Aims

The aim of this study was to compare the surgical and quality-of-life outcomes of children with skeletal dysplasia to those in children with idiopathic early-onset scoliosis (EOS) undergoing growth-friendly management.

Aims

The aim of this study was to compare the outcomes of surgery using growing rods in patients with severe versus moderate early-onset scoliosis (EOS).

The magnetically controlled growing rod (MCGR) system allows growth maintenance without the risk of anaesthesia, implant and wound complications associated with repeated surgeries. This is a medium-term report of the complications of MCGR from a multicentre study.

Twenty-six patients from 6 spine institutes that are part of a multicentre study with prospectively collected data of minimum 24 months follow-up were assessed. Pre-operative, immediate post-operative and most recent spine radiographs were reviewed to measure the Cobb angle and the rod lengthening distance. The causes and any associated risk factors for re-operations were examined.

Eleven patients required re-operation within the follow-up period, with a mean time to re-operation of 17 months after the initial surgery. Five were due to failure of rod distractions; 3 were due to failure of proximal foundation implants; 2 were due to rod breakage; and one case of superficial wound infection with failure of proximal fixation. Proximal junctional kyphosis occurred in 5 patients. Three had proximal anchor dislodgement and all five constructs were revised.

This is the largest series with the longest follow-up to date. Our series show that the perception that using MCGR may reduce the frequency of re-operations may not be entirely true. This is the first report to examine the need for re-operation after MCGR implantation, and highlights the inherent risks of any surgical treatment in this group of patients despite the advantages of this new implant. Longer-term studies and comparisons with traditional growing rods are required.

Introduction

We prospectively examined the effect of pedicle screw placement at a young age (<5 years) for early-onset spinal deformity on the growth and development of pedicles and the spinal canal.

Introduction: After the introduction of MRI in routine diagnostic work-up, Split cord malformations (SCM) in patients with Congenital spinal deformities (CSD) is more easily diagnosed and probably overtreated.

Aim: To evaluate the necessity of neurosurgical management of SCM before corrective spinal surgery.

Study Design: Retrospective case series

Patients and Methods: Thirty-two patients aged 11 years + 8 months (4–18 years) with CSDs with a follow up of 51,7+/−26,6 months were analyzed. SCM were classified as Type I(septum dividing the spinal cord and dura into two separate hemicords) and Type II(two hemicords within single dura) according to Pang. Eighteen patients with type I underwent neurosurgical intervention (spur excision and creating a single dural cuff) before corrective surgery (15 sequential and 3 simultaneous). Fourteen patients with type II were treated with posterior instrumentation without dealing with the intraspinal abnormalities. The basic maneuvers were translation, compression and shortening to realign spinal column, avoiding distraction forces and intrusion of any instrument into the spinal canal around anomalous segments. Neurological monitoring was done by the wake-up test.

Results: At final follow up, scoliosis improved from 65,7+/−22 to 37+/−15 degrees (45%) in type I and from 74,3+/−21,8 to 39,4+/−18,7 degrees (47%) in type II. The correction loss was 2,3 degrees in patients with type I SCM and 2,9 degrees in patients with type II SCM. One patient with type I SCM had paraparesis resulting from a misplaced upper thoracic pedicle screws with total recovery after revision. Another patient with type I SCM who had simultaneous surgeries had deterioration of her preoperative neurological deficit only to recover partially. Two patients with type I SCM and one patient with type II SCM developed deep wound infections and needed multiple debridements. Two patients with type I SCM had dural leakage that needed repair.

Conclusion: Although it is a common practice to operate all SCMs before corrective surgery in CSD, it may not be necessary in type II which can be managed safely without any neurosurgical intervention.

The Salter innominate osteotomy has been used successfully for many years in the treatment of developmental dysplasia of the hip. One of its main drawbacks is the need for internal fixation with pins and their subsequent removal. We describe a modification of this osteotomy that does not require pin fixation and secondary removal. We retrospectively reviewed 114 hips in 94 patients who had been operated on by a single surgeon. An oblique rather than the original horizontal osteotomy was used without internal fixation. There were 80 female and 14 male patients. The mean age at operation was 25 months (18 to 84) and the mean follow-up was 30 months (12 to 88). Most patients required additional open reduction and capsuloplasty. The mean pre-operative acetabular index was 37.9° (24° to 54°), which decreased to 19.9° (7° to 29°) in the immediate post-operative period, and improved to 14.6° (5° to 25°) at the final follow-up (student’s t-test, p < 0.0001).

We believe that by changing the direction of the osteotomy line, it is possible to avoid pin fixation. The radiological outcomes are comparable to those of the original technique, but longer follow-up will be necessary.

Introduction: Prior to skeletal maturity temporary hemiepiphyseal stapling is a treatment method for angular deformities of long bones. The purpose of this study is to investigate the effects of temporary hemiepiphyseal stapling on the bone geometry and histology of physis.

Materials & Methods: Proximal medial epipyseal stapling of the right tibia were done in 46 New Zealand rabbits. 23 of them were euthanized at the end of 3 weeks. For the remaining 23 rabbits staples were fixed subperiostally (group A) in 11, and extraperiosteally (group B) in 12 rabbits. After 3 weeks the staples removed and the rabbits were euthanized at the end of 6 weeks. Bromodeoxyuridine used to evaluate cellular activity of the growth plate. Radiographs utilized for bone alignment.

Results: The articular surface-diaphysis angle was significantly increased at the end three weeks when compared to controls (27.7° vs. −1.5°, p:0.001). Cellular activity was decreased but preserved in the stapled tibias. At the end of six weeks while the angular deformity was worsening in group A 22.9° vs. 35.6°, p:0.001) it was improving in group B (23.2 ° vs. 14.6°, p:0.001). Bone tissue bridging the growth plate was noted in group A. Cellular activity in the group B was higher than group A at the end of six weeks.

Conclusion: Hemiepiphyseal stapling causes decreased cellular activity at the growth plate, which leads to angulation. With removal of staples, increased cellular activity at the growth plate results in the improvement of the deformity if staples were inserted extraperiosteally. Temporary extraperiosteal hemiepiphyseal stapling could be used as a safe and effective method for treatment of angular deformities prior to skeletal maturity.