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Hybrid Growing Rod Technique of Osteotomy With Short Fusion and Spinal Distraction

An Alternative Solution for Long-Spanned Congenital Scoliosis

Sun, Xu, MD; Xu, Liang, MD; Chen, Zhonghui, MD; Shi, Benlong, MD; Chen, Xi, MD; Li, Song, MD; Du, Changzhi, MD; Zhou, Qingshuang, MD; Qiu, Yong, MD; Zhu, Zezhang, MD

doi: 10.1097/BRS.0000000000002933
DEFORMITY
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Study Design. Retrospective study.

Objective. The current study aimed to evaluate the effectiveness of the hybrid growing rod (GR) technique for the treatment of young children with congenital scoliosis (CS).

Summary of Background Data. Congenital vertebral anomalies within long-spanned kyphoscoliosis were difficult to be managed by either definitive spinal fusion or standard GR technique. Hybrid technique of one-stage posterior osteotomy with short fusion and GR distraction was proposed in previous studies. There is, however, paucity of data regarding its effectiveness.

Methods. Thirteen patients (mean age, 5.4 ± 2.0 yr) who had undergone hybrid GR treatment were retrospectively reviewed, including 8 patients treated with single GR and 5 patients with dual GR. All of their radiographic data were measured, and surgical complications were recorded.

Results. On average, the current cohort had 4.1 ± 1.7 lengthening procedures. After the index surgery, the major curve improved remarkably from 86.4° ± 11.9° to 37.3° ± 12.4° (P < 0.001). The global kyphosis significantly decreased from 66.8° ± 16.1° to 33.3° ± 3.5° postoperatively. Both value remained steady during follow-up. There were no significant difference between single GR and dual GR groups in terms of the coronal deformity correction, whereas correction loss of global kyphosis in single GR group was significantly higher than that in dual GR group (P = 0.039). After the index surgery, T1-S1 height averagely gained 4.4 ± 0.8 cm and it grew at an average rate of 1.31 ± 0.24 cm/yr during the follow-up. Two complications were identified in two patients, including one with rod fracture and one with proximal junctional kyphosis.

Conclusion. The hybrid GR technique was effective in correcting spinal deformity and allowing continuous spinal growth. The optimal indications were young children with apical vertebrae anomalies and a long-spanned kyphoscoliosis.

Level of Evidence: 3

Congenital vertebral anomalies within long-spanned kyphoscoliosis in young children were difficult to be managed by either definitive spinal fusion or standard growing rod (GR) technique. The current study demonstrated that hybrid technique of one-stage posterior osteotomy with short fusion and GR distraction was effective in improving spinal deformity correction and decreasing complications.

Department of Spine Surgery, Drum Tower Hospital, Nanjing University Medical School, Nanjing, China.

Address correspondence and reprint requests to Zezhang Zhu, MD, Department of Spine Surgery, Drum Tower Hospital, Nanjing University Medical School, Zhongshan Rd 321, Nanjing, China; E-mail: zhuzezhang@126.com

Received 10 July, 2018

Revised 16 October, 2018

Accepted 23 October, 2018

The manuscript submitted does not contain information about medical device(s)/drug(s).

The National Natural Science Foundation of China (grant no. 81772422) and the Natural Science Foundation of Jiangsu Province (BE2017606) funds were received in support of this work.

No relevant financial activities outside the submitted work.

Drs. XS and LX contributed equally to this work.

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