The effect of serial growing rod lengthening on the sagittal profile and pelvic parameters in early-onset scoliosis

Suken A. Shah, Ali F. Karatas, Arjun A. Dhawale, Ozgur Dede, Gregory M. Mundis, Laurens Holmes, Petya Yorgova, Geraldine Neiss, Charles E. Johnston, John B. Emans, George H. Thompson, Jeff B. Pawelek, Behrooz A. Akbarnia

Research output: Contribution to journalArticle

35 Citations (Scopus)

Abstract

STUDY DESIGN.: Retrospective case series. OBJECTIVE.: To report the effect of repeated growing rod (GR) lengthenings on the sagittal and pelvic profile in patients with early-onset scoliosis. SUMMARY OF BACKGROUND DATA.: Posterior distraction-based GRs have gained popularity as a technique for the surgical management of early-onset scoliosis. However, there are no published studies on the effect of serial GR lengthenings on sagittal balance, thoracic kyphosis (TK), lumbar lordosis (LL), and pelvic parameters. METHODS.: We retrospectively reviewed data from a multicenter early-onset scoliosis database. Forty-three patients who were able to walk with minimum 2-year follow-up who underwent single- or dual-GR surgery were included for review. Mean number of lengthenings was 6.4 (range, 3-16). Mean preoperative age was 5.6 years (standard deviation, 2.4 yr), and mean follow-up was 3.5 years. Maximum TK, LL, and sagittal balance were assessed preoperatively, after index surgery, and at the latest follow-up. RESULTS.: There was a significant decrease both in TK and LL after index surgery, which then increased during the lengthening period. There was a significant increase in both proximal junctional kyphosis and distal junctional angle. Pelvic parameters (pelvic tilt, pelvic incidence, sacral slope) were unchanged during the treatment period. Significant improvement was observed in sagittal balance. There was a correlation between the change in TK and change in LL. CONCLUSION.: TK decreased after index surgery and increased between the index surgery and the latest follow-up, which was accompanied by an increase in LL. All-screw proximal constructs had mean 9° more proximal junctional kyphosis than all-hook proximal constructs. An increase in proximal junctional kyphosis and distal junctional angle was found during the treatment period. Although there was an independent effect of number of lengthenings on TK, there was no significant detrimental effect on other sagittal spinopelvic parameters. GRs had a positive effect on sagittal vertical axis, which returned patients to a more neutral alignment through the course of treatment.Level of Evidence: 4.

Original languageEnglish (US)
Pages (from-to)E1311-E1317
JournalSpine
Volume39
Issue number22
DOIs
StatePublished - Oct 15 2014

Fingerprint

Kyphosis
Scoliosis
Lordosis
Thorax
Therapeutics
Databases
Incidence

Keywords

  • early-onset scoliosis
  • growing rods
  • kyphosis
  • lumbar lordosis
  • sagittal alignment
  • sagittal balance
  • thoracic

ASJC Scopus subject areas

  • Clinical Neurology
  • Orthopedics and Sports Medicine

Cite this

Shah, S. A., Karatas, A. F., Dhawale, A. A., Dede, O., Mundis, G. M., Holmes, L., ... Akbarnia, B. A. (2014). The effect of serial growing rod lengthening on the sagittal profile and pelvic parameters in early-onset scoliosis. Spine, 39(22), E1311-E1317. https://doi.org/10.1097/BRS.0000000000000565

The effect of serial growing rod lengthening on the sagittal profile and pelvic parameters in early-onset scoliosis. / Shah, Suken A.; Karatas, Ali F.; Dhawale, Arjun A.; Dede, Ozgur; Mundis, Gregory M.; Holmes, Laurens; Yorgova, Petya; Neiss, Geraldine; Johnston, Charles E.; Emans, John B.; Thompson, George H.; Pawelek, Jeff B.; Akbarnia, Behrooz A.

In: Spine, Vol. 39, No. 22, 15.10.2014, p. E1311-E1317.

