Authors: Pooria Hosseini MD MSc, Jeff Pawelek BS, Stacie Nguyen MPH, George H. Thompson MD, Suken A....

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Authors: Pooria Hosseini MD MSc, Jeff Pawelek BS, Stacie Nguyen MPH, George H. Thompson MD, Suken A. Shah MD, John M. Flynn MD, John P. Dormans MD, Behrooz A. Akbarnia MD, GSSG Rod Fracture and Lengthening Intervals in Traditional Growing Rods: Is There a Relationship? ICEOS 2015 , 9TH INTERNATIONAL CONGRESS ON EARLY ONSET SCOLIOSIS (ICEOS), Boston, MA, USA

description

Generally, traditional GR surgery in EOS requires periodic rod lengthening every 6 months until skeletal maturity Lengthening intervals vary between patients due to many reasons including complications FEA studies have shown that shorter lengthening intervals (more frequent lengthenings) results in lower rod fracture Agarwal A., A. A., Jayaswal A., Goel V. (2014). "Smaller Interval Distractions May Reduce Chances of Growth Rod Breakage Without Impending Desired Spinal Growth: A Finite Element Study " Spine Deformity 2: Introduction

Transcript of Authors: Pooria Hosseini MD MSc, Jeff Pawelek BS, Stacie Nguyen MPH, George H. Thompson MD, Suken A....

Page 1: Authors: Pooria Hosseini MD MSc, Jeff Pawelek BS, Stacie Nguyen MPH, George H. Thompson MD, Suken A. Shah MD, John M. Flynn MD, John P. Dormans MD, Behrooz.

Authors: Pooria Hosseini MD MSc, Jeff Pawelek BS, Stacie Nguyen MPH, George H. Thompson MD, Suken A. Shah MD, John M. Flynn MD, John P. Dormans MD,

Behrooz A. Akbarnia MD, GSSG

Rod Fracture and Lengthening Intervals in Traditional Growing Rods: Is There a

Relationship?

ICEOS 2015 , 9TH INTERNATIONAL CONGRESS ON EARLY ONSET SCOLIOSIS (ICEOS), Boston, MA, USA

Page 2: Authors: Pooria Hosseini MD MSc, Jeff Pawelek BS, Stacie Nguyen MPH, George H. Thompson MD, Suken A. Shah MD, John M. Flynn MD, John P. Dormans MD, Behrooz.

Pooria Hosseini None

Jeff Pawelek None

Stacie Nguyen None

George H. Thompson NuSpine Medical Technologies (B,C), Lippincott (C), Orthpediatrics (B), SpineForm (B).

Suken A. Shah Globus (A), Depuy, Artex, Depuy (C),

John M. Flynn Biomet (C), Wolter Kluwer Health (C).

John P. Dormans Elsevier (C), Mosby (C), Brooke’s Publishing (C)

Behrooz A. Akbarnia Depuy Spine (C), Nuvasive (A,B, C), K2M (B), Ellipse (A,B), Nocimed (A)

GSSG None

Disclosures A: Stock B: ConsultancyC: Royalties/Financial SupportD: Grants

Page 3: Authors: Pooria Hosseini MD MSc, Jeff Pawelek BS, Stacie Nguyen MPH, George H. Thompson MD, Suken A. Shah MD, John M. Flynn MD, John P. Dormans MD, Behrooz.

• Generally, traditional GR surgery in EOS requires periodic rod lengthening every 6 months until skeletal maturity

• Lengthening intervals vary between patients due to many reasons including complications

• FEA studies have shown that shorter lengthening intervals (more frequent lengthenings) results in lower rod fracture1.

1- Agarwal A., A. A., Jayaswal A., Goel V. (2014). "Smaller Interval Distractions May Reduce Chances of Growth Rod Breakage Without Impending Desired Spinal Growth: A Finite Element Study " Spine Deformity 2: 430-436.

Introduction

Page 4: Authors: Pooria Hosseini MD MSc, Jeff Pawelek BS, Stacie Nguyen MPH, George H. Thompson MD, Suken A. Shah MD, John M. Flynn MD, John P. Dormans MD, Behrooz.

