Does rod orientation and use of cross connector affect spinal height in magnetically controlled growing rod patients? Pooria Hosseini, Behrooz A. Akbarnia,

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Presentation transcript:

Does rod orientation and use of cross connector affect spinal height in magnetically controlled growing rod patients? Pooria Hosseini, Behrooz A. Akbarnia, Stacie Tran, Jeff Pawelek, Charles E. Johnston, Suken Shah, John Emans, Gregory M. Mundis, Burt Yaszay, Peter F. Sturm, GSSG International Congress on Early Onset Scoliosis (ICEOS); November 16 &17, 2017; San Diego, USA

Growing Spine Foundation funded the study Disclosure Growing Spine Foundation funded the study Behrooz A. Akbarnia - Nuvasive, K2M, DePuy Synthes (a), Nuvasive, K2M (d), Nuvasive, K2M (f), Nuvasive, K2M (g), GSF, SDSF, SRS, SOLAS (h) Charles E. Johnston – Medtronic, Saunders/Mosby-Elsevier (a), OrthopedicsJournal of Childrens Orthopedics, POSNA, SRS (h) Suken Shah – DePuy (a,c,g), Globus (e), Ethicon (g), Innovative surgical designs (f), K2M (g,i), NuVasive, Stryker (d), POSNA, SRS, Setting Scoliosis Straight, AAOS (h) John Emans – DePuy/Synthes spine (a), DePuy/Synthes spine, Medtronic spine, Zimmer/Biomet (d) Gregory M. Mundis – DePuy, Johnson and Johnson (b), ISSGF (g), K2M (a,b,d), NuVasive (a,b,d,g) Burt Yaszay – AAOS (h), DePuy, Johnson & Johnson (b,d,g), Globus (b,d), Harms Study group (g), K2M (d, g), NuVasive (b,d), Orthopediatrics, K2M (a), POSNA, SRS, spine deformity (h), Stryker (b) Peter F Sturm – DePuy, Medtronic, Nuvasive (d), Biomet (e), Journal of Children's Orthopaedics, Scoliosis Research Society, POSNA (h) Pooria Hosseini – SRS, SOLAS (h) For the remaining authors none were declared. (a) Royalties (b) Speakers bureau/paid presentations (c) Paid employee (d) Paid consultant (e) Unpaid consultant (f) Stock or stock options (g) Research support from a company or supplier as a PI (h) Board member/committee appointments for a society (i) Other financial or material support

Introduction Magnetically controlled growing rods (MCGR) are becoming the gold standard in surgical management for early onset scoliosis (EOS) patients. However, there are still many unanswered questions about the most effective use of this technique.

Purpose The purpose of this study was to investigate the effect of rod orientation and use of cross connectors on the spinal height gain in patients treated with MCGR.

Methods Retrospective study of multicenter EOS database. Inclusion criteria: EOS patients with spine-based dual MCGR Minimum 2-year follow up Available imaging

Methods The first analysis compared patients by rod orientation: standard (both rods in standard orientation) or offset rod (one rod in standard and the other in inverse orientation). The second analysis compared the use of cross connectors: yes (CC+) or no (CC-). The three outcome measures of interest included left and right rod height gain and percentage change for both T1-T12 and T1-S1 height. Cross Connector Rod lengthens at this point Offset rod Standard rod Rod lengthens at this point

Results – Rod orientation Rod orientation analysis 40 patients were divided into standard (n=13) and offset (n=27) groups. At pre-operative time point there was no significant differences in Age Gender BMI Follow up Ambulatory status Etiology Primary curve size T1-S1 height T1-T12 height Number of distractions per year

Rod orientation The left and right rod length gain per year, T1-T12 and T1-S1 height percentage change was similar between groups (p>0.5).

Results – Cross connector In the cross connector analysis patients were grouped to CC+ (n=17) and CC- (n=23). The aforementioned parameters in rod orientation section were also similar between groups except for number of distractions per year (CC+ 3.7 vs. CC- 3.0 per year; p=0.008). To control for this difference, all three height parameters were assessed based on height gain per distraction.

Cross connector Height gain per distraction was not statistically different between CC+ and CC- (P>0.05).

Conclusion Rod orientation and presence of cross connector do not appear to affect the rod, thoracic, and spinal height gain in EOS patients treated with MCGR. Future studies with larger sample sizes are required to confirm the findings.