title: Outcomes of Pelvic Fixation in Growing Rod Constructs: An Analysis of Patients With a Minimum of 4 Years of Follow-up.
abstract: Retrospective review.
  
  
  
  To evaluate which distal anchors in growing rod (GR) constructs optimally correct major curve, pelvic obliquity, sagittal alignment, T1-S1 length, thoracic kyphosis, and lumbar lordosis with the fewest complications at 4 or more years' postoperative follow-up.
  
  
  
  Pelvic fixation to the ilium and/or sacrum in GR constructs is used to treat patients with early-onset scoliosis. No studies have evaluated radiographical outcomes and complications in these patients at 4 or more years' follow-up.
  
  
  
  Included were 38 patients from a multicenter early-onset-scoliosis database with dual GRs anchored to the pelvis. Radiographic data included major curve, T1-S1 length, T5-T12 kyphosis, lordosis, sagittal alignment, and pelvic obliquity at preoperative and latest follow-up time points. Complications were evaluated for all anchor subtypes.
  
  
  
  Mean follow-up time was 5.3 ± 0.1 years. GRs with distal anchors to the ilium significantly improved major curve (49%, p = .013) and pelvic obliquity (78%, p = .035) compared with constructs anchored to the sacrum only. Constructs with iliac fixation with S1 screws provided greater correction of lumbar kyphosis than constructs with iliac fixation and no S1 screws (p = .023). Constructs with a single caudal crosslink had a greater T1-S1 length at latest follow-up than constructs with combined cephalad and caudal crosslinks (p = .027). There were no significant differences in the rates of infection or instrumentation failure between iliac and sacral fixation groups. GR constructs with distal anchors that used a posterior superior iliac spine start point had a higher infection rate (60%) than those inserted via a sacral-alar-iliac technique (7%) (p = .002).
  
  
  
  GR constructs anchored to the ilium provide significant improvements in the major curve and pelvic obliquity at a minimum of 4 years of follow-up versus constructs anchored to the sacrum alone.
  
  
  
  Level III, retrospective cohort study.
authors.affiliation: Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N Caroline St, Baltimore, MD 21231, USA.
authors.forename: Jaysson T
authors.initials: JT
authors.lastname: Brooks
authors.affiliation: Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N Caroline St, Baltimore, MD 21231, USA.
authors.forename: Amit
authors.initials: A
authors.lastname: Jain
authors.affiliation: Department of Orthopedic Surgery, Hospital Universitario La Paz, Paseo de la Castellana, 261, 28046 Madrid, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Sanchez-Perez-Grueso
authors.affiliation: Children's Orthopedic Center, Children's Hospital Los Angeles, 4650 Sunset Blvd, MS #69, Los Angeles, CA 90027, USA.
authors.forename: David L
authors.initials: DL
authors.lastname: Skaggs
authors.affiliation: Division of Pediatric Orthopaedic Surgery, Rainbow Babies & Children's Hospital, Case Western Reserve University, 11100 Euclid Ave, Cleveland, OH 44106, USA.
authors.forename: George H
authors.initials: GH
authors.lastname: Thompson
authors.affiliation: Department of Orthopaedic Surgery, University of California-San Diego, 200 West Arbor Dr, San Diego, CA 92103, USA; San Diego Center for Spinal Disorders, 6190 Cornerstone Ct, Ste 212, San Diego, CA 92121, USA.
authors.forename: Behrooz A
authors.initials: BA
authors.lastname: Akbarnia
authors.affiliation: Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N Caroline St, Baltimore, MD 21231, USA. Electronic address: editorialservices@jhmi.edu.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Sponseller
mesh_terms: D001863:Bone Screws; D005500:Follow-Up Studies; D006801:Humans; D010384:Pelvic Bones / Q000601:surgery*; D012189:Retrospective Studies; D012600:Scoliosis / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods*
keywords: Early-onset scoliosis; Growing rod constructs; Iliac fixation; Pelvic anchors; Sacral fixation