Showing papers by "Behrooz A. Akbarnia published in 2007"

Growing rod techniques in early-onset scoliosis.

Abstract: Background The surgical treatment of severe early-onset scoliosis (EOS) is controversial. Obtaining and maintaining deformity correction, achieving adequate spinal growth, allowing lung development, and the high complication rate make surgical treatment very challenging. Growing rods are the most common method of management. Methods Currently, there are 3 systems being used for the surgical treatment of EOS: single growing rod, dual growing rods, and the vertical expandable titanium prosthetic rib implant. Each system has its advantages and disadvantages. These are presented and discussed in this review. Results The current clinical and radiographic results indicate that all 3 techniques can be effective in the surgical management of EOS. Vertical expandable prosthetic titanium rib (VEPTR), which is not considered a true growing rod system, is particularly effective in congenital scoliosis with fused ribs. Conclusions The current expandable spinal implant systems appear effective in controlling progressive EOS, allowing for spinal growth and improving lung development. All have a moderate complication rate, especially rod breakage and hook displacement.

Management themes in early onset scoliosis.

Abstract: Children with early onset scoliosis present with the deformity in the first five years of life. Radiographic criteria may be helpful to distinguish between the curves that will progress from those that will spontaneously resolve. Severe cardiopulmonary problems can occur in patients with untreated progressive curves. A comprehensive evaluation should be performed to identify the true cause of the deformity, including any conditions that are commonly associated with early onset scoliosis. Progressive curves of ≥20° may require the use of magnetic resonance imaging to assess for occult lesions of the central nervous system. Surgical treatment of spinal deformity should be considered when nonoperative measures, including bracing and casting, are not indicated or fail to arrest curve progression. Surgical methods continue to evolve and are primarily directed at obtaining and maintaining curve correction while simultaneously preserving or encouraging spinal and trunk growth. There are three surgical options for the treatment of early onset scoliosis: spinal fusion to halt the growth of the spine entirely, hemiepiphysiodesis or temporary tethering to cause a convex arrest of growth, and the use of growing-rod instrumentation to allow spinal growth by way of distraction. In 1954, James described the three types of idiopathic scoliosis—infantile, juvenile, and adolescent—on the basis of the age of onset: infantile denotes curves that develop at three years of age or less; juvenile, those that develop between four and nine years of age; and adolescent, those that occur between ten years of age and the time at which growth is complete1. These three periods correspond to distinct periods of growth during childhood and adolescence. The infantile and adolescent periods are marked by an increased growth velocity, whereas most of the juvenile period, in contrast, correlates with a deceleration of spinal growth. Consequently, the onset of scoliosis is relatively uncommon during …

Early onset scoliosis: future directions.

Abstract: The management of children with severe, progressive early onset scoliosis has been greatly advanced in the last decade, yet there is considerably more research to be accomplished in the future. In this concluding article, we review some of the major issues for future research with regard to this rare but potentially fatal disease. Despite the similar clinical appearances of the various forms of early onset scoliosis, the etiologies are different; however, little is known regarding etiology, particularly with regard to genetic defects. Further research is necessary to distinguish the various types of early onset scoliosis. Only by understanding the etiology can true advances be made in altering the natural history of early onset scoliosis. Research in the area of etiology will require increased funding through the National Institutes of Health and other agencies. Due to its low prevalence, early onset scoliosis currently does not have a high priority with these agencies. ### Growing Rods #### Single and Dual Growing Rods As discussed throughout this symposium, posterior instrumentation without fusion, with the use of single or dual growing rods, has been used to treat progressive early onset scoliosis in young children. The goals of treatment have been to achieve correction of the spinal deformity, maintain correction during the subsequent growth period, allow spinal growth and lung development, and avoid or eliminate the need for definitive fusion of the spine at an early age. A recent study has demonstrated improved surgical results with use of the dual growing rod technique1. These improvements are primarily due to the ability to achieve a more stable construct and to the performance of more frequent lengthening procedures. The results of a recent long-term study that examined the outcomes of the dual growing rod technique have confirmed that there is significantly better correction of scoliosis (p = 0.0256) and better achievement of growth1 …