Abstract
Introduction
The spine is a key factor in the growth of thorax, abdomen, and pelvis. By the age of 5 years, the spine reaches 50% of its adult length. Therefore, spinal fusion in a 5-year-old child can result in about 12.5 cm loss of spinal growth. Disruption of the growth of the spine due to fusion performed in the treatment of early-onset scoliosis leads to thoracic insufficiency syndrome. The ideal technique should maintain the correction of the deformity, allow continued spinal growth, should not require postoperative immobilization, and also should have low complication rates. There are several growing rod techniques which have been defined but none of them fulfill all of these conditions. The aim of this article is to define a new modification on the growing rod technique.
Patients and Methods
Ten children have been operated in authors' institution, at an average age of 8 (range, 4–9) years. The surgical technique involved short segment instrumentation applied on the convex side of the apex of the deformity. Pedicle screws or hooks were used at stable anchor levels of the concave side of the deformity. Two rods, one proximal and one distal, were fixed to anchor sites and connected by a domino connector. After distracting the concave side, a transverse connector was used between the short segment and the long one, and this connector was compressed to maintain a translational force on the apex of the deformity. The frequency of lengthening procedure is 6 to 9 months.
Results
The average follow-up was 11 months. The average preoperative coronal plane curve was 46 degree and corrected to 13 degree showing 74% scoliosis correction after index surgery.
Conclusion
The main goal of the treatment of early-onset spinal deformities in children is to correct the deformity while maintaining the growth of the spine. All the described techniques up to now have been based on distraction of the concave side and the compression of the convex side of the deformity at stable vertebrae. The technique defined in this study, distracts the concave side while applying a translational force at the apex of the deformity by a transverse connector. The authors believe that this new technique will maintain more effective correction. Other advantages include less surgical dissection so less likely to cause a spontaneous fusion of the spine, shorter operation time, and low risk of surgery-associated complications. Long-term outcomes of the treatment by this new technique should be investigated by the mean spinal growth, and the correction of the spinal deformity.