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Spine Deform. 2018 Sep - Oct;6(5):607-613. doi: 10.1016/j.jspd.2018.02.012.

Achievement of Guided Growth in Children With Low-Tone Neuromuscular Early-Onset Scoliosis Using a Segmental Sublaminar Instrumentation Technique.

Author information

1
CHOC Children's Hospital, 1201 W La Veta Ave., Orange, CA 92868, USA. Electronic address: osseousmd@aol.com.
2
CHOC Children's Hospital, 1201 W La Veta Ave., Orange, CA 92868, USA.
3
Riverside County Regional Medical Center, 26520 Cactus Ave., Moreno Valley, CA 92555, USA.

Abstract

OBJECTIVES/SUMMARY OF BACKGROUND DATA:

Segmental sublaminar spinal instrumentation without fusion results in guided growth and correction of deformity in early-onset scoliosis (EOS). The purpose of this study is to report the outcomes of a series of children with low-tone EOS that were treated surgically with a modification of a Luque trolley technique.

METHODS:

This study is a retrospective chart and radiographic review of a single-center series of 13 consecutive children who met inclusion criteria with documented progression of scoliosis greater than 25°. All children received surgical treatment with guided growth without fusion using a modified Luque trolley technique. The children's preoperative, postoperative, and most recent radiographs were assessed for Cobb angle, T1-T12 and T1-S1 height, and sagittal alignment including proximal junctional kyphosis. Surgimap spine software was used for calibration and measurement purposes. Complications and need for repeat and/or secondary surgical procedures were recorded.

RESULTS:

The mean age at surgery was 7.4 years (4.6-10.5). On average, 15 segments (13-16) were instrumented. None of the children went on to a spontaneous fusion, and the average growth rate per year from T1-T12 and T1-S1 was 0.9 cm/y and 1.5 cm/y, respectively. The mean total growth from T1-T12 and T1-S1 was 22.3 cm (16.6-30.2) and 37.5 cm (30.1-46.4). A total of three additional surgeries were needed in two children to address complications. There were no mortalities.

CONCLUSIONS:

Sublaminar guided growth is a safe and effective treatment in the Low Tone Neuromuscular subset of EOS. Follow-up studies failed to show signs of auto fusion, and implant failure was not observed in our cohort. All children displayed growth postoperatively without the need for multiple distraction-based surgeries. Guided growth minimizes the risks associated with multiple surgical procedures while maintaining correction and allowing for near-normal rates of spinal growth.

KEYWORDS:

Early-onset scoliosis; Neuromuscular scoliosis; Segmental Sublaminar Spinal Instrumentation

PMID:
30122398
DOI:
10.1016/j.jspd.2018.02.012
[Indexed for MEDLINE]

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