Cornelius Wimmer

Perkutane dorsale Stabilisierung an der Brust- und Lendenwirbelsäule mit dem Expedium LIS

OBJECTIVE Fusion can be done from the thoracic spine up to the sacrum. A cannulated Expedium screw as well as the rod can be placed percutaneously. This minimally invasive approach creates only a minor muscular trauma. INDICATIONS Osteochondrosis of the lumbar and thoracic spine. Spondylolisthesis grade I-III according to Meyerding. Instability after nucleotomy. Type A and B fractures according to Magerl. Spondylodiscitis. Flexible scoliosis of the lumbar and thoracic spine. CONTRAINDICATIONS Osteoporosis (t score < -1.5). Spondylolisthesis grade IV according to Meyerding. SURGICAL TECHNIQUE The patient should be positioned prone, lying flat on the table. Use of two C-arms, one in anteroposterior and the other in lateral view. Marking of the entry point of the pedicle on the skin. Short skin incision (15 mm). Insertion of the Jamshidi needle into the pedicle. A guide wire should be inserted. Removal of the needle and start with the dilatation system, first the small one and then the big one. Preparation of the pedicle with a tap and insertion of the pedicle screw with the open and closed extension sleeves. Measurement of the rod length and insertion of the rod. Fixation of the rod with screw and removal of the extension sleeves. POSTOPERATIVE MANAGEMENT The patient should be mobilized on the same day or the 1st day after surgery with or without a corset. RESULTS From 2005 to 2006, 72 patients (45 female, 27 male) with a mean age of 44 years (35-73 years) were treated using this technique. Follow-up examinations were performed 3, 6, 12, and 24 months after surgery. The mean follow-up was 14 months (3-24 months). Fusion rate was evaluated by computed tomography scan or X-ray. Implant-related complications were not observed.ZusammenfassungOperationszielMit dem Expedium LIS können Stabilisierungen von der mittleren Brustwirbelsäule bis zum Sakrum erfolgen. Eine perkutane Platzierung kanülierter Expedium-Polyaxialschrauben ist möglich. Mit dem System kann der Stab perkutan eingebracht werden. Durch das perkutane Einbringen des Stabes entsteht ein minimales Muskeltrauma. Bei den offenen Stabilisierungsverfahren wird ein maximales Gewebetrauma gesetzt, welches zu einer fettigen Atrophie führt, die im Magnetresonanztomogramm nachgewiesen werden kann. Der Erhalt der Rückenmuskulatur ist für die angrenzenden Bewegungssegmente im weiteren Verlauf notwendig, um nicht frühzeitig eine angrenzende Degeneration der Bewegungssegmente zu schaffen.IndikationenOsteochondrose der Brust- und Lendenwirbelsäule.Spondylolisthese Grad I–III nach Meyerding.Instabilität bei Postnukleotomiesyndrom.Frakturen der Typen A und B nach Magerl.Spondylodiszitis.Flexible thorakale und lumbale Skoliosen.KontraindikationenOsteoporose (DEXA-t-Score < –1,5).Spondylolisthese Grad IV nach Meyerding.OperationstechnikLagerung des Patienten auf dem Bauch mit zwei C-Bögen im lateralen und anterior-posterioren Strahlengang. Platzierung einer Knochenbiopsienadel am seitlichen Pedikelrand nach einem Längsschnitt von 1,5 cm. Präparation des Pedikels nach Einbringen des Kirschner-Drahts. Einbringen der kanülierten Pedikelschraube mit Schraubenverlängerungen. Implantation des Stabes perkutan von der proximalen Schraube ausgehend. Setzen der Madenschraube. Entfernung der Schraubenverlängerung.WeiterbehandlungMobilisation des Patienten am selben Tag oder am 1. postoperativen Tag ohne Korsett. Am 7. postoperativen Tag Beginn mit isometrischen Übungen. Körperliche Schonung bis zu 3 Monate nach der Operation.ErgebnisseZwischen 2005 und 2006 wurden 72 Patienten (45 Frauen, 27 Männer) im Alter von 44 Jahren (35–73 Jahre) operiert. Die Patienten wurden 3, 6, 12 und 24 Monate postoperativ nachuntersucht. Die durchschnittliche Nachkontrollzeit betrug 14 Monate (3–24 Monate). Der knöcherne Durchbau wurde mit Hilfe eines Computertomogramms oder einer Röntgenaufnahme festgestellt. Bei allen Patienten zeigte sich eine Fusion. Implantatbedingte Komplikationen waren nicht feststellbar.AbstractObjectiveFusion can be done from the thoracic spine up to the sacrum. A cannulated Expedium screw as well as the rod can be placed percutaneously. This minimally invasive approach creates only a minor muscular trauma.IndicationsOsteochondrosis of the lumbar and thoracic spine.Spondylolisthesis grade I–III according to Meyerding.Instability after nucleotomy.Type A and B fractures according to Magerl.Spondylodiscitis.Flexible scoliosis of the lumbar and thoracic spine.ContraindicationsOsteoporosis (t score < –1.5).Spondylolisthesis grade IV according to Meyerding.Surgical TechniqueThe patient should be positioned prone, lying flat on the table. Use of two C-arms, one in anteroposterior and the other in lateral view. Marking of the entry point of the pedicle on the skin. Short skin incision (15 mm). Insertion of the Jamshidi needle into the pedicle. A guide wire should be inserted. Removal of the needle and start with the dilatation system, first the small one and then the big one. Preparation of the pedicle with a tap and insertion of the pedicle screw with the open and closed extension sleeves. Measurement of the rod length and insertion of the rod. Fixation of the rod with screw and removal of the extension sleeves.Postoperative ManagementThe patient should be mobilized on the same day or the 1st day after surgery with or without a corset.ResultsFrom 2005 to 2006, 72 patients (45 female, 27 male) with a mean age of 44 years (35–73 years) were treated using this technique. Follow-up examinations were performed 3, 6, 12, and 24 months after surgery. The mean follow-up was 14 months (3–24 months). Fusion rate was evaluated by computed tomography scan or X-ray. Implant-related complications were not observed.