Retrospective study of multicenter EOS database Inclusion criteria

a) dual growing rod surgery b) minimum 2-year follow-up c) minimum 2 lengthenings d) Only patients with revision surgery related to rod

fracture were included

Only patients with revision surgery related to rod fracture were included.

Methods

Page 5: Authors: Pooria Hosseini MD MSc, Jeff Pawelek BS, Stacie Nguyen MPH, George H. Thompson MD, Suken A. Shah MD, John M. Flynn MD, John P. Dormans MD, Behrooz.

56

82

Total 138 RFNRF

Methodology

Page 6: Authors: Pooria Hosseini MD MSc, Jeff Pawelek BS, Stacie Nguyen MPH, George H. Thompson MD, Suken A. Shah MD, John M. Flynn MD, John P. Dormans MD, Behrooz.

• Lengthening intervals a) RF: only up to the first fracture b) NRF: all intervals

• Demographics• Construct details• Radiographic parameters

Data collection

Page 7: Authors: Pooria Hosseini MD MSc, Jeff Pawelek BS, Stacie Nguyen MPH, George H. Thompson MD, Suken A. Shah MD, John M. Flynn MD, John P. Dormans MD, Behrooz.

Parameter NRF RF P value

Mean pre-op age 7.3 yrs 5.7 yrs < 0.001

Etiologies NM (39%) Syn (39.3%) > 0.05

Last lengthening interval prior to rod # Vs. mean interval in NRF

8.6 m 9.2 m 0.610

Mean pre-op major curve size

72.9° 75.5° 0.279

Max kyphosis 51.9° 51.9° 0.619

% curve correction post surgery

45.9% 43.9% 0.431

Rod diameter 4.8 mm 4.6 mm 0.262

Rod type NA SS Ti 0.00449.2 % 38 %

ResultsNM: NeuromascularSyn: SyndromicNA: Not applicableSS: Stainless steelTi: titanium

Page 8: Authors: Pooria Hosseini MD MSc, Jeff Pawelek BS, Stacie Nguyen MPH, George H. Thompson MD, Suken A. Shah MD, John M. Flynn MD, John P. Dormans MD, Behrooz.

INTERVALS (months)

1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th

NRF 8 8.64 9.23 9.77 9 8.15 11.3 9.79 6.74 7.59 -

RF 8.16 8.26 8.06 7.88 9.06 8.39 10 6.46 6.77 9.33 14.3

P > 0.05

Results

Page 9: Authors: Pooria Hosseini MD MSc, Jeff Pawelek BS, Stacie Nguyen MPH, George H. Thompson MD, Suken A. Shah MD, John M. Flynn MD, John P. Dormans MD, Behrooz.

• Lengthening intervals were not statistically different in RF and NRF groups. Hence, shorter lengthening intervals (more frequent lengthenings) should not benefit the traditional dual growing rods in terms of rod fracture prevention.

• Patients who had rod fracture were younger at the time of index surgery and had more SS rods.

Conclusion

Page 10: Authors: Pooria Hosseini MD MSc, Jeff Pawelek BS, Stacie Nguyen MPH, George H. Thompson MD, Suken A. Shah MD, John M. Flynn MD, John P. Dormans MD, Behrooz.

Lengthening intervals did not appear to be a risk factor for the incidence of the rod fracture in the traditional dual growing rods.

Significance

Page 11: Authors: Pooria Hosseini MD MSc, Jeff Pawelek BS, Stacie Nguyen MPH, George H. Thompson MD, Suken A. Shah MD, John M. Flynn MD, John P. Dormans MD, Behrooz.

• MCGR cases have a wider range of lengthening intervals (1-9 m) vs. TGR cases with min of about 5 m and longer

• To study the real effects of lengthening intervals on the rod fracture we recommend the review of the effects of lengthening intervals on rod fracture in MCGR constructs

Future studies

Page 12: Authors: Pooria Hosseini MD MSc, Jeff Pawelek BS, Stacie Nguyen MPH, George H. Thompson MD, Suken A. Shah MD, John M. Flynn MD, John P. Dormans MD, Behrooz.

Thank you


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