title: Staged Growing Rods With Preimplantation of Spinal Anchors for Complex Early Onset Scoliosis.
abstract: BACKGROUND
  Treatment of early onset scoliosis (EOS) with growing rods (GR) can be challenging in patients with significant deformity, hyperkyphosis, or poor bone quality, due to risks of neurological deficit and hardware pull-out. The objective of this study is to report a series of EOS patients managed with a 2-stage GR technique used to minimize these complications.
  
  
  METHODS
  Two-stage GR technique was performed in 8 patients at mean age of 5.4 (range, 3.4 to 7.9) years. At stage 1, proximal and distal anchors were implanted with local fusion. At stage 2, the distraction rods were inserted. There were at least 3 months between stages 1 and 2, and halo-gravity traction was used before stage 2 unless contraindicated. Demographic, clinical, and surgical data were retrospectively reviewed with mean 4.9 (range, 2.0 to 9.4) years of follow-up. Radiographic measurements including Cobb and kyphosis angles were evaluated before stage 1, after halo-gravity traction, after stage 2, and at last follow-up. Indications for staging, anchor healing time, and complications were collected and analyzed.
  
  
  RESULTS
  Indications for 2-stage surgery were poor bone quality in 5 patients and neurological changes during initial attempt at GR placement in 3 patients. The mean time between stage 1 and 2 was 23 (15 to 45) weeks. Patients have undergone mean 7 (3 to 16) lengthenings. Three patients have been converted to magnetically controlled GR. The major coronal Cobb angle improved from mean 81 degrees (range, 61 to 97) preoperatively to 40 degrees (24 to 50) after stage 2 and remained at 40 degrees (27 to 53) at last follow-up. Kyphosis remained controlled from 45 degrees (10 to 76) preoperatively to 38 degrees (9 to 61) after stage 2 to 41 degrees (17 to 65) at last follow-up. Complications included superficial wound problems (4 patients), broken rods (2 patients), proximal migration (2 patients), and implant prominence (1 patient). At minimum 2-year follow-up, no patients had lingering neurological complications or instrumentation-bone failure of the GR construct.
  
  
  CONCLUSIONS
  Two-stage GR technique can effectively be utilized in EOS patients with poor bone quality or in the event of intraoperative neurological changes. Satisfactory deformity correction can be obtained and routine serial lengthenings can take place with minimal complications.
  
  
  METHODS
  Level IV- case series.
authors.affiliation: *Department of Orthopedic Surgery, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY †Department of Orthopedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA.
authors.forename: Jaime A
authors.initials: JA
authors.lastname: Gomez
authors.forename: Alexandra
authors.initials: A
authors.lastname: Grzywna
authors.forename: Regina
authors.initials: R
authors.lastname: Hanstein
authors.forename: John B
authors.initials: JB
authors.lastname: Emans
authors.forename: M Timothy
authors.initials: MT
authors.lastname: Hresko
authors.forename: Daniel
authors.initials: D
authors.lastname: Hedequist
authors.forename: Lawrence I
authors.initials: LI
authors.lastname: Karlin
authors.forename: Michael P
authors.initials: MP
authors.lastname: Glotzbecker
mesh_terms: D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D005260:Female; D006801:Humans; D007738:Kyphosis / Q000601:surgery*; D008297:Male; D009989:Orthotic Devices; D011183:Postoperative Complications / Q000209:etiology; D019736:Prostheses and Implants; D012189:Retrospective Studies; D012600:Scoliosis / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods*; D053441:Suture Anchors; D014143:Traction / Q000706:statistics & numerical data; D016896:Treatment Outcome