Operative treatment of scolioses with the VEPTR instrumentation

ZusammenfassungOperationszielDas VEPTR-Instrumentarium wurde primär zur Behandlung des Thoraxinsuffizienzsyndroms (TIS) eingesetzt, das mit einer Fusion der Rippen und begleitender Skoliose einhergeht. Gleichzeitig wurden auch isolierte kongenitale Skoliosen mit oder ohne Wirbelkörperfehlbildung behandelt. Ziel war es, das Thoraxvolumen zu erweitern, die Thoraxsymmetrie wiederherzustellen und die Lungenfunktion zu verbessern. Die Thoraxsymmetrie wird mit einer Wachstumslenkung (Distraktion) an der Konkavseite wiederhergestellt. Während des Wachstums der Kinder ist alle 4–6 Monate ein Nachstellen an der konkaven Seite durch operative Distraktion notwendig. Mit der VEPTR-Instrumentation wird das Wachstum unter Korrektur der Skoliose weiterhin ermöglicht.IndikationenTIS.Kongenitale Skoliose mit und ohne Rippensynostosen.„Early-onset“-Skoliose (EOS).Neurogene Skoliose.KontraindikationenSchwerwiegende Kyphose > 70° nach Cobb.Osteoporotische Wirbelsäulenveränderungen.Kinder > 10 Jahre.OperationstechnikLagerung der kleinen Kinder in Seitenlage oder Schräglage auf einem Spezialrahmen. Bei einer thorakalen kongenitalen Skoliose wird eine Thorakokostotomie vorgenommen. In diesem Fall erfolgt eine Seitenlagerung der Patienten. Die Rippensynostosen werden osteotomiert. Es wird eine Distraktion mit dem Laminaspreizer durchgeführt. Die expandierbare Titanrippe wird eingesetzt. Geht die Krümmung in die Lendenwirbelsäule hinein, empfiehlt sich die Implantation eines Hybrids, d.h., lateral wird das „rib to rib“-Implantat und medialseitig das „rib to lumbar spine“-Implantat gesetzt. Je nach Wachstum ist im Abstand von 4–6 Monaten ein Nachspannen notwendig.WeiterbehandlungDie Mobilisation der Patienten ist ab dem 3. postoperativen Tag korsettfrei möglich.ErgebnisseVon 2005 bis 2009 wurden 39 Kinder (24 Mädchen und 15 Buben, durchschnittliches Alter 7,5 Jahre [3–13 Jahre]) mit VEPTR operiert. Die Diagnose war in 16 Fällen eine kongenitale, in elf Fällen eine neurogene Skoliose und in zwölf Fällen eine EOS. Sieben der 39 Kinder hatten bereits eine operative Behandlung erhalten. Die Verkrümmungen wurden nach Cobb bestimmt. Der Cobb-Winkel betrug präoperativ im Durchschnitt 65° (45–130°), postoperativ nach der VEPTR-Implantation im Durchschnitt 32° (25–75°). Beim Ersteingriff kam es zu keinen intraoperativen Komplikationen. Die durchschnittliche Operationszeit betrug 95 min (65–185 min).Der intraoperative Blutverlust lag im Durchschnitt bei 125 ml (65–180 ml). Bei 29 der 39 Patienten wurde ein- bis neunmal eine Nachspannungsoperation durchgeführt. Die dadurch erreichte Korrektur betrug im Durchschnitt 15,7° (19,8%). In drei Fällen wurde das VEPTR-Implantat ausgebaut und eine endgültige Fusion nach Wachstumsabschluss vorgenommen. Alle Kinder bzw. Eltern waren mit der Operation zufrieden und würden dem Eingriff noch einmal zustimmen.AbstractObjectiveIn 1993, A. Campel published the VEPTR (vertical expandable prosthetic titanium rib) instrumentation for the treatment of thoracic insufficiency syndrome (TIS). The goal of surgery is to lengthen and expand the constricted concave hemithorax to the height of the convex sides to increase thoracic volume, to obtain thoracic symmetry, to improve thoracic function, to maintain these improvement during growth of the child, and to avoid growth inhibition procedures, if possible.IndicationsTIS.Congenital scoliosis.Early-onset scoliosis (EOS).Neurogenic scoliosis.ContraindicationsHyperkyphosis > 70° according to Cobb.Osteoporotic bone.Children > 10 years.Surgical TechniqueThrough a standard thoracotomy incision, an openingwedge thoracocostotomy is performed by cutting a transverse osteotomy from transverse process to sternum through the fused ribs at the apex of the thoracic deformity. The interval is distracted by lamina spreaders. A vertical expandable prosthetic titanium rib (VEPTR) is inserted to hold the acute operative correction. Curves going into the lumbar spine are treated with a hybrid device. In follow-up surgeries at intervals of 4–6 months the devices are expanded through a limited incision at their base to maintain correction with growth.Postoperative Management Postoperative Management Patients can be mobilized after the 3rd day of surgery without a brace.ResultsFrom 2005 to 2009, 39 patients (24 female, 15 male, mean age at surgery 7.5 years [3–13 years]) were treated with VEPTR. The diagnosis was congenital scoliosis in 16, neurogenic scoliosis in eleven, and EOS in twelve cases. Seven of the 39 patients had undergone previous surgery. The curve was measured according to Cobb. The mean Cobb angle was 65° (45–130°) preoperatively and 32° (25–75°) postoperatively. During the first surgery, no complications occurred. Mean operating time was 95 min (65–185 min). Mean blood loss amounted to 125 ml (65–180 ml).29 of the 39 patients had one to nine lengthening procedures. The mean correction achieved was 15.7° (19.8%). In three cases, the VEPTR instrumentation was removed and a final fusion performed.All parents and patients were satisfied with the operation and would undergo it again.OBJECTIVE In 1993, A. Campel published the VEPTR (vertical expandable prosthetic titanium rib) instrumentation for the treatment of thoracic insufficiency syndrome (TIS). The goal of surgery is to lengthen and expand the constricted concave hemithorax to the height of the convex sides to increase thoracic volume, to obtain thoracic symmetry, to improve thoracic function, to maintain these improvement during growth of the child, and to avoid growth inhibition procedures, if possible. INDICATIONS TIS. Congenital scoliosis. Early-onset scoliosis (EOS). Neurogenic scoliosis. CONTRAINDICATIONS Hyperkyphosis > 70 degrees according to Cobb. Osteoporotic bone. Children > 10 years. SURGICAL TECHNIQUE Through a standard thoracotomy incision, an openingwedge thoracocostotomy is performed by cutting a transverse osteotomy from transverse process to sternum through the fused ribs at the apex of the thoracic deformity. The interval is distracted by lamina spreaders. A vertical expandable prosthetic titanium rib (VEPTR) is inserted to hold the acute operative correction. Curves going into the lumbar spine are treated with a hybrid device. In follow-up surgeries at intervals of 4-6 months the devices are expanded through a limited incision at their base to maintain correction with growth. POSTOPERATIVE MANAGEMENT Postoperative Management Patients can be mobilized after the 3rd day of surgery without a brace. RESULTS From 2005 to 2009, 39 patients (24 female, 15 male, mean age at surgery 7.5 years [3-13 years]) were treated with VEPTR. The diagnosis was congenital scoliosis in 16, neurogenic scoliosis in eleven, and EOS in twelve cases. Seven of the 39 patients had undergone previous surgery. The curve was measured according to Cobb. The mean Cobb angle was 65 degrees (45-130 degrees ) preoperatively and 32 degrees (25-75 degrees ) postoperatively. During the first surgery, no complications occurred. Mean operating time was 95 min (65-185 min). Mean blood loss amounted to 125 ml (65-180 ml). 29 of the 39 patients had one to nine lengthening procedures. The mean correction achieved was 15.7 degrees (19.8%). In three cases, the VEPTR instrumentation was removed and a final fusion performed. All parents and patients were satisfied with the operation and would undergo it again.

