title: Early onset scoliosis with intraspinal anomalies: management with growing rod.
abstract: To evaluate clinical and radiological outcomes of growing rod (GR) in the management of Early Onset Scoliosis (EOS) with intraspinal anomalies.
  
  
  
  The effect of repeated distractions following GR, in the presence of intraspinal anomalies has not been studied.
  
  
  
  During 2007-2012, 46 patients underwent fusionless surgery. Out of these 46 patients, 13 patients had one or more intraspinal anomalies. 11 patients had undergone prior neurosurgical procedure while 2 (filum terminale lipoma and syringomyelia) did not. A total of 88 procedures were conducted during the treatment period; 13 index surgeries, 74 distractions of GR and 1 unplanned surgery.
  
  
  
  The age at surgery was 6.8 ± 2.5 years (3.5-12 years). 11 patients had congenital scoliosis and 2 had idiopathic scoliosis. A total of 19 (41.30 %) intraspinal anomalies [Tethered Cord Syndrome (TCS) 08, Split Cord Malformation (SCM) 08, Syringomyelia 01, Meningomyelocele 01, Filum terminale Lipoma 01] were seen. The average lengthening procedures per patient were 5.7 (4-9) with distraction interval of 6.7 (6-7.25) months. Pre-operative Cobb angle was 78.50 ± 18.1 (54-114°) and improved to 53.10 ± 16.70 (36-84°) at final follow-up. A total of 15 complications related to implant (9), wound (2), anesthesia (2) and neurological (2) occurred in 7 patients. Among the two neurological complications, one patient sustained fall in the post-op period and reported to the emergency department with paraplegia and broken proximal screw. While other patient experienced MEP changes during index procedure. None of the patients had any neurological complications during repeated lengthening procedures.
  
  
  
  The most common cord anomalies associated with EOS in our study are TCS and SCM. Although presence of previous intraspinal anomaly does not seem to increase the incidence of neurological deficit, use of neuromonitoring is advisable for all index procedure and selected distractions.
  
  
  
  Level 4 (case series).
authors.affiliation: Department of Orthopaedics, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, 110029, India.
authors.forename: Arvind
authors.initials: A
authors.lastname: Jayaswal
authors.affiliation: Department of Orthopaedics, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, 110029, India. pankajkandwal27@gmail.com.
authors.forename: Pankaj
authors.initials: P
authors.lastname: Kandwal
authors.affiliation: Department of Orthopaedics, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, 110029, India.
authors.forename: Ankur
authors.initials: A
authors.lastname: Goswami
authors.affiliation: Department of Orthopaedics, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, 110029, India.
authors.forename: G
authors.initials: G
authors.lastname: Vijayaraghavan
authors.affiliation: Department of Orthopaedics, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, 110029, India.
authors.forename: Ashok
authors.initials: A
authors.lastname: Jariyal
authors.affiliation: Department of Orthopaedics, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, 110029, India.
authors.forename: B N
authors.initials: BN
authors.lastname: Upendra
authors.affiliation: Department of Orthopaedics, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, 110029, India.
authors.forename: Ankit
authors.initials: A
authors.lastname: Gupta
mesh_terms: D002420:Cauda Equina / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008067:Lipoma / Q000150:complications; D008297:Male; D008591:Meningomyelocele / Q000150:complications; D009436:Neural Tube Defects / Q000150:complications; D019857:Osteogenesis, Distraction / Q000295:instrumentation / Q000379:methods*; D010524:Peripheral Nervous System Neoplasms / Q000150:complications; D011859:Radiography; D012600:Scoliosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D013116:Spinal Cord / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000473:pathology*; D013595:Syringomyelia / Q000150:complications; D016896:Treatment Outcome
keywords: Detethering; Distractions; Early onset scoliosis (EOS); Fusionless surgery; Growing rods (GR); Intraspinal anomalies; Meningomyelocele; Motor evoked potential (MEP); Split cord malformation (SCM); Syringomyelia; Tethered cord syndrome (TCS)