Kyphosis and Implantation: Modeling a Clinical Phenomenom

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Kyphosis and Implantation: Modeling a Clinical Phenomenom Richard H Gross, MD (grossr@musc.edu) Hai Yao, PhD (yaoh@musc.edu Greg Wright, MS (mrgregjwright@gmail.com) From the Medical University of South Carolina Charleston, SC

Rib construct a product of desperation for managing kyphotic deformity in boy with VATER syndrome and osteoporosis Current studies 66 month followup Preop sternal compression on stomach, relieved by kyphos correction

2011 SRS new investigator grant Purpose: Test strength of current fixation methods (growing rods, VEPTR, rib construct)to kyphotic pullout forces in a porcine model Synthes spine refused to make VEPTR’s available for study 2 groups tested – 6 spines each from 21.6 plus or minus 1.5 Kg pigs. The pig has 15 ribs. Pedicle screws in T3-4. Flouroscopic confirmation of screw location 2 downgoing hooks on 3-4, upgoing hooks on 5-6

Pedicle screws As kyphotic deflection and force increased, there was a partial failure(arrow), then complete failure in all specimens

Rib construct No failure in any of the 6 constructs tested

Results No failure observed with rib construct. Average deflection 50.3 degrees, maximum bending force 119.7 N For pedicle screws, failure recorded on all 6 spines. Average deflection angle at failure 35.8 degrees. Average bending force at failure 118.6

Conclusions The rib construct offers superior resistance to kyphotic pullout forces when compared to pedicle screws. Unfortunately, we were unable to test the VEPTR. One clinical paper reported poor results with the VEPTR for patients with kyphosis Reinker K, Simmons JW, Patil V, Stinson Z. Can VEPTR([REGISTERED]) control progression of early-onset kyphoscoliosis? A cohort study of VEPTR([REGISTERED]) patients with severe kyphoscoliosis. Clinical Orthopaedics & Related Research. 469(5):1342-8. 2011 May Thus, at this time, we feel the rib construct is the only reliable method for control of kyphosis in the management of early onset spinal deformity