Die operative Behandlung von Skoliosen mit dem „vertical expandable prosthetic titanium rib“ (VEPTR)

ZusammenfassungOperationszielDas VEPTR-Instrumentarium wurde primär zur Behandlung des Thoraxinsuffizienzsyndroms (TIS) eingesetzt, das mit einer Fusion der Rippen und begleitender Skoliose einhergeht. Gleichzeitig wurden auch isolierte kongenitale Skoliosen mit oder ohne Wirbelkörperfehlbildung behandelt. Ziel war es, das Thoraxvolumen zu erweitern, die Thoraxsymmetrie wiederherzustellen und die Lungenfunktion zu verbessern. Die Thoraxsymmetrie wird mit einer Wachstumslenkung (Distraktion) an der Konkavseite wiederhergestellt. Während des Wachstums der Kinder ist alle 4–6 Monate ein Nachstellen an der konkaven Seite durch operative Distraktion notwendig. Mit der VEPTR-Instrumentation wird das Wachstum unter Korrektur der Skoliose weiterhin ermöglicht.IndikationenTIS.Kongenitale Skoliose mit und ohne Rippensynostosen.„Early-onset“-Skoliose (EOS).Neurogene Skoliose.KontraindikationenSchwerwiegende Kyphose > 70° nach Cobb.Osteoporotische Wirbelsäulenveränderungen.Kinder > 10 Jahre.OperationstechnikLagerung der kleinen Kinder in Seitenlage oder Schräglage auf einem Spezialrahmen. Bei einer thorakalen kongenitalen Skoliose wird eine Thorakokostotomie vorgenommen. In diesem Fall erfolgt eine Seitenlagerung der Patienten. Die Rippensynostosen werden osteotomiert. Es wird eine Distraktion mit dem Laminaspreizer durchgeführt. Die expandierbare Titanrippe wird eingesetzt. Geht die Krümmung in die Lendenwirbelsäule hinein, empfiehlt sich die Implantation eines Hybrids, d.h., lateral wird das „rib to rib“-Implantat und medialseitig das „rib to lumbar spine“-Implantat gesetzt. Je nach Wachstum ist im Abstand von 4–6 Monaten ein Nachspannen notwendig.WeiterbehandlungDie Mobilisation der Patienten ist ab dem 3. postoperativen Tag korsettfrei möglich.ErgebnisseVon 2005 bis 2009 wurden 39 Kinder (24 Mädchen und 15 Buben, durchschnittliches Alter 7,5 Jahre [3–13 Jahre]) mit VEPTR operiert. Die Diagnose war in 16 Fällen eine kongenitale, in elf Fällen eine neurogene Skoliose und in zwölf Fällen eine EOS. Sieben der 39 Kinder hatten bereits eine operative Behandlung erhalten. Die Verkrümmungen wurden nach Cobb bestimmt. Der Cobb-Winkel betrug präoperativ im Durchschnitt 65° (45–130°), postoperativ nach der VEPTR-Implantation im Durchschnitt 32° (25–75°). Beim Ersteingriff kam es zu keinen intraoperativen Komplikationen. Die durchschnittliche Operationszeit betrug 95 min (65–185 min).Der intraoperative Blutverlust lag im Durchschnitt bei 125 ml (65–180 ml). Bei 29 der 39 Patienten wurde ein- bis neunmal eine Nachspannungsoperation durchgeführt. Die dadurch erreichte Korrektur betrug im Durchschnitt 15,7° (19,8%). In drei Fällen wurde das VEPTR-Implantat ausgebaut und eine endgültige Fusion nach Wachstumsabschluss vorgenommen. Alle Kinder bzw. Eltern waren mit der Operation zufrieden und würden dem Eingriff noch einmal zustimmen.AbstractObjectiveIn 1993, A. Campel published the VEPTR (vertical expandable prosthetic titanium rib) instrumentation for the treatment of thoracic insufficiency syndrome (TIS). The goal of surgery is to lengthen and expand the constricted concave hemithorax to the height of the convex sides to increase thoracic volume, to obtain thoracic symmetry, to improve thoracic function, to maintain these improvement during growth of the child, and to avoid growth inhibition procedures, if possible.IndicationsTIS.Congenital scoliosis.Early-onset scoliosis (EOS).Neurogenic scoliosis.ContraindicationsHyperkyphosis > 70° according to Cobb.Osteoporotic bone.Children > 10 years.Surgical TechniqueThrough a standard thoracotomy incision, an openingwedge thoracocostotomy is performed by cutting a transverse osteotomy from transverse process to sternum through the fused ribs at the apex of the thoracic deformity. The interval is distracted by lamina spreaders. A vertical expandable prosthetic titanium rib (VEPTR) is inserted to hold the acute operative correction. Curves going into the lumbar spine are treated with a hybrid device. In follow-up surgeries at intervals of 4–6 months the devices are expanded through a limited incision at their base to maintain correction with growth.Postoperative Management Postoperative Management Patients can be mobilized after the 3rd day of surgery without a brace.ResultsFrom 2005 to 2009, 39 patients (24 female, 15 male, mean age at surgery 7.5 years [3–13 years]) were treated with VEPTR. The diagnosis was congenital scoliosis in 16, neurogenic scoliosis in eleven, and EOS in twelve cases. Seven of the 39 patients had undergone previous surgery. The curve was measured according to Cobb. The mean Cobb angle was 65° (45–130°) preoperatively and 32° (25–75°) postoperatively. During the first surgery, no complications occurred. Mean operating time was 95 min (65–185 min). Mean blood loss amounted to 125 ml (65–180 ml).29 of the 39 patients had one to nine lengthening procedures. The mean correction achieved was 15.7° (19.8%). In three cases, the VEPTR instrumentation was removed and a final fusion performed.All parents and patients were satisfied with the operation and would undergo it again.OBJECTIVE In 1993, A. Campel published the VEPTR (vertical expandable prosthetic titanium rib) instrumentation for the treatment of thoracic insufficiency syndrome (TIS). The goal of surgery is to lengthen and expand the constricted concave hemithorax to the height of the convex sides to increase thoracic volume, to obtain thoracic symmetry, to improve thoracic function, to maintain these improvement during growth of the child, and to avoid growth inhibition procedures, if possible. INDICATIONS TIS. Congenital scoliosis. Early-onset scoliosis (EOS). Neurogenic scoliosis. CONTRAINDICATIONS Hyperkyphosis > 70 degrees according to Cobb. Osteoporotic bone. Children > 10 years. SURGICAL TECHNIQUE Through a standard thoracotomy incision, an openingwedge thoracocostotomy is performed by cutting a transverse osteotomy from transverse process to sternum through the fused ribs at the apex of the thoracic deformity. The interval is distracted by lamina spreaders. A vertical expandable prosthetic titanium rib (VEPTR) is inserted to hold the acute operative correction. Curves going into the lumbar spine are treated with a hybrid device. In follow-up surgeries at intervals of 4-6 months the devices are expanded through a limited incision at their base to maintain correction with growth. POSTOPERATIVE MANAGEMENT Postoperative Management Patients can be mobilized after the 3rd day of surgery without a brace. RESULTS From 2005 to 2009, 39 patients (24 female, 15 male, mean age at surgery 7.5 years [3-13 years]) were treated with VEPTR. The diagnosis was congenital scoliosis in 16, neurogenic scoliosis in eleven, and EOS in twelve cases. Seven of the 39 patients had undergone previous surgery. The curve was measured according to Cobb. The mean Cobb angle was 65 degrees (45-130 degrees ) preoperatively and 32 degrees (25-75 degrees ) postoperatively. During the first surgery, no complications occurred. Mean operating time was 95 min (65-185 min). Mean blood loss amounted to 125 ml (65-180 ml). 29 of the 39 patients had one to nine lengthening procedures. The mean correction achieved was 15.7 degrees (19.8%). In three cases, the VEPTR instrumentation was removed and a final fusion performed. All parents and patients were satisfied with the operation and would undergo it again.

