Showing papers by "Behrooz A. Akbarnia published in 2018"

Outcomes of growing rod surgery for severe compared with moderate early-onset scoliosis: a matched comparative study.

Abstract: Aims The aim of this study was to compare the outcomes of surgery using growing rods in patients with severe versus moderate early-onset scoliosis (EOS). Patients and Methods A review of a multicentre EOS database identified 107 children with severe EOS (major curve ≥ 90°) treated with growing rods before the age of ten years with a minimum follow-up of two years and three or more lengthening procedures. From the same database, 107 matched controls with moderate EOS were identified. Results The mean preoperative major curve was 101° (90 to 139) in the severe group and 67° (33° to 88°) in the moderate group (p < 0.001), which was corrected at final follow-up to 57° (10° to 96°) in the severe group and 40° (3° to 85°) in the moderate group (p < 0.001). T1-S1 height increased by a mean of 54 mm (-8 to 131) in the severe group and 27 mm (-4 to 131) in the moderate group at the initial surgery (p < 0.001), and by 50 mm (-17 to 200) and 54 mm (-11 to 212), respectively, during distraction (p = 0.84). The mean n...

Expert Consensus and Equipoise: Planning a Randomized Controlled Trial of Magnetically Controlled Growing Rods.

Abstract: Study Design Expert consensus building using combined Delphi method and Nominal group technique. Objectives To identify the current state of equipoise surrounding the use of magnetically controlled growing rods (MCGRs) and to determine consensus for planning a randomized controlled trial (RCT) with MCGRs. Background The use of MCGRs for the treatment of early-onset scoliosis (EOS) is a new technology. Optimal use has not been thoroughly investigated and much uncertainty exists. Areas of uncertainty include construct architecture, timing of lengthenings, and amount of distraction per lengthening. Expert discussion and consensus is useful at this early juncture and necessary when designing an RCT. Methods Two rounds of surveys were administered to a group of experienced pediatric spine surgeons, followed by a 2-hour, face-to-face meeting in November 2015 and a 1-hour, face-to-face meeting in February 2016. The first survey used example cases to establish agreement around the proper use of MCGRs and identified areas of equipoise and disagreement. The second survey again used example cases—this time selected for their equipoise status—to solicit trial arms for a potential RCT of MCGRs and identified important open questions in the use of MCGRs. Lastly, the face-to-face meetings employed iterative voting to preliminarily plan an RCT of MCGRs. Results Following the Delphi survey rounds and the two Nominal face-to-face meetings, the group of experts decided on an MCGR RCT design that standardized all patients to bidirectional constructs, and randomized to a lengthening interval of 6 versus 16 weeks with a standardized equation for calculating the total yearly lengthening that approximates normal spine growth. Conclusion This endeavor indicates expert support for the use of MCGR in children older than 6 years, with curves greater than 60°. The uncertainty surrounding frequency of lengthening justifies an RCT of MCGRs. Level of Evidence Level V.

Radiographic Outcome Differences in Distraction-Based Growing Rod Constructs Using Tandem Versus Wedding Band Connectors

Abstract: Study Design Comparative cohort study. Objective To compare coronal deformity control, lengthening efficacy, and sagittal alignment between distraction-based growing rod constructs utilizing tandem versus wedding band connectors. Summary of Background Data Different construct designs exist for growing rod treatment of early-onset scoliosis. All use a version of a rod connector, with the two main types being tandem and wedding band. Little data exist to quantify the impact of connector choice on radiographic outcomes of treatment. Methods A multicenter database of prospectively and retrospectively collected data on early-onset scoliosis patients was reviewed. Patients of any thoracic or thoracolumbar coronal plane deformity whose initial growing rod treatment was initiated before age 10 years and underwent at least 3 years of dual growing rod treatment with either tandem or wedding band connectors were included. Preoperative, immediate postoperative, and prefinal radiographs were reviewed and compared in regard to major curve magnitude, T1–T12 and T1–S1 spinal length, length of instrumentation, and sagittal plane measures. Results A total of 209 patients were included. The overall percent change from preoperative to prefinal in all radiographic parameters was not different between the two groups indicating similar efficacy in treatment. After controlling for institutional variation, the improvement of the major coronal Cobb angle from preoperative to prefinal was statistically improved for the tandem group (34° vs. 29°, p = .002) and the difference in T5–T12 kyphosis from preoperative to prefinal was significantly different between the groups (−6° vs. +1.3°, p = .008). Conclusion We identified little difference in the effects of connector type on radiographic outcomes of patients treated with traditional growing rod, which indicates that both wedding band and tandem connectors function similarly. The small differences detected suggest that tandem connectors may improve major Cobb correction, and wedding band connectors may maintain thoracic kyphosis over time. Level of Evidence Level III

Radiographic and Surgical Outcomes After Stand-Alone Lateral Lumbar Interbody Fusion

Abstract: Objectives: Lateral lumbar interbody fusion (LLIF) is increasingly being utilized in isolation to achieve a large surface-area interbody fusion with an indirect decompression for spinal stenosis. This retrospective chart review was done to determine the viability of performing stand-alone (SA) LLIF. Methods: Forty-nine patients at least 18 years of age with minimum one-year follow-up at a single institution underwent SA-LLIF using minimally invasive surgery (MIS) approach without further posterior surgery between 2011 and 2015. One to five-level fusions were included. Retrospective review of surgical outcomes and radiographic parameters were examined preoperatively, acutely postoperatively and at 1 year postoperatively. Results: Forty-nine patients (102 spinal segments) underwent SA-LLIF. Fusion levels ranged from one to five with a mean of 2.1 ± 2.1. Mean blood loss was 68 ± 63.2cc and mean surgical time was 143.4 ± 66.5 minutes. Fifty-seven percent had undergone prior spine surgery unrelated to their index procedure. Complication rate was 38.9% and reoperation rate was 20.4%. No difference in complication rates was noted between constructs with three or more levels fused versus less than three levels fused. At one-year, significant improvement was noted with pelvic tilt, pelvic incidence, and lumbar lordosis. Conclusions: SA-LLIF is an optional MIS treatment of stable degenerative disc disease and spinal stenosis, with good one-year correction and maintenance of radiographic parameters. With complication rate of 38.9% and reoperation rate of 20.4%, true benefit of forgoing posterior supplemental fixation may be questioned.

Early Onset Scoliosis Treated with Magnetically Controlled Growing Rods

Abstract: Early onset scoliosis presents a challenging problem for both the patient and treating surgeon. Multiple techniques have been described to preserve growth and pulmonary development while managing the spinal deformity. A recent advancement has been the creation of magnetically controlled growing rods (MCGR). In this chapter we present the case of a patient with Prader-Willi syndrome and a 109° curve. He initially underwent treatment with traditional spine-based growing rods (TGR) and underwent conversion to MCGR when it became available in the United States. He has continued to be managed by magnetic lengthening and has not yet undergone final fusion. His curve has been maintained between 30 and 40° with the use of MCGR. He has had no complications to date.