Fusionless Correction for Early Onset Scoliosis (EOS)

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Fusionless Correction for Early Onset Scoliosis
(EOS)

• Emma Orton
• BME 281

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What is EOS?

• Diagnosed before the skeletal age of 10
• There is a lateral curve of the spine
• Causes pulmonary problems later in life
• There are three different types
• Infantile Idiopathic- diagnosed between 0 and 3
  years old and the patient is otherwise healthy
• Juvenile Idiopathic-diagnosed between 4 and 10
  years old
• Congenital-is developed within the first 6 weeks
  of embryonic formation and is when vertebrae are
  not formed correctly

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Cobb Angle
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Possible Treatments

• Braces
• For older patients with a less severe curve
• will not be helpful for patients aged 2-7 years
  with curves of 50 to 60 degrees
• VECTR
• Vertical prosthetic titanium prosthetic rib
• Pushes ribs apart widening the thorax and
  straightening the spine
• Dual Growing Rods
• Growing Rods with Magnetic Expansion Control
• Spinal Fusion
• Many other surgical treatments

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Why are Fusionless Treatments Better?

• When fusion is used the curve of the spine is
  improved but growth stops
• Fusionless treatments are important for children
  especially those under 10
• Children under 5 still have up to 12.5 cm of
  vertical growth
• Lungs do not fully develop till about 8 years old
• Fusion does work for patients who are fully grown

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Criteria for Dual Growing Rods

• The general criteria is
• Significant potential axial growth remaining
• A deformity that is continuing to progress
• A deformity that is flexible or can be made
  flexible

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Dual Growing Rods Experiment 1

• 38 patients
• Followed for anywhere between 2 and 7 years (on
  average 3.3 years)
• Patients received lengthenings on average every
  6.8 months
• The cobb angle decreased from 74 degrees to 38
  degrees on average
• There was axial growth (T1-S1)

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Dual Growing Rod Experiment 2

• 23 patients
• Cobb angle corrected from 82 degrees to 38
  degrees on average
• On average 1.24cm per year of axial spinal growth
• Improvement of space in the thorax
• 13 complications with 11 patients

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Dual Growing Rod Experiment 3

• Group 1 had a single rod with a short apical
  fusion
• Group 2 had only a single rod
• Group 3 had dual rod implantation
• Group 1 had the worst results with 23 correction
  (6.4cm of axial growth) while group three had the
  best with 71 correction (12.1 cm of axial growth)

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Pros and Con of Dual Growing Rod
Pros
Cons

• One of the most efficient ways of treating EOS
• Opens up the thorax preventing many future
  pulmonary issues
• Continues to allow for growth

• Each patient must receive an invasive surgery
  every six months for a span of a few years
  (usually till age 10 for girls and age 13 for
  boys)
• This leads to more opportunities to contract some
  kind of infection
• Very physically and psychologically grueling

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Magnetically Controlled Growing Rods (MCRG)

• Attached in basically the same way as the dual
  growing rods
• Lengthened during quick follow-ups in the office
  without any invasive surgery every 3-4 months
• This allows for the curve to be managed until
  their skeletal structure has matured enough for
  spinal fusion
• The EOS is then tracked using radiographs

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MCGR

• This technique is very new in the United States
  so not many hospitals are doing it
• The first one was completed in Washington DC on a
  ten year old boy
• The requirements are a skeletal age of 10 years
  old or younger and a Cobb angle of 50 degrees or
  greater
• Approved by the FDA in February of 2014

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MCGR Experiment

• Criteria
• Younger than 11 years old
• Major curve of at least 30 degrees
• Radiographic thoracic height (T1-T12) less then
  22cm
• No previous spine surgery
• 2 year follow-up
• The Experiment
• 12 MCGR patients
• 12 TGR patients
• All paired by gender number of rods, age, curve
  and type of EOS

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Results

• Major Curve Correction
• Very similar with MCGR and TRG patients
• Overall it was 32 and 33
• Spinal Height(T1-S1)
• MCGR- 8.1mm/year
• TGR- 9.7mm/year
• This is not considered significantly different
• Throacic Height(T1-T12)

MCGR TRG
Height before surgery 158mm 166mm
Height immediately following surgery 186mm 189mm
Growth per year 1.5mm/yr 2.3mm/yr
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Results

• MCRG
• 16 surgeries
• 137 noninvasive lengthenings
• 8 implant related complications
• TRG
• 73 surgeries
• 12 for initial implant
• 56 for lengthening
• 11/12 had complications
• 4 surgical site infection and 13 implant related
• NOTE All of these patient were from different
  facilities so there could be some variations
  in results

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Discussion of Results

• MCGR-does not allow for the sagittal plane to
  contour ideally because of where the actuator has
  to be located
• TRG-May produce better results when solely
  looking at numbers but when the surgeries and
  many complications are added in it is not ideal
• It is possible that the MCRG would have had
  results even more similar or better than the TRG
  results had there been a longer follow up
  (average follow up for TR patients was 1.6 years
  longer)

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References

• 1 "Congenital Scoliosis." - Scoliosis Research
  Society (SRS). N.p., n.d. Web. 22 Sept. 2015.
• types of scoliosis
• 2 "Anatomy of the Spine." Spine Anatomy
  Southern Oregon Neurosurgical Spine Associates,
  PC. N.p., n.d. Web. 26 Sept. 2015.
• 3 "MD Lingo." MD Lingo. N.p., n.d. Web. 26
  Sept. 2015.
• 4 Hershman, Staurt H., Justin J. Park, and
  Baron S. Lonner. "Fusionless Surgery for
  Scoliosis." Fusionless Surgery for Scoliosis
  (2013) n. pag. Web. 22 Sept. 2015.
• 5  "Frequently Asked Questions." Growing Spine
• Foundation. N.p., n.d. Web. 22 Sept. 2015.
• 6 Pawlek, Jeff B., and Growing Spine Study
  Group. "Traditional Growing Rods Versus
  Magnetically Controlled Growing Rods for the
  Surgical Treatment of Early-Onset Scoliosis A
  Case-Matched 2-Year Study." 2.6 (2014) 493-97.
  Web.
• 7 Controlled Growing Rods Treat Scoliosis in
  Children." MedGadget. N.p., n.d. Web. 22 Sept.
  2015.
• 8 Chueng, and Samartzis. "Management of EOS."
  N.p., n.d. Web.