A minimum of 2 year follow up of 22 EOS patients who were treated with 2 nd generation MCGR Karsten Ridderbusch, Christian Hagemann, Ralf Stücker Childrens.

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Presentation transcript:

A minimum of 2 year follow up of 22 EOS patients who were treated with 2 nd generation MCGR Karsten Ridderbusch, Christian Hagemann, Ralf Stücker Childrens Hospital Hamburg-Altona University Clinic Hamburg

Disclosures Consultant – Synthes GmbH – Ellipse Childrens Hospital Hamburg-Altona

Patients 22 EOS patients had primery surgery with 2nd generation MCGR (MAGEC ★ ) All surgeries were done in double rod technique Single center Inclusion criteria for study – EOS of any etiology – > 40° scoliosis and > 5° progression / year – Minimum follow-up of 24 months and at least 6 lengthening procedures (lengthening is performed every 4 months) Childrens Hospital Hamburg-Altona ★ Cleared by FDA 2‘ 2014

Patients 15 female, 7 males Age: 8.8 ( years) 7 neuromuscular, 6 syndromic, 4 neurofibromatosis, 2 idiopathic, 2 thoracogenic, 1 congenital scoliosis 20 thoracic, 1 thoracolumbar, 1 lumbar curves Average F/U – 31 months, (24-46 months) Childrens Hospital Hamburg-Altona

Surgical technique 2 separate incisions 4 screws as distal monosegmental foundation 4 screws + 2 clamps proximally Dual 5.5 mm rods Contouring Testing of distraction Subfascial positioning Cross linking Childrens Hospital Hamburg-Altona

Distractions Outpatient procedure Use of Dimeglio data X-rays pre and post lengthenings Ultrasound documentation of lengthening 4 months intervalls – Logistic reasons – Reduce radiation exposure Childrens Hospital Hamburg-Altona

Radiographic analysis Cobb angle T1-T12 length T1-S1 length Kyphosis (T1-T12) Lordosis (L1-L5) Childrens Hospital Hamburg-Altona

Results Pre-opPost-opChange (%)FUChange (%) Cobb (°)61 ± 1428 ± ± 1356 Kyphosis (°)44 ± 2428 ± ± 1420 Lordosis (°)41 ± 1531 ± ± 915 T1-T12 (cm)18.3 ± ± ± T1-S1 (cm)29.6 ± ± ± = statistically significant (p < 0,05) Childrens Hospital Hamburg-Altona

Complications 7 patients had at least 1 complication which leads to revision surgery 4 junctional kyphosis 2 screw pull out 1 lumbar adding on 1 deep wound infection 1 actuator pin broke Childrens Hospital Hamburg-Altona PJK

Curve correction and T1-S1 growth AuthorCobb before surgery (only primary procedures) Cobb after surgery Correction in % Cobb at follow-up Correction in % T1-S1 growth/month Cheung n=2 67°25° (67%)29° (57%)1 mm Dannawi n=34 69°47° (32%)41° (41%)0,9 mm Akbarnia N=14 60°34° (43%)31° (48%)1,6 mm Hickey n=4 74°42° (43%) 0,4 mm (2 patients) Hamburg N=22 61°28° (54%)27° (56%) Ø 31 months FU 0,7 mm Ø 31 months FU Childrens Hospital Hamburg-Altona

MCGR - results Results in terms of correction and maintaining correction comparable to traditional growing rods Safe and effective non fusion technology Distraction mechanism reliable Complications rate acceptable compared to conventional GR Childrens Hospital Hamburg-Altona

Questions to be answered What is the complication rate after longer follow-up ? Is distraction mechanism reliable after longer follow-up ? Can autofusion be avoided ? What is the best distraction protocoll ? Childrens Hospital Hamburg-Altona