| Popis: |
BACKGROUND: Early onset scoliosis (EOS) is defined as scoliosis occurring before the age of 5 years. The management presents a unique challenge where both natural history and fusion lead to impaired cardiopulmonary function of the child. AIM: To assess the outcome of the use of non-fusion instrumentation and repetitive elongation ('growth rods') in EOS. METHODS: A retrospective review of 14 consecutive patients who underwent growth rod implantation and lengthening procedure for EOS was performed. Growth rod constructs were constructed predominately from modular commercially available sets using laminar hooks, pedicle screws and connection blocks, with single or double rod constructs. Vertical expanding prosthetic titanium ribs (VEPTR) were used in two patients. Patients returned to theatre at six-monthly intervals for a lengthening procedure. Patients were assessed with regard to type of scoliosis, age at surgery, number of lengthenings done, progression of Cobb angle, amount of construct lengthening, amount of spine growth achieved and complications. RESULTS: The most common type of scoliosis seen was idiopathic (five), followed by neuromuscular (four), conjoined twins (two), syndromic (two), and congenital (one). Five patients were followed until final fusion, one procedure was stopped due to wound complications and one patient was lost to follow-up. The 14 patients had a median of seven lengthenings each. The median pre-operative Cobb angle was 56° (IQR 46.5°-59.5°) and median last follow-up Cobb angle of 32.5° (IQR 27.0°-44.5°). The median spine growth achieved was 97 mm (IQR 69-122 mm). Eight of the 14 patients (57%) experienced 14 complications during their lengthening procedures. CONCLUSIONS: The growth rod instrumentation provides spinal deformity correction and control, while allowing ongoing growth of the spine. It is a labour-intensive process with significant incidence of complications. There is however very little other choice in these patients due to concerns of early fusion restricting pulmonary development. |
