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Scientific Articles   |    
Growing-Rod Graduates: Lessons Learned from Ninety-nine Patients Who Completed Lengthening
John M. Flynn, MD1; Lauren A. Tomlinson, BS1; Jeff Pawelek, BS2; George H. Thompson, MD3; Richard McCarthy, MD4; Behrooz A. Akbarnia, MD2; the Growing Spine Study Group
1 Division of Orthopaedic Surgery, The Children’s Hospital of Philadelphia, 3400 Civic Center Boulevard, 2nd Floor, Wood Building, Philadelphia, PA 19104. E-mail address for J.M. Flynn: Flynnj@email.chop.edu
2 San Diego Center for Spinal Disorders, 4130 La Jolla Village Drive, Suite 300, La Jolla, CA 92037
3 Division of Pediatric Orthopaedic Surgery, Rainbow Babies and Children’s Hospital, 11100 Euclid Avenue, Cleveland, OH 44106
4 Department of Orthopaedic Surgery, Arkansas Children’s Hospital, 1 Children’s Way, Little Rock, AR 72202
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  • Disclosure statement for author(s): PDF

Investigation performed at The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, and the San Diego Center for Spinal Disorders, La Jolla, California

A commentary by Michael J. Pensak, MD, and Jeffrey D. Thomson, MD, is linked to the online version of this article at jbjs.org.



Disclosure: One or more of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of an aspect of this work. In addition, one or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2013 Oct 02;95(19):1745-1750. doi: 10.2106/JBJS.L.01386
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Abstract

Background: 

Growing-rod spinal instrumentation systems are a valuable tool for managing severe early-onset scoliosis. There is little information about the end point of treatment.

Methods: 

A multicenter early-onset-scoliosis database was searched to identify patients who had undergone treatment with growing rods and either had had a final operative procedure or were still being treated with the growing rods after reaching skeletal maturity (defined as fourteen years of age or older). Clinical, radiographic, and operative data were analyzed.

Results: 

Ninety-nine patients met the inclusion criteria, and ninety-two (93%) of them had had a final operative procedure. The remaining seven patients (7%) were older than fourteen years but had not undergone a final procedure. Of the ninety-two patients who had a final procedure, seventy-nine (86%) had an instrumented fusion, nine (10%) had growing-rod exchanges and fusion in situ, three (3%) had the growing rods left in place and fusion in situ, and one (1%) had only growing-rod removal. The mean age (and standard deviation) at the final fusion was 12.4 ± 1.9 years. In forty-four (55%) of eighty patients for whom the information was available, the number of vertebral levels fused was the same as the number of vertebral levels spanned by the growing rods. The percent correction of the curve after final fusion was none or minimal (≤20%) in eleven (18%) of the sixty-two patients for whom sufficient-quality radiographs were available, moderate (21% to 50%) in thirty (48%), and substantial (≥51%) in nine (15%); the curve had worsened in twelve patients (19%). The mean duration of growing-rod treatment was 5.0 ± 2.6 years. Of fifty-eight operative reports made at final fusion that contained comments on spinal flexibility, eleven (19%) described the spine as being mobile, eleven (19%) described decreased flexibility, and thirty-six (62%) described the spine as being completely stiff. At final fusion, twenty-two patients (24%) had osteotomies and seven patients (8%) had a thoracoplasty.

Conclusions: 

Most patients underwent growing-rod removal and final instrumented fusion. The final fusion often included the same levels spanned by the growing rods and usually achieved <50% additional correction of the deformity remaining at the end of the growing-rod management.

Level of Evidence: 

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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