Ahmed Ezzat Siam

Preliminary Results of Treatment of Early Onset Scoliosis using Magnetic Growing Rods

Introduction One of the major disadvantages of traditional growing rod systems is the requirement for multiple surgical procedures to lengthen the rods as the patient grows. This has been avoided by introduction of magnetically controlled growing rod (MCGR). Materials and Methods A prospective uncontrolled, single-center, single-surgeon, clinical and radiological study. Between November 2012 and August 2015, 16 children with EOS were treated using MCGR. Preoperative, postoperative and final follow-up (FFU) whole spine radiographs were reviewed to determine the degree of spinal deformity and correction, measured using Cobb angle. T1–S1 length was calculated. Clinical notes to determine number of rod lengthening procedures using remote control device and to record any complications during surgery or FU period. Mean age was 11.6 years, 3 boys and 13 girls; 11 children had primary correction by MCGR; 7 of them had neuromuscular, three infantile and one congenital scoliosis. All had a dual MCGR implanted. The remaining five patients had previously undergone other growing rod operation before converting to MCGR implant. Results Mean pre-operative Cobb angle of the primary group was 63.2°, postoperative 35.6° (40.5% correction), FFU 39°. Mean initial percentage of the lengthening was 14.8%. Thoracic kyphosis changed from preoperative mean of 49.1° to 34.1° postoperatively. One patient had wound infection, three had pull-out of proximal screws/hooks, one sustained a breakage of a single-rod construct 6 months after surgery and was replaced by a double magnetic-rod construct. A total of 40 distractions have been performed. Mean FU was 15.5 months. Conclusions In our consecutive series of patients treated with MCGR we found that scoliosis was well controlled. Cobb angle was significantly reduced following surgery in patients who had MCGR performed as a primary procedure. Generally, the correction was maintained at FFU. Despite the relatively high complication rate, comparing our results for MCGR and other growing rod techniques, they are comparable, without need to repeated surgery.

Contribution of Arab Researchers to the Spine Literature over the last 20 years

Introduction Although the ancient Egyptian Imhotep was the first to report a document on spinal injuries, the Edwin Smith Papyrus dating 3000–2500 BC, actual contribution of Arab spinal surgeons to spine research is limited. The aim of this study was to assess the contribution of Arab spine surgeons to spine research in the last two decades. Methods A systemic review of PubMed/Medline including spine-related articles published in journals specialized for spine, orthopaedics and traumatology or neurosurgery, since 1985. Journals focusing mainly on radiology, physical medicine, general medicine, general surgery and others have been excluded. Articles published before the end of July 2015 have been included. At least one affiliation or one author must be based in one of the 22 Arab countries. Bibliometric analysis of the number of articles published from each country, type of study, institution, impact factor (JCR 2014) and trend of publications frequency over 20 years. Quality of publications was assessed by number of citations and level of evidence of clinical studies (LOE). Results The review revealed 445 articles; 66 of them have been excluded being published in non spine-related journals, as well as 10 letters to the editors. Of 369 remaining publications, 115 were case reports with a mean of 1.32 citations/case report, mostly originated from Morocco (38), Lebanon (24), Saudi Arabia and Tunisia (14). The remaining 254 original articles have been analyzed; most frequently clinical studies (228 articles). Of these, 8 articles have been published in German and 5 in French. Spine was the favorite journal of Arab scientists with 47 publications, followed by ESJ with 32, ASJ, International Orthopaedics and Bone Joint Spine with 14 articles each. Articles published in Spine were also most frequently cited, 4.89 times on average, Bone Joint Spine 3.43 and ESJ 3.41 citations/article. Most of publications originated from the university: 192 articles, followed by public hospitals with 36 articles, military hospitals 13 and private sector with 13 articles. Egyptian authors published 120, Saudis 35 and Lebanese 32 articles. Institutionally, University of Alexandria published highest number of spine-related articles; 40, followed by Cairo University with 38, the American University in Beirut 16 and Assiut University 14 Articles. Of original articles, a mean of 2.47 citations/article has been calculated. Studies with LOE I had a mean of 5.25 citations/article. Publications from non-surgical departments had a higher citation rate than surgical departments. Tunisian publications have highest rate of citations/article: 4, followed by Kuwait 3,75 and Saudi Arabia 3.71. Riyadh-based publications have been cited 4.94 times in average, followed by those from Kuwait City 3.75 and Jeddah 3.6 citations/article. Conclusion The Trend is a progressively increasing contribution of Arab spinal researchers to the global spine research over the last two decades. It is not only the absolute number of published articles but also the percentage related to the global research is increasing. Institutions should emphasize the importance and increase awareness of researches about the value of peer-reviewed publications.