Growth modulation in operative treatment of juvenile scoliosis by USS paediatric

OBJECTIVE Growth modulation in operative treatment of juvenile scoliosis can be done by USS paediatric instrumentation to control spinal growth in patients of small stature with juvenile scoliosis. The double-rod system has to be distracted every 4-6 months. The system is used in young patients too tall for VEPTR (vertical expandable prosthetic titanium rib) instrumentation. The system with a very low profile allows reduced soft-tissue pressure saving soft tissue from atrophy or the development of pseudocysts above the screws. With this procedure controlled growth with growth modulation of the spine is possible and final spondylodesis can be done later. INDICATIONS Congenital, idiopathic and neuromuscular scolioses. Children, who are too tall and big for a VEPTR instrumentation. Cobb angle > 40 degrees or progression > 10 degrees during brace therapy. CONTRAINDICATIONS Adults. Dysplastic pedicles with vertebral anomalies. Arthrogryposis. SURGICAL TECHNIQUE The patient should be positioned prone, lying flat on the table. Median skin incision with subperiosteal preparation of the paraspinal muscles is done to expose the vertebrae. Next, the pedicle is prepared with a tap, and the USS paediatric pedicle screw system with its very low profile is inserted under fluoroscopic control in anterior-posterior and lateral view. In the upper thoracic spine the authors use screws 4.2 mm in diameter, in the lower thoracic spine 5-mm screws, and in the lumbar spine 6-mm screws. Measurement of the rod length and insertion of the rod are performed. When spinal growth for > 4 years is expected, distraction of the double-rod system by the use of two dominos is done on the concave and convex side of the curve to modulate spinal growth. When spinal growth for 2-4 years is expected, distraction is done just at the concave side of the curve. For correction of the curve, either segmental correction or classic derotation by the Cotrel-Dubousset technique can be performed. POSTOPERATIVE MANAGEMENT Postoperative on block rotation. Mobilization of the patient on day 2 after surgery with a rigid brace. Individual rigid custom-made plaster brace for 3-8 months. During postoperative recovery, muscular efforts should be reduced for 6 months after first implantation. Distraction of the system is necessary every 4-6 months to modulate spinal growth. RESULTS From 2004 to 2008, 26 patients (15 girls, eleven boys) with a mean age of 9 years (6-13 years) were treated using this technique. Follow-up examinations were performed 3, 6, 12, and 24 months after surgery. The mean follow-up was 26 months (6-40 months). At first implantation of the scoliosis instrumentation, just little scoliosis correction was done depending on the quality of bone. At every distraction, an average correction of the Cobb angle of 5 degrees was reached. The Cobb angle could be reduced from 71 degrees to 34 degrees on average. Fusion rate in the cranial and caudal part was evaluated by X-ray. 5-mm rods have a reduced stiffness of 50% compared to USS 6-mm rods. Average spinal growth was about 5.6 cm (4.0-8.1 cm) over a period of 3.2 +/- 1.2 years. During 2-year follow-up, rod or pedicle screw breakage, dislocation, or loosening of the Cobb angle did not occur.

