rods. Changing the foundations does it affect the results ? (Review of 21 cases) Growing Spine Study Group HAZEM B ELSEBAIE FRCS, MD Cairo University Hospital

Why single rod ? - Less bulky Less skin problems (under nourished) Convex rod is more prominent under skin - Convex rod easier to dislodge proximally - Can be suitable for younger ages Leaves a virgin field for final fusion Less operative time and blood loss The logic is to distract the concave side

The Foundations Comparison of single and dual growing rod techniques followed through definitive surgery: a preliminary study Thompson GH, Akbarnia BA, Kostial P, Poe-Kochert C, Armstrong DG, Roh J, Lowe R, Asher MA, Marks DS. Spine. 2005 Sep 15;30(18):2039-44 Growing rod techniques in early-onset scoliosi Thompson GH, Akbarnia BA, Campbell RM Jr. J Pediatr Orthop. 2007 Apr-May;27(3):354-61 JPO 2007 The recent studies comparing single and dual rods used: -Single claw proximally spanning 1 or 2 levels -Hooks or screws distally “Dual rods offer better results due to better ability to control the spine” Ndsavbasd,vb Changing the foundations can it affect these results?

The Foundations Proximally: 4 hooks (double claw, claw in a claw) 3 levels Proximally: 4 hooks (double claw, claw in a claw) 2 levels Distally: 2 pedicle screws 2 levels JPO 2007

Methods Between 2002 and 2007 Abulreish Pediatric Hospital Cairo Egypt 21 patients early onset scoliosis Average age at surgery 6ys (4-9) 8 had annulotomy Mean follow up 36 months (12 - 60) Average 4 distractions (1-9) Diagnoses: infantile and juvenile idiopathic scoliosis (13), congenital (3), neurofibromatosis (3), syndromic (1) post hydrocephalus(1).

Results Complications Average coronal Cobb angle preoperatively 85 (45-123) Average angle latest F Up 36 (11-61) Percentage of correction 58% T1-S1 length increased an average of 1.32 cm per year. Complications 7 of the 21 patients (30%) , a total of 11 complications All were implant related including: 4 proximal claw pull out 5 rod breakage (in 3 patients) one loose set screw of the tandem one pedicle screw distal migration no skin problems, no infections, no neurological complications .

Case 1 5 ½ years boy idiopathic 81 32

Case 2 4 ½ years boy idiopathic 76 28 3 distractions

25 90 Case 3 6 1/2y ears girl idiopathic severe curve 8 distractions

5 distractions 71 34 Case 4 71/2 years girl Congenital Previous attempt of apical fusion 5 distractions 71 34

Case 5 71/2 years girl Neurofibromatosis 5 distractions 33 70

8 distractions Case 6 6y idiopathic Had an attempt of limited in situ fusion !!!!!!!! at the age of 3ys 8 distractions

Conclusion Changing the foundations can improve the results in single rod growing implants. Despite adding one level to the proximal fusion mass, this construct with single rod has encouraging results with improved outcome, better correction and less complications. Proper rod contouring, solid fusion around the foundations, routine frequent distractions are crucial in achieving the expected surgical outcome. Dual rods: kyphosis (power) , double major curves (control) , increase body weight with big flexible curves (strength).