Comparison of initial efficacy between single and dual growing rods in treatment of early onset scoliosis

Background Initial results for the use of single and dual growing rod techniques in the treatment of early onset scoliosis （EOS） has been seldom documented. The aim of this research was to investigate the initial efficacy of single and dual growing rods in treatment of EOS. Methods A retrospective study of 25 early onset scoliosis cases treated with growing rod technique between November 2002 and May 2010 was performed, including six cases in the single growing rod group and 19 cases in the dual growing rod group. Operation time, intra-operative bleeding, correction rate, changes in C7-S1 distance, and incidence of complications of the first operation were compared for the two techniques. Results The average post-operative follow-up duration was 31.9 months. There was no statistical difference observed between operation time, intra-operative bleeding, and complication incidence between the single and dual growing rod groups. In addition, no statistical difference was observed in the pre-operative coronal Cobb＇s angle （P 〉0.05）, or in the pre-operative sagittal Cobb＇s angle between both groups （P 〉0.05）. The correction rate of the dual growing rod group was significantly superior to that of the single growing rod group in the coronal plane （P 〈0.01）, but not in the sagittal plane （P 〉0.05）. The C7-S1 distance in the dual growing rod group was significantly larger than that in the single growing rod group （P 〈0.05）. Conclusions The growing rod technique is an effective option for surgical treatment of EOS. The dual growing rod technique shows relative superiority in the correction outcome as compared to the single growing rod technique.

Primary effect of dual growing rod technique for the treatment of severe scoliosis in young children

Background Treatment of rapidly progressing scoliosis in young children is a challenge for spine surgeons. Some surgeons had begun to use dual growing rod technique for treatment of rapidly progressing scoliosis in young children and had achieved acceptable results. The aim of this study was to determine the primary results and complications of this new technique in China. Methods Eleven children suffering from rapidly progressing scoliosis were treated with dual growing rod technique between November 2004 and March 2009 at Peking Union Medical College Hospital （PUMCH）. There were 10 females and 1 male in the group with Risser sign of 0 grade. The mean age at initial surgery was 6.1 years （range, 2.1-10.9 years）. Ten patients were diagnosed as congenital scoliosis and 1 patient neuromuscular scoliosis. All the patients had 1-4 lengthening procedures （mean, 1.8 procedures） after the initial surgeries. The radiographic results of all the patients were investigated. Results The coronal Cobb angle of scoliosis improved from （67.64±11.43）% to （34.64±8.26）% after initial surgery with the correction rate observed at （47.15±16.48）%. The coronal trunk shift improved from （2.00±1.73） cm to （1.49±1.31） cm after initial surgery. The T1-S1 height increased from （25.47±6.16） cm to （28.84±5.69） cm after initial surgery. The coronal Cobb angle of scoliosis was （36.82±11.76）% and the coronal trunk shift was （1.11±1.29） cm after the most recent lengthening procedure with the most recent correction rate observed at （44.73±19.43）%. The T1-S1 height was （31.29±4.50） cm after the most recent lengthening procedure with an average T1-S1 length increase of 1.6 （range, 1.0-2.7） cm per year during the lengthening period. The sagittal balance was maintained. Five of the total patients （45.5%） had complications including： hook displacement, pedical screw loosening, and broken rod. We performed revision surgeries with simultaneous lengthening procedures in all 5 cases with satisfactory results. Conclusions The dual growing rod technique was useful in the management of rapidly progressing scoliosis in young children. This technique could control severe scoliosis, allow for spinal growth, and maintain the coronal and sagittal balance. But the technique has high complications requiring strict and regular follow-up.

Lung function after growing rod surgery for progressive early-onset scoliosis： a preliminary study

Pulmonary problems often occur in patients with early-onset scoliosis （EOS）. However, lung function in patients with EOS after growing rod surgery has not been documented. The aim of this study was to investigate lung function after the treatment for EOS with growing rod and its possible correlative factors. Methods Eight patients with EOS were treated with growing rod surgery at Peking Union Medical College Hospital from September 2002 to September 2009. Four patients had finished the final fusion surgery （group 1）, and the other 4 （group 2） were in the process of periodic lengthening. Preoperative forced vital capacity （FVC）, ratio of FVC to predicted FVC, forced expiratory volume in 1 second （FEV1）, ratio of FEV1 to predicted FEV1, and radiographic measurements of Cobb＇s angle and C7-S1 distance were recorded. Lung function changes and correlations between lung function changes and radiographic changes （Cobb＇s angle and C7-S1 distance） were analyzed. Results In group 1, FVC and FEV1 both increased. FVC showed a significant difference （P=0.01）, but FEV1 did not （P =0.05）. In group 2, FVC and FEV1 also increased, and both showed a significant difference （P=0.04 and P=0.02, respectively）. Ratio of FVC to predicted FVC and ratio of FEV1 to predicted FEV1 changed similarly and did not show statistical differences in the 2 groups. There were no significant correlations between lung function changes and radiographic changes （Cobb＇s angle and C7-S1 distance） （P=0.10 and P=0.41, respectively）. Conclusions Lung function increases after growing rod surgery in patients with EOS. Lung function changes do not correlate with Cobb＇s angle changes or C7-S1 distance changes.