Wachstumslenkende operative Behandlung der juvenilen Skoliose mit USS paediatric

OBJECTIVE Growth modulation in operative treatment of juvenile scoliosis can be done by USS paediatric instrumentation to control spinal growth in patients of small stature with juvenile scoliosis. The double-rod system has to be distracted every 4-6 months. The system is used in young patients too tall for VEPTR (vertical expandable prosthetic titanium rib) instrumentation. The system with a very low profile allows reduced soft-tissue pressure saving soft tissue from atrophy or the development of pseudocysts above the screws. With this procedure controlled growth with growth modulation of the spine is possible and final spondylodesis can be done later. INDICATIONS Congenital, idiopathic and neuromuscular scolioses. Children, who are too tall and big for a VEPTR instrumentation. Cobb angle > 40 degrees or progression > 10 degrees during brace therapy. CONTRAINDICATIONS Adults. Dysplastic pedicles with vertebral anomalies. Arthrogryposis. SURGICAL TECHNIQUE The patient should be positioned prone, lying flat on the table. Median skin incision with subperiosteal preparation of the paraspinal muscles is done to expose the vertebrae. Next, the pedicle is prepared with a tap, and the USS paediatric pedicle screw system with its very low profile is inserted under fluoroscopic control in anterior-posterior and lateral view. In the upper thoracic spine the authors use screws 4.2 mm in diameter, in the lower thoracic spine 5-mm screws, and in the lumbar spine 6-mm screws. Measurement of the rod length and insertion of the rod are performed. When spinal growth for > 4 years is expected, distraction of the double-rod system by the use of two dominos is done on the concave and convex side of the curve to modulate spinal growth. When spinal growth for 2-4 years is expected, distraction is done just at the concave side of the curve. For correction of the curve, either segmental correction or classic derotation by the Cotrel-Dubousset technique can be performed. POSTOPERATIVE MANAGEMENT Postoperative on block rotation. Mobilization of the patient on day 2 after surgery with a rigid brace. Individual rigid custom-made plaster brace for 3-8 months. During postoperative recovery, muscular efforts should be reduced for 6 months after first implantation. Distraction of the system is necessary every 4-6 months to modulate spinal growth. RESULTS From 2004 to 2008, 26 patients (15 girls, eleven boys) with a mean age of 9 years (6-13 years) were treated using this technique. Follow-up examinations were performed 3, 6, 12, and 24 months after surgery. The mean follow-up was 26 months (6-40 months). At first implantation of the scoliosis instrumentation, just little scoliosis correction was done depending on the quality of bone. At every distraction, an average correction of the Cobb angle of 5 degrees was reached. The Cobb angle could be reduced from 71 degrees to 34 degrees on average. Fusion rate in the cranial and caudal part was evaluated by X-ray. 5-mm rods have a reduced stiffness of 50% compared to USS 6-mm rods. Average spinal growth was about 5.6 cm (4.0-8.1 cm) over a period of 3.2 +/- 1.2 years. During 2-year follow-up, rod or pedicle screw breakage, dislocation, or loosening of the Cobb angle did not occur.

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.

Conversion of Implant Failure in Early Onset Scoliosis to Magnetic Growing Rod. A Series of Five Cases

Introduction Conventional growing systems allow spinal growth to continue and prevent curve progression but need multiple interventions that increase the risk of infection, complications of anesthesia. A more advanced, less invasive method is the remotely distractible, magnetically controlled growing rod (MCGR) system which has been developed to allow frequent non-invasive distractions. This is the first series focusing on the conversion of failed growing implant to MCGR. Materials and Methods A prospective single center study from 11/2012 to 8/2015 with consecutive patients with progressive deformity and implant failure. Five children have been converted to MCGR; one boy and 4 girls; mean age 11.9 years. The scoliosis was infantile in two and neuromuscular in 3 cases. Four patients had VEPTR and one had a conventional growing rod. Results Mean preoperative Cobb angle was 56.6°, thoracic kyphosis 59.6° and spinal length (T1-S1) 339mm. The upper fixation level was T3-T5 with a lower fixation to T11 and L2 in the infantile scoliosis and L3 in two neuromuscular cases. One neuromuscular scoliosis was fixed with hooks to the iliac crest. Mean operative time was 135 minutes and blood loss 217 ml. Mean postoperative Cobb angle was 48.1°, thoracic kyphosis of 49.8% and spinal length 379mm. During this study a total of 15 distractions have been performed to all children. At final FU (mean of 21.8m), mean Cobb angle was 48° (total additional correction of 2.5°), thoracic kyphosis of 51.5° (total additional correction of 3.2°) and spinal length of 387 mm (total spinal growth of 33 mm). One case reached to final fusion after 2 distractions. Double rods have been the rule with exception of one neuromuscular case. This single rod was broken after 6 months and replaced by a double rod system. The other complication was a proximal junctional kyphosis (PJK) that occurred primarily after VEPTR and again after magnetic rod. Conclusion Although conversion of implant failure from VEPTR and growing rod systems to MCGR is a good option to allow growth of the instrumented segment, this gives limited results when performed at a relatively older age. The postoperative correction in these cases is relatively limited due to prior correction by the older systems. One complication related to the implant occurred with single rod construct. Correction by MCGR will face the same challenge to prevent PJK, like other growing rod systems. The new technique provided a non-surgical repeated (sometimes outpatient) distractions.

