3rd International Congress on Early Onset Scoliosis and Growing Spine, 2021 November Istanbul, TURKE - PowerPoint PPT Presentation

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3rd International Congress on Early Onset Scoliosis and Growing Spine, 2021 November Istanbul, TURKE

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Final fusion- female min. 10 years old, male min 12 years old, between the ... In 2 patients hemothorax developed during definitive spinal fusion surgery. ... – PowerPoint PPT presentation

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Title: 3rd International Congress on Early Onset Scoliosis and Growing Spine, 2021 November Istanbul, TURKE


1
3rd International Congress on Early Onset
Scoliosis and Growing Spine, 20-21 November
Istanbul, TURKEY
  • THE EARLY POST-OPERATIVE CLINICAL RESULTS IN THE
    PATIENTS WITH PROGRESSIVE EARLY ONSET SCOLIOSIS
    THAT UNDERWENT POSTERIOR SPINAL FUSION FOLLOWING
    GROWING ROD TECHNIQUE
  • Atici Y. , Akman Y.E. , Ozluk A.V. , Mert M. ,
    Acikgoz I. , Ozturkmen Y. , Uzumcugil O. ,
    Carkci E. , Caniklioglu M.
  • Istanbul Education and Training Hospital,
    Istanbul, TURKEY

2
TREATMENT IN EARLY ONSET SCOLIOSISGOAL
  • To avoid the deformity to progress ,
  • To help the skeletal and the respiratory systems
    to normally develop, before the definitive spinal
    fusion procedure.
  • normal development ,
  • protected growth potential as much as possible.

3
Basics in Early Onset ScoliosisTreatment
  • Age, type of the deformity , localisation
  • Cobbs anglelt25 conservative follow-up,
  • low risk
  • progression gt10 surgery
  • Cobbs angle between 25 - 35 moderate risk
    and presence of progression surgery
  • Progressive deformitiesgt45 surgery high risk
  • Treatment aims to correct the deformity
  • Spinal column, thorax and lung development going
    on

4
Management Themesin Early Onset Scoliosis
  • Incision-long midline or two seperate midline
  • Instrumentation- at least 2 anchors (HOOK/SCREW
    or CLAW)
  • Upper level(generally T2-T4)
  • Inferior level( at least 2 or 3 levels under the
    end vertebra of the deformity)
  • Rod-submuscular/subcutaneous, single/dual, 3/16
    inches in length, in the appropriate shape of
    physiological body curves (kyphosis and lordosis)
  • Tandem (domino) connector- on the thoracolumbar
    junction
  • Local fusion performed in the INSTRUMENTED SITES
  • Postop brace- mandatory for the first 6 months
  • Distraction- Once a 6 month, generally performed
    in the proximal segment.
  • Final fusion- female min. 10 years old, male min
    12 years old, between the instrumentation levels.

5
Patients
  • 5 cases, all females
  • Subcutaneous single rod was applied in 4 cases,
    subcutaneous dual rod was applied in 1 case
  • Distractions performed in 6 months interval
  • Etiology idiopathic in 4 cases, congenital in 1
    case
  • The mean age at the beginning of the distractions
    10,4 (8,5-12,1) years.
  • Mean follow-up period after posterior spinal
    fusion 8,4 (3-23) months
  • Mean total follow-up time 35,3 (22,4-60,5)
    months
  • Mean age during posterior spinal fusion was 12,6
    (11,5-14,5) years.

6
Results
  • Cobbs angle improved!

  • preoperative after fusion
    during the first visit
  • Mean thoracal Cobbs angle 62,6 (range 55-
    67) 26,2 (range 18-32)
  • Mean lumbar Cobbs angle 29,4 (range 0-
    60) 8,6 (range 0-32)
  • Mean T1-S1 length 32,2 (24-36)
    cm 39,8 (34-42) cm
  • Respiratory function tests performed late
    post-operatively in all cases

  • FVCgt80 in all cases
  • Fusion achieved in all cases.

7
Complications
  • During distraction period, in 2 patients there
    was pull-out of the hooks in the proximal levels.
  • There was pull-out of the pedicle screws in the
    proximal levels in one patient and in 2 patients
    the rods broke down for 3 times.
  • In 2 patients hemothorax developed during
    definitive spinal fusion surgery.
  • One of the patients had paraplegia during
    definitive fusion surgery.

8
Screw pull-out
9
Hook Displacement
10
Rod Fracture
11
Example Case 1
12
Example Case 2
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