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| MA Hongru,ZHU Zezhang,XIA Sanqiang.Efficiency and safety of growing rod in early-onset scoliosis with co-existing intraspinal anomalies[J].Chinese Journal of Spine and Spinal Cord,2019,(6):524-529. |
| Efficiency and safety of growing rod in early-onset scoliosis with co-existing intraspinal anomalies |
| Received:March 04, 2019 Revised:May 20, 2019 |
| English Keywords:Early-onset scoliosis Growing rod Intraspinal anomalies Efficiency Safety |
| Fund:江苏省自然科学基金青年基金资助项目（BK20170126）；江苏省博士后科研资助计划（1701018C）；中国博士后科学基金面上资助项目（2017M610323） |
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| English Abstract: |
| 【Abstract】 Objectives: To investigate the efficiency and safety of growing rod in early-onset scoliosis(EOS) with co-existing intraspinal anomalies. Methods: A total of 73 EOS patients undergoing growing rod at our center between November 2009 and August 2016 was retrospectively reviewed, of whom 11 patients including 2 males and 9 females were enrolled in the study. The average age at initial surgery was 8.2±1.3 years(6-10 years). The etiologies were congenital scoliosis in 9 patients and neuromuscular scoliosis in 2 patients. 16 intraspinal anomalies were identified in 11 patients, including syringomyelia in 3 patients, tethered cord malformation in 1 patient, split cord malformation in 3 patients, syringomyelia with tethered cord syndrome in 2 patients, tethered cord syndrome with split cord malformation in 1 patient, syringomyelia with split cord malformation and tethered cord syndrome in 1 patient. Two patients were found to have neurological deficit before index surgery, one with Honor syndrome and the other with neurogenic bladder and perineum numb. No neurological symptom was found in the other patients. The Cobb angle and T1-S1 height before and after the implant of growing rod and at last visit were documented and compared by paired t test. The peri-operative and post-operative neurological and implant-related complications were noted for each patient. Results: A total of 45 operations was conducted including 11 rod fixation and 34 lengthening procedures. The average interval of distractions was 11.2±1.1(8-12) months. The average follow-up was 39.7±11.6(24-72) months. The mean Cobb angle was 85.2°±23.4° preoperatively, 51.4°±18.9° after index surgery and 52.8°±19.4° at last visit. The mean T1-S1 height was 24.6±3.9cm preoperatively, 28.9±3.4cm after index surgery and 31.9±3.4cm at last visit. Compared with the measurements before index surgery, the Cobb angle and T1-S1 height after the implant of growing rod and at last visit were significantly different (P<0.001). Five complications were identified in 3 patients. Loosening of instruments combined with coronal imbalance and pelvic obliquity was detected in 1 patient before the third distraction, and revision surgery was conducted during distraction simultaneously. Loosening of lower instrumented screw combined with sagittal imbalance was found in 1 patient after the third distraction, and the final fusion surgery was performed 10 months after third distraction. Proximal junctional kyphosis was observed after the second distraction in 1 patient, and no significant progression was found till the last visit. For all 11 patients, no neurological complication was found during follow-up. Conclusions: For EOS patients with asymptomatic or stably-symptomatic intraspinal anomalies, growing rod is relatively safe and effective in clinical practice. |
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