Use of Magnetic Spinal Growth Rods (MCGR) With and Without Preoperative Halo-gravity Traction (HGT) for the Treatment of Severe Early-onset Scoliosis (EOS).

BACKGROUND: Correction of severe scoliosis through distraction-based techniques poses a challenge. Magnetically controlled growing rod (MCGR) hardware complications are common with a 27.8% to 46.7% revision rate in under 2 years. Loss of correction and diminishing returns are the norm. Treatment of severe scoliosis with halo-gravity traction (HGT) before MCGR has not been previously reported. The purpose of this study was to assess initial correction, maintenance of correction, and complication rate in patients with severe scoliosis treated with and without HGT before MCGR. METHODS: IRB-approved retrospective single site cohort study of a prospectively collected database. Forty-two patients underwent MCGR between 2014 and 2017 at a single site, 12 with prior growing constructs were excluded, 30 patients were included, 12 patients underwent preoperative HGT. Charts were reviewed for demographic, clinical, and radiographic information. RESULTS: The HGT group had larger major curves averaging 90 (69 to 114) degrees versus 77 (56 to 113) degrees in the non-HGT group P=0.018. Percent correction on preoperative flexibility films were 17% versus 40% for those in the HGT versus non-HGT group, P=0.000. An additional 22% correction of the curve magnitude occurred between the flexibility and in-traction films representing 43% of the total correction achieved, P=0.000, was achieved. EBL, and postoperative major curve and major curve correction were not significant. Thirteen percent of patients experienced complications. Average follow-up was 712 versus 561 days in the HGT versus non-HGT groups. CONCLUSIONS: Large, rigid curves can achieve equivalent correction to flexible curves with HGT. Forty-three percent of the total correction achieved occurred during traction. Thirty percent of the total correction occurred at implantation of the MCGR in the HGT group versus 28% in the non-HGT group. At most recent follow-up HGT patients had statistically maintained their major curve correction better than non-HGT patients. LEVEL OF EVIDENCE: Level III-therapeutic study.

Paper #33: Magnetic Spinal Growth Rods (MCGR) with and without Preoperative Traction for the Treatment of Severe Scoliosis.

Large rigid curves can be treated with MCGR and preop traction with equivalent correction to smaller flexible curves and maintain correction over time.

Surgical outcome in patients treated for hemangioma during infancy, childhood, and adolescence: a retrospective review of 44 consecutive patients.

BACKGROUND: Hemangiomas are the most common tumors in infancy and childhood and account for 7% of benign soft tissue tumors. Diagnosis is usually made in infancy or childhood. There are only a few reports on the surgical treatment of these lesions, likely because the lesions are quite vascular, have a tendency to infiltrate into the muscle and other tissues, and the recurrence rate is quite high. METHODS: We reviewed the outcome of surgical treatment on 44 consecutive children and adolescents with 47 surgically treated hemangiomas. Hemangiomas involving the face and the head were excluded. RESULTS: Eleven lesions were surgically treated before the age of 5 years, 20 lesions between the ages of 5 and 12 years, and 16 lesions were treated after the age of 12 years. Eleven lesions had intralesional resection, 33 lesions underwent marginal resection, 2 lesions were managed with wide resection, and 1 lesion underwent radical resection. The overall recurrence rate was 22.2%. CONCLUSIONS: In the pediatric population, it is desirable to perform definitive treatment whenever possible, thereby minimizing morbidity, both functional and psychological. Asymptomatic lesions should be monitored to confirm the diagnosis and to look for signs of progression. Symptomatic lesions can be treated with surgical excision if this does not result in significant functional impairment. A marginal resection may be used to treat most superficial soft tissue tumors. Intramuscular hemangiomas pose a more difficult therapeutic problem. When the lesion is limited in size, it may be treated with wide local excision. However, if the lesion is more diffusely spread into the muscle unit, the morbidity created by extensive muscle resection has to be weighed against the morbidity of the condition or alternative treatment methods. Whenever possible, a wide marginal resection should be carried out to minimize the risk of recurrence and avoid further surgical procedures. We recommend prolonged follow-up of these patients because 7% of the patients included in this study required late review due to multiple recurrences of these lesions. LEVEL OF EVIDENCE: Level IV (case series).