Behrooz A. Akbarnia

Idiopathic Scoliosis: Infantile and Juvenile

It “develops rapidly and relentlessly, causing the severest form of orthopaedic cripple with dreadful deformity, marked dwarfi ng and shortening of life”

Dual Growing Rods for the Treatment of Early-Onset Scoliosis

Introduction The dual growing-rod technique involves implantation of a set of two rods and two anchor groups (upper and lower foundations) to exert frequent distractions to allow for spinal growth. Step 1 Initial Surgery Positioning Pay special attention to the effect of positioning on sagittal alignment. Step 2 Initial Surgery Neuromonitoring Use multimodality intraoperative neuromonitoring, including SSEPs, MEPs, EMG, and H-Reflexes. Step 3 Initial Surgery Exposure Avoid broad exposure of uninstrumented levels to prevent the risk of spontaneous fusion. Step 4 Initial Surgery Preparation of Foundations The foundation is an assembly of at least four anchors at two or three vertebrae along with one or two rods. Step 5 Initial Surgery Choosing the Anchors Use hooks or pedicle screws for the proximal foundation and use bilateral pedicle screws (a four-anchor construct) for the distal foundation. Step 6 Initial Surgery Rod Contouring and Rod Assembly Cut two 4.5-mm rods and contour them to the appropriate sagittal and coronal alignment, being careful not to overcorrect in the sagittal and coronal planes. Step 7 Initial Surgery Tandem Connector Attachment Place a tandem connector at the thoracolumbar junction to allow for future lengthening. Step 8 Initial Surgery Final Implant Assembly Pass the preassembled rods and tandem connector from caudad to cephalad beneath the fascia, securing them to the foundation and performing the first lengthening. Step 9 Initial Surgery Wound Closure Gentle handling of the skin and associated deeper tissues is essential to avoid complications. Steps 1 and 2 Lengthening Positioning and Neuromonitoring These are the same as those for the initial surgery. Step 3 Lengthening Exposure Make one incision between the two connectors on or in line with the original incision. Step 4 Lengthening Lengthening Inside Versus Outside the Tandem Connector Lengthening can be performed inside or outside the tandem connector. Step 5 Lengthening Closure See Step 9 for the initial surgery. Results The quantity and quality of research on growth-sparing techniques for early-onset scoliosis have increased substantially in the past three years. What to Watch For IndicationsContraindicationsPitfalls & Challenges.