H3S2 (3 hooks, 2 screws) construct: a simple growing rod technique for early onset scoliosis.
OBJECTIVE
The purpose of this study was to review the preliminary results of an original fusionless method of treatment for progressive scoliosis in young children.


METHODS
This study retrospectively reviewed the clinical records and radiographs of 23 children with progressive scoliosis who failed to respond to conservative treatment and underwent fusionless surgery using a single solid growing rod construct. All of them were ambulatory and had a follow-up of minimum 2 years. Sixteen patients were treated by consecutive distraction of a single intramuscular rod, and seven patients with rodding and anterior apical convex fusion. The etiology of the scoliosis included 11 idiopathic, 6 syndromic, 4 congenital, and 2 neurofibromatosis. At initial surgery, the average age was 9.3 ± 2.8 years, with a mean Cobb angle of 68° ± 32°. Six patients underwent progressive scoliosis correction in a Stagnara cast prior to surgery, and one patient with an external halo-pelvic Ilizarov device.


RESULTS
Fusionless single rodding allowed to maintain scoliosis correction in all patients. At an average of 3.5 ± 0.9 years after initial surgery, the 23 patients showed a correction of 57 % in the magnitude of the original curvature. Trunk height increase was documented in all patients and ranged from 1.5 to 11.9 cm. Rod failure was found in three patients and two patients had hardware infection. Only four cases of proximal junctional kyphosis were found at last follow-up.


CONCLUSIONS
Preliminary results from these series of patients show that the presented fusionless single growing rod technique allows to maintain correction of progressive early onset scoliosis while permitting spinal growth, with low complication rate. With this technique, lengthening procedures are used only once in every 10 months and patients are more comfortable as no brace is needed in most cases. This technique does not require any specific spine device. The procedure is simple and efficacious as long as some guidelines are respected.
Department of Pediatric Orthopedics, Necker Enfants Malades Hospital, 149 rue de Sèvres, 75743 Paris Cedex 15, France. l.miladi@nck.aphp.fr
Lotfi
L
Miladi
Alexandre
A
Journe
Maryline
M
Mousny
D001863:Bone Screws; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D019637:Orthopedic Procedures / Q000295:instrumentation* / Q000379:methods*; D012189:Retrospective Studies; D012600:Scoliosis / Q000601:surgery*; D013131:Spine / Q000254:growth & development / Q000601:surgery; D016896:Treatment Outcome