Research output: Contribution to journalArticle

Shah, SA, Karatas, AF, Dhawale, AA, Dede, O, Mundis, GM, Holmes, L, Yorgova, P, Neiss, G, Johnston, CE, Emans, JB, Thompson, GH, Pawelek, JB & Akbarnia, BA 2014, 'The effect of serial growing rod lengthening on the sagittal profile and pelvic parameters in early-onset scoliosis', Spine, vol. 39, no. 22, pp. E1311-E1317. https://doi.org/10.1097/BRS.0000000000000565
Shah, Suken A. ; Karatas, Ali F. ; Dhawale, Arjun A. ; Dede, Ozgur ; Mundis, Gregory M. ; Holmes, Laurens ; Yorgova, Petya ; Neiss, Geraldine ; Johnston, Charles E. ; Emans, John B. ; Thompson, George H. ; Pawelek, Jeff B. ; Akbarnia, Behrooz A. / The effect of serial growing rod lengthening on the sagittal profile and pelvic parameters in early-onset scoliosis. In: Spine. 2014 ; Vol. 39, No. 22. pp. E1311-E1317.
@article{f0fec4b818fb495b8791f2207aa0085d,
title = "The effect of serial growing rod lengthening on the sagittal profile and pelvic parameters in early-onset scoliosis",
abstract = "STUDY DESIGN.: Retrospective case series. OBJECTIVE.: To report the effect of repeated growing rod (GR) lengthenings on the sagittal and pelvic profile in patients with early-onset scoliosis. SUMMARY OF BACKGROUND DATA.: Posterior distraction-based GRs have gained popularity as a technique for the surgical management of early-onset scoliosis. However, there are no published studies on the effect of serial GR lengthenings on sagittal balance, thoracic kyphosis (TK), lumbar lordosis (LL), and pelvic parameters. METHODS.: We retrospectively reviewed data from a multicenter early-onset scoliosis database. Forty-three patients who were able to walk with minimum 2-year follow-up who underwent single- or dual-GR surgery were included for review. Mean number of lengthenings was 6.4 (range, 3-16). Mean preoperative age was 5.6 years (standard deviation, 2.4 yr), and mean follow-up was 3.5 years. Maximum TK, LL, and sagittal balance were assessed preoperatively, after index surgery, and at the latest follow-up. RESULTS.: There was a significant decrease both in TK and LL after index surgery, which then increased during the lengthening period. There was a significant increase in both proximal junctional kyphosis and distal junctional angle. Pelvic parameters (pelvic tilt, pelvic incidence, sacral slope) were unchanged during the treatment period. Significant improvement was observed in sagittal balance. There was a correlation between the change in TK and change in LL. CONCLUSION.: TK decreased after index surgery and increased between the index surgery and the latest follow-up, which was accompanied by an increase in LL. All-screw proximal constructs had mean 9° more proximal junctional kyphosis than all-hook proximal constructs. An increase in proximal junctional kyphosis and distal junctional angle was found during the treatment period. Although there was an independent effect of number of lengthenings on TK, there was no significant detrimental effect on other sagittal spinopelvic parameters. GRs had a positive effect on sagittal vertical axis, which returned patients to a more neutral alignment through the course of treatment.Level of Evidence: 4.",
keywords = "early-onset scoliosis, growing rods, kyphosis, lumbar lordosis, sagittal alignment, sagittal balance, thoracic",
author = "Shah, {Suken A.} and Karatas, {Ali F.} and Dhawale, {Arjun A.} and Ozgur Dede and Mundis, {Gregory M.} and Laurens Holmes and Petya Yorgova and Geraldine Neiss and Johnston, {Charles E.} and Emans, {John B.} and Thompson, {George H.} and Pawelek, {Jeff B.} and Akbarnia, {Behrooz A.}",
year = "2014",
month = "10",
day = "15",
doi = "10.1097/BRS.0000000000000565",
language = "English (US)",
volume = "39",
pages = "E1311--E1317",
journal = "Spine",
issn = "0362-2436",
publisher = "Lippincott Williams and Wilkins",
number = "22",

}

TY - JOUR

T1 - The effect of serial growing rod lengthening on the sagittal profile and pelvic parameters in early-onset scoliosis

AU - Shah, Suken A.

AU - Karatas, Ali F.

AU - Dhawale, Arjun A.

AU - Dede, Ozgur

AU - Mundis, Gregory M.

AU - Holmes, Laurens

AU - Yorgova, Petya

AU - Neiss, Geraldine

AU - Johnston, Charles E.

AU - Emans, John B.

AU - Thompson, George H.

AU - Pawelek, Jeff B.

AU - Akbarnia, Behrooz A.

