Secondary Logo

Journal Logo

Dual Growing Rod Instrumentation with Pedicle Screw Foundation at a Single Institution: Assessment of Outcomes and Complications: E‐Poster #23

Zebala, Lukas P. MD (Washington University School of Medicine); Kuklo, Timothy R. MD, JD; Lenke, Lawrence G. MD; Luhmann, Scott J.; Auerbach, Joshua D. MD; Bridwell, Keith H. MD

Spine Journal Meeting Abstracts: September 2009 - Volume 10 - Issue - p 171
  • Free

Introduction: Early onset scoliosis (EOS) is often refractory to nonoperative treatment and frequently requires growing rod (GR) techniques. The study purpose was to report GR outcomes with pedicle screw fixation (PS) at one institution.

Methods: Consecutive case series of 16 patients (6M, 10F) with minimum 2‐year follow‐up (F/U) treated with GR for progressive scoliosis (6 idiopathic, 8 syndromic and 2 congenital). Average age at initial surgery was 4.9±1.8 years. All patients had dual rod (3.5 or 4.5 mm) submuscular GR with mainly PS anchors. 4 patients had anterior spinal fusion prior to GR. Average F/U was 3.5±1.5 years.

Results: There were 6.1±3 lengthenings/pt (total surgeries 8.0±3) at an interval of 7.7±2.3 months. 9 patients had an unexpected return to the OR with 66% having multiple returns (range, 1–3). Main curve Cobb improved from 73.°±16.9 to 46.8°±14.9 (p<0.001) after GR and 43.8±17.5° (p<0.001) at last F/U. Coronal and sagittal balance, T2‐T12, T5‐T12 and T12‐S1 Cobb angles were not statistically different at F/U. T1‐S1 length increased from 26.2±4.3 cm to 29.9±4.2 cm (p=0.04) after initial GR insertion and 32.9±3.9 cm (p<0.001; total 6.9±2.0) after last F/U, and average growth was 1.2±0.4 cm/year. T1‐T12 length increased from 15.5±3.0 cm to 17.8±2.7 cm (p=0.05) after initial GR insertion and 20.2±3.9 cm (p=0.002) after last F/U. 10 patients had broken rods with 70% having multiple occurrences of broken rods. 127 PS were implanted with only 12 (9%) PS revisions for loosening (no catastrophic failures) during F/U. 3 infections (1 superficial, 1 deep, 1 superficial at ICBG site) occurred during F/U. 2 patients had definitive fusion during F/U.

Conclusion: GR with PS is effective in controlling coronal (37% main curve correction) and sagittal deformity. GR provided an average spinal elongation of 3.7 cm and an average of 3.2 cm of spinal growth at last F/U. Broken rods are common (59%) but did not compromise outcome and were easily revised. PS appear safe and effective (9% needing revision) as anchors without catastrophic failure.

Significance: GR with PS anchors is effective at controlling scoliosis and allows for spinal growth. PS complications were minimal. Broken rods are common and families should be advised of this occurrence.

© 2009 Lippincott Williams & Wilkins, Inc.