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Classification of EOS Treatment

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Presentation on theme: "Classification of EOS Treatment"— Presentation transcript:

1 Classification of EOS Treatment
Behrooz A. Akbarnia, MD Clinical Professor, University of California, San Diego Medical Director, San Diego Center for Spinal Disorders La Jolla, California 3rd International Congress on Early Onset Scoliosis and Growing Spine (ICEOS) November 20-21, 2009 Istanbul, Turkey

2 No Disclosure in Relation to This Presentation
Disclosures Author Relationships Disclosed Behrooz A. Akbarnia DePuy Spine ( a, b, e), K2M (a, b, e) Ellipse (b), Medtronic (a) No Disclosure in Relation to This Presentation (a) Grants/Research Support (b) Consultant (c) Stock/Shareholder (d) Speakers’ Bureau (e) Other Financial Support

3 David L. Skaggs, MD Children’s Hospital Los Angeles University of Southern California

4 Need to speak the same language
EOS Significant variations exist in recommended treatment options for EOS Sponseller, et al: Submitted to JPO Vitale et al: submitted to CORR Salari et al: IMAST 2009 Need to speak the same language

5 Treatment Non-Surgical Fusion Growth Friendly Techniques

6 Non-Surgical Treatment
Casting Bracing Stretching /exercise Non-Evidence Based Treatment

7 Early Fusion = Poor Pulmonary Function
Goldberg, et al 11 patients 4.1 years 16 year f/u FVC 41% (12-67%) Emans, et al 13 pts 2.6 years 7 vertebrae 11 yr f/u FVC 62% (34-95%) ↓ PFTs with earlier fusion ↓ PFTs with more vertebrae fused Rare <9 yo Spine, 2003 SRS, 2004

8 Classification of Growth Friendly Techniques
< age 8 ? All etiologies Distraction based Growing Rods VEPTR Remote Lengthening (Phenix/ Ellipse) < age 9 ? All etiologies

9 Growth Friendly Implant Classification
< age 8 ? All etiologies Distraction based Growing Rods VEPTR Phenix Guided Growth Luque-Trolley Shilla < age 9 ? All etiologies < age 9 ? All etiologies

10 Growth Friendly Implant Classification
< age 8 ? All etiologies Distraction based Growing Rods VEPTR Phenix Guided Growth Luque-Trolley Shilla Tension Based Tether Staple < age 9 ? All etiologies Only VEPTR FDA Approved for Spine* < age 9 ? All etiologies >age 8 Non-congenital

11 Distraction Based – Traditional Growing Rods
Spine Anchors Surgical Distraction @ 6 months Final Fusion

12 Distraction Based – Rib Anchors
+/- thorocotomy

13 Distraction Based – Non-surgical Distraction - Phenix

14 Guided Growth Luque Trolley Shilla

15 Luque Trolley (no apical fusion)
9 pts. 9 years old All fused spontaneously All required further surgery 7/9 instrument failure Pre-op curve Final curve 51o Little growth of instrumented area – vague Lubicky, Spine, 1992

16 Shilla 2+10 yrs 62o progressive 62o Developed by Rick McCarthy

17 Shilla Open Screws – no fusion
no bone exposed allow rod to slide multiaxial 3 level fusion compression distraction derotation

18 Tension Based Treatment
Staples Tethers Growth Restricting ? “Older” young kids

19 Courtesy Dr. Betz Best for curves <25o With growth remaining 5° -9°
8 yo female 3 year f/u Courtesy Dr. Betz 5° 25° -9° 25° Nov. 2002 March 2005

20 Tethers Animal models Problematic Future ? Braun, JBJS, 2006
Newton, Spine, 2005

21 Wall, 2009 Time = 0 Time = 8 weeks HemiBridgeTM Curvature increased

22 Treatment Classification
Non-Surgical Casts Braces Intentional Fusion Growth Friendly Implants Little Published Evidence of Efficacy Evidence of Pulmonary Harm Complication Ridden Best option for young children

23 Classification of Growth Friendly Techniques
< age 8 ? All etiologies < age 9 ? All etiologies Distraction based Growing Rods VEPTR Phoenix Guided Growth Luque-Trolley Shilla Tension Based Tether Staple < age 9 ? All etiologies >age 8 Non-congenital

24 Thank you

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