title: A classification of growth friendly spine implants.
abstract: BACKGROUND
  Various types of spinal implants have been used with the objective of minimizing spinal deformities while maximizing the spine and thoracic growth in a growing child with a spinal deformity.
  
  
  OBJECTIVE
  The aim of this study was to describe a classification system of growth friendly spinal implants to allow researchers and clinicians to have a common language and facilitate comparative studies. Growth friendly spinal implant systems fall into 3 categories based upon the forces of correction the implants exert on the spine, which are as follows: Distraction-based systems correct spinal deformities by mechanically applying a distractive force across a deformed segment with anchors at the top and bottom of the implants, which commonly attach to the spine, rib, and/or the pelvis. The present examples of distraction-based implants are spine-based or rib-based growing rods, vertical expandable titanium rib prosthesis, and remotely expandable devices. Compression-based systems correct spinal deformities with a compressive force applied to the convexity of the curve causing convex growth inhibition. This compressive force may be generated both mechanically at the time of implantation, as well as over time resulting from longitudinal growth of vertebral endplates hindered by the spinal implants. Examples of compression-based systems are vertebral staples and tethers. Guided growth systems correct spinal deformity by anchoring multiple vertebrae (usually including the apical vertebrae) to rods with mechanical forces including translation at the time of the initial implant. The majority of the anchors are not rigidly attached to the rods, thus permitting longitudinal growth over time as the anchors slide over the rods. Examples of guided growth systems include the Luque trolley and Shilla.
  
  
  CONCLUSIONS
  Each system has its benefits and shortcomings. Knowledge of the fundamental principles upon which these systems are based may aid the clinician to choose an appropriate treatment for patients. Having a common language for these systems may aid in comparative research. Vertical expandable titanium rib prosthesis is used with humanitarian exemption. The other devices mentioned in this manuscript are not approved for growing constructs by the Food and Drug Administration and are used off-label.
authors.affiliation: *Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles †San Diego Center for Spinal Disorders, Rady Children's Hospital, La Jolla, San Diego, CA ‡Children's Hospital of Philadelphia, Philadelphia, PA §Johns Hopkins Children's Center, Baltimore, MD ∥Morgan Stanley Children's Hospital, New York, NY.
authors.forename: David L
authors.initials: DL
authors.lastname: Skaggs
authors.forename: Behrooz A
authors.initials: BA
authors.lastname: Akbarnia
authors.forename: John M
authors.initials: JM
authors.lastname: Flynn
authors.forename: Karen S
authors.initials: KS
authors.lastname: Myung
authors.forename: Paul D
authors.initials: PD
authors.lastname: Sponseller
authors.forename: Michael G
authors.initials: MG
authors.lastname: Vitale
mesh_terms: D001858:Bone Nails / Q000145:classification*; D002648:Child; D005260:Female; D006801:Humans; D007595:Joint Prosthesis / Q000145:classification; D008297:Male; D010388:Pelvis / Q000601:surgery; D011859:Radiography; D012600:Scoliosis / Q000000981:diagnostic imaging / Q000601:surgery; D013122:Spinal Diseases / Q000000981:diagnostic imaging / Q000601:surgery; D013123:Spinal Fusion / Q000295:instrumentation*; D013131:Spine / Q000000981:diagnostic imaging / Q000254:growth & development* / Q000601:surgery*; D017792:Surgical Stapling / Q000145:classification; D014025:Titanium / Q000008:administration & dosage; D016896:Treatment Outcome
chemical_list: D014025:Titanium