Die operative Behandlung von Skoliosen mit dem „vertical expandable prosthetic titanium rib“ (VEPTR)@@@Operative Treatment of Scolioses with the VEPTR Instrumentation

ZusammenfassungOperationszielDas VEPTR-Instrumentarium wurde primär zur Behandlung des Thoraxinsuffizienzsyndroms (TIS) eingesetzt, das mit einer Fusion der Rippen und begleitender Skoliose einhergeht. Gleichzeitig wurden auch isolierte kongenitale Skoliosen mit oder ohne Wirbelkörperfehlbildung behandelt. Ziel war es, das Thoraxvolumen zu erweitern, die Thoraxsymmetrie wiederherzustellen und die Lungenfunktion zu verbessern. Die Thoraxsymmetrie wird mit einer Wachstumslenkung (Distraktion) an der Konkavseite wiederhergestellt. Während des Wachstums der Kinder ist alle 4–6 Monate ein Nachstellen an der konkaven Seite durch operative Distraktion notwendig. Mit der VEPTR-Instrumentation wird das Wachstum unter Korrektur der Skoliose weiterhin ermöglicht.IndikationenTIS.Kongenitale Skoliose mit und ohne Rippensynostosen.„Early-onset“-Skoliose (EOS).Neurogene Skoliose.KontraindikationenSchwerwiegende Kyphose > 70° nach Cobb.Osteoporotische Wirbelsäulenveränderungen.Kinder > 10 Jahre.OperationstechnikLagerung der kleinen Kinder in Seitenlage oder Schräglage auf einem Spezialrahmen. Bei einer thorakalen kongenitalen Skoliose wird eine Thorakokostotomie vorgenommen. In diesem Fall erfolgt eine Seitenlagerung der Patienten. Die Rippensynostosen werden osteotomiert. Es wird eine Distraktion mit dem Laminaspreizer durchgeführt. Die expandierbare Titanrippe wird eingesetzt. Geht die Krümmung in die Lendenwirbelsäule hinein, empfiehlt sich die Implantation eines Hybrids, d.h., lateral wird das „rib to rib“-Implantat und medialseitig das „rib to lumbar spine“-Implantat gesetzt. Je nach Wachstum ist im Abstand von 4–6 Monaten ein Nachspannen notwendig.WeiterbehandlungDie Mobilisation der Patienten ist ab dem 3. postoperativen Tag korsettfrei möglich.ErgebnisseVon 2005 bis 2009 wurden 39 Kinder (24 Mädchen und 15 Buben, durchschnittliches Alter 7,5 Jahre [3–13 Jahre]) mit VEPTR operiert. Die Diagnose war in 16 Fällen eine kongenitale, in elf Fällen eine neurogene Skoliose und in zwölf Fällen eine EOS. Sieben der 39 Kinder hatten bereits eine operative Behandlung erhalten. Die Verkrümmungen wurden nach Cobb bestimmt. Der Cobb-Winkel betrug präoperativ im Durchschnitt 65° (45–130°), postoperativ nach der VEPTR-Implantation im Durchschnitt 32° (25–75°). Beim Ersteingriff kam es zu keinen intraoperativen Komplikationen. Die durchschnittliche Operationszeit betrug 95 min (65–185 min).Der intraoperative Blutverlust lag im Durchschnitt bei 125 ml (65–180 ml). Bei 29 der 39 Patienten wurde ein- bis neunmal eine Nachspannungsoperation durchgeführt. Die dadurch erreichte Korrektur betrug im Durchschnitt 15,7° (19,8%). In drei Fällen wurde das VEPTR-Implantat ausgebaut und eine endgültige Fusion nach Wachstumsabschluss vorgenommen. Alle Kinder bzw. Eltern waren mit der Operation zufrieden und würden dem Eingriff noch einmal zustimmen.AbstractObjectiveIn 1993, A. Campel published the VEPTR (vertical expandable prosthetic titanium rib) instrumentation for the treatment of thoracic insufficiency syndrome (TIS). The goal of surgery is to lengthen and expand the constricted concave hemithorax to the height of the convex sides to increase thoracic volume, to obtain thoracic symmetry, to improve thoracic function, to maintain these improvement during growth of the child, and to avoid growth inhibition procedures, if possible.IndicationsTIS.Congenital scoliosis.Early-onset scoliosis (EOS).Neurogenic scoliosis.ContraindicationsHyperkyphosis > 70° according to Cobb.Osteoporotic bone.Children > 10 years.Surgical TechniqueThrough a standard thoracotomy incision, an openingwedge thoracocostotomy