Authors: Pooria Hosseini MD MSc, Jeff Pawelek BS, Stacie Nguyen MPH, George H. Thompson MD, Suken A. Shah MD, John M. Flynn MD, John P. Dormans MD, Behrooz.

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Presentation transcript:

Authors: Pooria Hosseini MD MSc, Jeff Pawelek BS, Stacie Nguyen MPH, George H. Thompson MD, Suken A. Shah MD, John M. Flynn MD, John P. Dormans MD, Behrooz A. Akbarnia MD, GSSG Rod Fracture and Lengthening Intervals in Traditional Growing Rods: Is There a Relationship? ICEOS 2015, 9TH INTERNATIONAL CONGRESS ON EARLY ONSET SCOLIOSIS (ICEOS), Boston, MA, USA

Pooria HosseiniNone Jeff PawelekNone Stacie NguyenNone George H. ThompsonNuSpine Medical Technologies (B,C), Lippincott (C), Orthpediatrics (B), SpineForm (B). Suken A. ShahGlobus (A), Depuy, Artex, Depuy (C), John M. FlynnBiomet (C), Wolter Kluwer Health (C). John P. DormansElsevier (C), Mosby (C), Brooke’s Publishing (C) Behrooz A. AkbarniaDepuy Spine (C), Nuvasive (A,B, C), K2M (B), Ellipse (A,B), Nocimed (A) GSSGNone Disclosures A: Stock B: Consultancy C: Royalties/Financial Support D: Grants

Generally, traditional GR surgery in EOS requires periodic rod lengthening every 6 months until skeletal maturity Lengthening intervals vary between patients due to many reasons including complications FEA studies have shown that shorter lengthening intervals (more frequent lengthenings) results in lower rod fracture Agarwal A., A. A., Jayaswal A., Goel V. (2014). "Smaller Interval Distractions May Reduce Chances of Growth Rod Breakage Without Impending Desired Spinal Growth: A Finite Element Study " Spine Deformity 2: Introduction

Retrospective study of multicenter EOS database Inclusion criteria a)dual growing rod surgery b)minimum 2-year follow-up c)minimum 2 lengthenings d)Only patients with revision surgery related to rod fracture were included Only patients with revision surgery related to rod fracture were included. Methods

Methodology

Lengthening intervals a)RF: only up to the first fracture b)NRF: all intervals Demographics Construct details Radiographic parameters Data collection

ParameterNRFRFP value Mean pre-op age7.3 yrs5.7 yrs< EtiologiesNM (39%)Syn (39.3%)> 0.05 Last lengthening interval prior to rod # Vs. mean interval in NRF 8.6 m9.2 m0.610 Mean pre-op major curve size 72.9°75.5°0.279 Max kyphosis51.9° % curve correction post surgery 45.9%43.9%0.431 Rod diameter4.8 mm4.6 mm0.262 Rod typeNASSTi %38 % Results NM: Neuromascular Syn: Syndromic NA: Not applicable SS: Stainless steel Ti: titanium

INTERVALS (months) 1st2nd3rd4th5th6th7th8th9th10th11th NRF RF P > 0.05 Results

Lengthening intervals were not statistically different in RF and NRF groups. Hence, shorter lengthening intervals (more frequent lengthenings) should not benefit the traditional dual growing rods in terms of rod fracture prevention. Patients who had rod fracture were younger at the time of index surgery and had more SS rods. Conclusion

Lengthening intervals did not appear to be a risk factor for the incidence of the rod fracture in the traditional dual growing rods. Significance

MCGR cases have a wider range of lengthening intervals (1-9 m) vs. TGR cases with min of about 5 m and longer To study the real effects of lengthening intervals on the rod fracture we recommend the review of the effects of lengthening intervals on rod fracture in MCGR constructs Future studies

Thank you