PY - 2014/10/15

Y1 - 2014/10/15

N2 - STUDY DESIGN.: Retrospective case series. OBJECTIVE.: To report the effect of repeated growing rod (GR) lengthenings on the sagittal and pelvic profile in patients with early-onset scoliosis. SUMMARY OF BACKGROUND DATA.: Posterior distraction-based GRs have gained popularity as a technique for the surgical management of early-onset scoliosis. However, there are no published studies on the effect of serial GR lengthenings on sagittal balance, thoracic kyphosis (TK), lumbar lordosis (LL), and pelvic parameters. METHODS.: We retrospectively reviewed data from a multicenter early-onset scoliosis database. Forty-three patients who were able to walk with minimum 2-year follow-up who underwent single- or dual-GR surgery were included for review. Mean number of lengthenings was 6.4 (range, 3-16). Mean preoperative age was 5.6 years (standard deviation, 2.4 yr), and mean follow-up was 3.5 years. Maximum TK, LL, and sagittal balance were assessed preoperatively, after index surgery, and at the latest follow-up. RESULTS.: There was a significant decrease both in TK and LL after index surgery, which then increased during the lengthening period. There was a significant increase in both proximal junctional kyphosis and distal junctional angle. Pelvic parameters (pelvic tilt, pelvic incidence, sacral slope) were unchanged during the treatment period. Significant improvement was observed in sagittal balance. There was a correlation between the change in TK and change in LL. CONCLUSION.: TK decreased after index surgery and increased between the index surgery and the latest follow-up, which was accompanied by an increase in LL. All-screw proximal constructs had mean 9° more proximal junctional kyphosis than all-hook proximal constructs. An increase in proximal junctional kyphosis and distal junctional angle was found during the treatment period. Although there was an independent effect of number of lengthenings on TK, there was no significant detrimental effect on other sagittal spinopelvic parameters. GRs had a positive effect on sagittal vertical axis, which returned patients to a more neutral alignment through the course of treatment.Level of Evidence: 4.

AB - STUDY DESIGN.: Retrospective case series. OBJECTIVE.: To report the effect of repeated growing rod (GR) lengthenings on the sagittal and pelvic profile in patients with early-onset scoliosis. SUMMARY OF BACKGROUND DATA.: Posterior distraction-based GRs have gained popularity as a technique for the surgical management of early-onset scoliosis. However, there are no published studies on the effect of serial GR lengthenings on sagittal balance, thoracic kyphosis (TK), lumbar lordosis (LL), and pelvic parameters. METHODS.: We retrospectively reviewed data from a multicenter early-onset scoliosis database. Forty-three patients who were able to walk with minimum 2-year follow-up who underwent single- or dual-GR surgery were included for review. Mean number of lengthenings was 6.4 (range, 3-16). Mean preoperative age was 5.6 years (standard deviation, 2.4 yr), and mean follow-up was 3.5 years. Maximum TK, LL, and sagittal balance were assessed preoperatively, after index surgery, and at the latest follow-up. RESULTS.: There was a significant decrease both in TK and LL after index surgery, which then increased during the lengthening period. There was a significant increase in both proximal junctional kyphosis and distal junctional angle. Pelvic parameters (pelvic tilt, pelvic incidence, sacral slope) were unchanged during the treatment period. Significant improvement was observed in sagittal balance. There was a correlation between the change in TK and change in LL. CONCLUSION.: TK decreased after index surgery and increased between the index surgery and the latest follow-up, which was accompanied by an increase in LL. All-screw proximal constructs had mean 9° more proximal junctional kyphosis than all-hook proximal constructs. An increase in proximal junctional kyphosis and distal junctional angle was found during the treatment period. Although there was an independent effect of number of lengthenings on TK, there was no significant detrimental effect on other sagittal spinopelvic parameters. GRs had a positive effect on sagittal vertical axis, which returned patients to a more neutral alignment through the course of treatment.Level of Evidence: 4.

KW - early-onset scoliosis

KW - growing rods

KW - kyphosis

KW - lumbar lordosis

KW - sagittal alignment

KW - sagittal balance

KW - thoracic

UR - http://www.scopus.com/inward/record.url?scp=84930069503&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84930069503&partnerID=8YFLogxK

U2 - 10.1097/BRS.0000000000000565

DO - 10.1097/BRS.0000000000000565

M3 - Article

C2 - 25299170

AN - SCOPUS:84930069503

VL - 39

SP - E1311-E1317

JO - Spine

JF - Spine

SN - 0362-2436

IS - 22

ER -