1. John T. Smith, MD Jessica V. Morgan John A. Heflin, MD
Conversion of Rib-Based Distraction Constructs to Luque-Trolleys to Manage Severe Proximal Junctional Kyphosis: A report of 4 cases.
John T. Smith, MD
Jessica V. Morgan
John A. Heflin, MD

2. Disclosures
Smith: Consultant: DepuySynthes, Globus, Biomet, Spineguard. Royalties: VEPTR 2 device; Board of Directors: Children’s Spine Foundation
Heflin: Consultant: Globus, Medtronic
Morgan: Nothing to disclose

3. Background: Proximal Junctional Kyphosis (PJK)
Common after growth-friendly rib-based or spine-based distraction
Prominent implants
Skin problems
Cosmetic issues
Growth-friendly salvage options are limited

4. Luque Trolley’s Potentially allow for continued growth
Very low profile
Reduce need for repetitive surgery
This study presents 4 cases where LT’s were used as a salvage procedure for PJK

5. Technique Remove upper rib hooks
Contour rod to match or improve existing kyphosis
Pass a minimum of 2 sub-laminar wires at proximal end
Leave adequate length for growth

6. Case Example 1
10 y/o male with congenital kyphosis managed with rib-based distraction since age 3
Multiple wound dehisences, prominent instrumentation and PJK

7. Case Example 2 8 y/o male with scoliosis and NF1
Significant PJK and prominent instrumentation
Converted to a Luque Trolley

8. Results 4 Patients Diagnosis varied:
Age Initial implantation: 3.3 years
Age at conversion to LT: 9.1 years
Length of follow-up:
1.8 years
Pre conversion kyphosis: 84 degrees
Post conversion kyphosis: 77 degrees
3 of 4 patients had wound problems prior to conversion
All patients showed continued spinal growth after LT conversion

9. Discussion
Luque Trolley’s offer an option for salvage of growth-friendly distraction constructs where PJK occurs and implants are prominent
Longer follow-up is needed to determine if continued growth will occur

10. Thank you