title: Minimizing complications with single submuscular growing rods: a review of technique and results on 88 patients with minimum two-year follow-up.
abstract: METHODS
  Retrospective clinical and radiologic review of consecutive series of patients treated with single submuscular growing rods from a single center with a minimum of 2-year follow-up.
  
  
  OBJECTIVE
  To describe the surgical technique and methods used to minimize complications and to report on the outcomes of a large consecutive series of patients treated with single submuscular growing rods for scoliosis in the immature spine from a single center.
  
  
  BACKGROUND
  Previous studies have reported on the safety and efficacy of single and dual growing-rod constructs; however, these studies have been of small patient numbers with varying results.
  
  
  METHODS
  Between 1999 and 2007, 88 patients underwent the insertion of a single, submuscular growing-rod construct for scoliosis. A clinical and radiologic review of these 88 consecutive patients with a minimum of 2-year follow-up was conducted. Diagnoses include idiopathic, neuromuscular, syndromic, and congenital. Data include Cobb angle measurements, T1-S1 heights, number, and frequency of lengthening as well as complications.
  
  
  RESULTS
  The patients underwent single submuscular growing-rod insertion at an average age of 7.0 years. The mean follow-up period was 42 months. Twenty-eight patients had a simultaneous apical fusion. Growing-rod lengthening was performed on an average at 9-month intervals. The average initial Cobb angle was 73° (range: 40-117) and improved to 44° (range: 9-90) at final follow-up. T1-S1 height gain was 3.37 cm; this translates to 1.04 cm growth/yr. No significant difference was noted between those who had undergone apical fusion and those without. Complications noted in this series include 8 incidences of superficial infection and 3 of deep infection, proximal junctional kyphosis in 2 patients requiring early fusion, 31 rod fractures, 10 cases of proximal anchor failure, and 6 distal anchor failures. Thirty patients within study group have reached definitive fusion.
  
  
  CONCLUSIONS
  Favorable outcomes have been demonstrated in this large single-center series of growing-rod constructs used to treat scoliosis in the growing spine. Their safety and efficacy in controlling spinal deformity and allowing spinal growth along with an acceptable rate of complications would support the continued use of single growing-rod constructs as a scoliosis management option.
authors.affiliation: Department of Spinal Surgery, Great Ormond Street Hospital, London, United Kingdom. najmafarooq@doctors.net.uk
authors.forename: Najma
authors.initials: N
authors.lastname: Farooq
authors.forename: Enrique
authors.initials: E
authors.lastname: Garrido
authors.forename: Farhaan
authors.initials: F
authors.lastname: Altaf
authors.forename: Joanne
authors.initials: J
authors.lastname: Dartnell
authors.forename: Suken A
authors.initials: SA
authors.lastname: Shah
authors.forename: Stewart K
authors.initials: SK
authors.lastname: Tucker
authors.forename: Hilali
authors.initials: H
authors.lastname: Noordeen
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D016268:Internal Fixators / Q000009:adverse effects*; D008297:Male; D012189:Retrospective Studies; D012600:Scoliosis / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects* / Q000295:instrumentation* / Q000379:methods; D013131:Spine / Q000254:growth & development / Q000601:surgery*; D016896:Treatment Outcome