Quantitative Characteristics of Consecutive Lengthening Episodes in Early-onset Scoliosis (EOS) Patients With Dual Growth Rods.

STUDY DESIGN: A prospective single-center study. OBJECTIVE: The aim of this study was to record the characteristic forces and lengths observed during distraction episodes in early-onset scoliosis (EOS), and analyze their interdependencies on the key variability among the patients. SUMMARY OF BACKGROUND DATA: The goal of the growing-rod technique is to achieve deformity correction alongside maintaining growth of the spine. The deformity correction is achieved during the initial surgery, but follow-up distraction episodes are necessary to maintain the growth. The key variables, under the control of a surgeon, that affect the growth are the applied distraction forces and the distraction lengths. Since the advent of dual growth rod technique, there have been many studies exploring the relationship between these and the actual growth. However, there is sparse evidence on the actual magnitude of distraction forces, and none on its association with patient's parameters such as sex, age, and deformity. METHODS: In a consecutive series of 47 patients implanted with dual growth rods, the distraction forces (in N) and the lengths (in mm) achieved during each distraction episode and compared against the episode-specific demographics. The values obtained from each side, that is, concave and convex sides, were averaged to calculate the mean. Statistical analysis was performed using t-distribution because for each normalized time points (distraction episode). RESULTS: In cumulative, the distraction force increased by an amount of 268%, with 120% increase in the early stages (distractions episodes 1-6) and 68% increase in the later stages (distractions episodes 6-11), whereas the cumulative decrease in the length over 11 distractions episodes was 47%, with 34% and 20% in the early and later stages, respectively. The study does not identify any significant trend with respect to sex, age, and deformity. CONCLUSION: The distraction force and the length increased and decreased respectively with every consecutive distraction episode, with no correlation to sex, age, extent of deformity, or the extent of correction. LEVEL OF EVIDENCE: 5.

Severe Rigid Scoliosis: Review of Management Strategies and Role of Spinal Osteotomies.

Severe rigid curves pose a considerable challenge to the treating spine surgeon. In our practice, approximately 30%-40% of patients with scoliosis present late with severe rigid scoliosis (>90° and <30% correction on bending films). Controversy still exists with regard to the ideal surgical strategy for correcting these rigid curves. Rigid scoliosis often presents in the form of either sharp angular or rounded deformities. Rounded deformities can be effectively managed with an anterior release to loosen the apex and posterior instrumentation (with osteotomies, if required). In contrast, severe rigid scoliosis, which is a sharp angular deformity, is not very amenable to anterior release and is best managed by posterior-only vertebral column resection and posterior instrumentation.

Anterior versus posterior procedure for surgical treatment of thoracolumbar tuberculosis: A retrospective analysis.

BACKGROUND: Approach for surgical treatment of thoracolumbar tuberculosis has been controversial. The aim of present study is to compare the clinical, radiological and functional outcome of anterior versus posterior debridement and spinal fixation for the surgical treatment of thoracic and thoracolumbar tuberculosis. MATERIALS AND METHODS: 70 patients with spinal tuberculosis treated surgically between Jan 2005 and Dec 2009 were included in the study [corrected]. Thirty four patients (group I) with mean age 34.9 years underwent anterior debridement, decompression and instrumentation by anterior transthoracic, transpleural and/or retroperitoneal diaphragm cutting approach. Thirty six patients (group II) with mean age of 33.6 years were operated by posterolateral (extracavitary) decompression and posterior instrumentation. Various parameters like blood loss, surgical time, levels of instrumentation, neurological recovery, and kyphosis improvement were compared. Fusion assessment was done as per Bridwell criteria. Functional outcome was assessed using Prolo scale. Mean followup was 26 months. RESULTS: Mean surgical time in group I was 5 h 10 min versus 4 h 50 min in group II (P>0.05). Average blood loss in group I was 900 ml compared to 1100 ml in group II (P>0.05). In group I, the percentage immediate correction in kyphosis was 52.27% versus 72.80% in group II. Satisfactory bony fusion (grades I and II) was seen in 100% patients in group I versus 97.22% in group II. Three patients in group I needed prolonged immediate postoperative ICU support compared to one in group II. Injury to lung parenchyma was seen in one patient in group I while the anterior procedure had to be abandoned in one case due to pleural adhesions. Functional outcome (Prolo scale) in group II was good in 94.4% patients compared to 88.23% patients in group I. CONCLUSION: Though the anterior approach is an equally good method for debridement and stabilization, kyphus correction is better with posterior instrumentation and the posterior approach is associated with less morbidity and complications.