Early onset scoliosis with intraspinal anomalies: management with growing rod

Objective To evaluate clinical and radiological outcomes of growing rod (GR) in the management of Early Onset Scoliosis (EOS) with intraspinal anomalies. Background data The effect of repeated distractions following GR, in the presence of intraspinal anomalies has not been studied. Methods During 20...

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Bibliographic Details
Published in:European spine journal 2016-10, Vol.25 (10), p.3301-3307
Main Authors: Jayaswal, Arvind, Kandwal, Pankaj, Goswami, Ankur, Vijayaraghavan, G., Jariyal, Ashok, Upendra, B. N., Gupta, Ankit
Format: Article
Language:English
Subjects:
Cauda Equina - pathology
Child
Child, Preschool
Female
Humans
Lipoma - complications
Male
Medicine
Medicine & Public Health
Meningomyelocele - complications
Neural Tube Defects - complications
Neurosurgery
Original Article
Osteogenesis, Distraction - instrumentation
Osteogenesis, Distraction - methods
Peripheral Nervous System Neoplasms - complications
Radiography
Scoliosis - diagnostic imaging
Scoliosis - etiology
Scoliosis - pathology
Scoliosis - surgery
Spinal Cord - abnormalities
Spinal Cord - diagnostic imaging
Spinal Cord - pathology
Surgical Orthopedics
Syringomyelia - complications
Treatment Outcome
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Summary:Objective To evaluate clinical and radiological outcomes of growing rod (GR) in the management of Early Onset Scoliosis (EOS) with intraspinal anomalies. Background data The effect of repeated distractions following GR, in the presence of intraspinal anomalies has not been studied. Methods 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. Results 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. Conclusion 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. Study design Level 4 (case series).
ISSN:0940-6719
1432-0932
DOI:10.1007/s00586-016-4566-5