is performed by cutting a transverse osteotomy from transverse process to sternum through the fused ribs at the apex of the thoracic deformity. The interval is distracted by lamina spreaders. A vertical expandable prosthetic titanium rib (VEPTR) is inserted to hold the acute operative correction. Curves going into the lumbar spine are treated with a hybrid device. In follow-up surgeries at intervals of 4–6 months the devices are expanded through a limited incision at their base to maintain correction with growth.Postoperative Management Postoperative Management Patients can be mobilized after the 3rd day of surgery without a brace.ResultsFrom 2005 to 2009, 39 patients (24 female, 15 male, mean age at surgery 7.5 years [3–13 years]) were treated with VEPTR. The diagnosis was congenital scoliosis in 16, neurogenic scoliosis in eleven, and EOS in twelve cases. Seven of the 39 patients had undergone previous surgery. The curve was measured according to Cobb. The mean Cobb angle was 65° (45–130°) preoperatively and 32° (25–75°) postoperatively. During the first surgery, no complications occurred. Mean operating time was 95 min (65–185 min). Mean blood loss amounted to 125 ml (65–180 ml).29 of the 39 patients had one to nine lengthening procedures. The mean correction achieved was 15.7° (19.8%). In three cases, the VEPTR instrumentation was removed and a final fusion performed.All parents and patients were satisfied with the operation and would undergo it again.OBJECTIVE In 1993, A. Campel published the VEPTR (vertical expandable prosthetic titanium rib) instrumentation for the treatment of thoracic insufficiency syndrome (TIS). The goal of surgery is to lengthen and expand the constricted concave hemithorax to the height of the convex sides to increase thoracic volume, to obtain thoracic symmetry, to improve thoracic function, to maintain these improvement during growth of the child, and to avoid growth inhibition procedures, if possible. INDICATIONS TIS. Congenital scoliosis. Early-onset scoliosis (EOS). Neurogenic scoliosis. CONTRAINDICATIONS Hyperkyphosis > 70 degrees according to Cobb. Osteoporotic bone. Children > 10 years. SURGICAL TECHNIQUE Through a standard thoracotomy incision, an openingwedge thoracocostotomy is performed by cutting a transverse osteotomy from transverse process to sternum through the fused ribs at the apex of the thoracic deformity. The interval is distracted by lamina spreaders. A vertical expandable prosthetic titanium rib (VEPTR) is inserted to hold the acute operative correction. Curves going into the lumbar spine are treated with a hybrid device. In follow-up surgeries at intervals of 4-6 months the devices are expanded through a limited incision at their base to maintain correction with growth. POSTOPERATIVE MANAGEMENT Postoperative Management Patients can be mobilized after the 3rd day of surgery without a brace. RESULTS From 2005 to 2009, 39 patients (24 female, 15 male, mean age at surgery 7.5 years [3-13 years]) were treated with VEPTR. The diagnosis was congenital scoliosis in 16, neurogenic scoliosis in eleven, and EOS in twelve cases. Seven of the 39 patients had undergone previous surgery. The curve was measured according to Cobb. The mean Cobb angle was 65 degrees (45-130 degrees ) preoperatively and 32 degrees (25-75 degrees ) postoperatively. During the first surgery, no complications occurred. Mean operating time was 95 min (65-185 min). Mean blood loss amounted to 125 ml (65-180 ml). 29 of the 39 patients had one to nine lengthening procedures. The mean correction achieved was 15.7 degrees (19.8%). In three cases, the VEPTR instrumentation was removed and a final fusion performed. All parents and patients were satisfied with the operation and would undergo it again.

[Surgical treatment of early-onset scoliosis with the StarLock implant system].

OBJECTIVE The problem of early-onset scoliosis is the progression of spine curvature. With the StarLock instrumentation a corrected spinal growth can be achieved. Distraction is necessary once or twice a year. INDICATIONS Idiopathic, congenital and neuromuscular scoliosis. CONTRAINDICATIONS Ostoeoporosis. Arthrogryposis. Kyphosis. SURGICAL TECHNIQUE The use of a C-arm (anterior-posterior and lateral view) has to be possible. Pedicle screws are placed at the proximal and distal end of the curvature. Through distraction of the rods which are screwed to each other via parallel connectors, correction of the scoliosis can be achieved. POSTOPERATIVE MANAGEMENT Mobilization should be started 1 day postoperatively using an individual corset for 6 months. Distraction has to be done once or twice a year. RESULTS From March 2003 to October 2005, 14 children with early- onset scoliosis were treated with the StarLock instrumentation. After the first operation, the Cobb angle improved from 65 degrees (42-80 degrees ) to 26.5 degrees (18-45 degrees ) in the thoracic spine and from 22 degrees (18-55 degrees ) to 15 degrees (10-32 degrees ) in the lumbar spine. Lenghtenings were done every 6.8 months (5-9 months). The follow-up time was 4.5 years (3-6 years). COMPLICATIONS three rods and two screws broke. Infections and neurologic deficits were not observed.ZusammenfassungOperationszielDurch Implantation des StarLock-Instrumentariums bei frühkindlichen Skoliosen sollen eine weitere Progredienz der Wirbelsäulenverkrümmung verhindert und ein korrigierendes Wirbelsäulenwachstum ermöglicht werden. Hierfür werden uni- oder bilateral zwei Stäbe, welche proximal bzw. distal mit Pedikelschrauben an der Wirbelsäule verankert werden, über Parallelverbinder verschraubt. Das korrigierende Wachstum der Wirbelsäule wird durch einbis zweimaliges Nachspannen im Jahr erreicht.IndikationenKongenitale Skoliose.Idiopathische „early-onset“-Skoliose.Neurogene „early-onset“-SkolioseKontraindikationen Osteoporose.Arthrogrypose.Hyperkyphose.OperationstechnikUnter Bildverstärkerkontrolle im anterior-posterioren und seitlichen Strahlengang werden an zuvor festgelegten Wirbelkörpern am proximalen und distalen Ende der Verkrümmung Pedikelschrauben gesetzt. Mit Hilfe unterschiedlicher Backen können die Stäbe an diesen verankert und über Parallelverbinder miteinander verschraubt werden. Bei den ein- bis zweimal jährlich notwendigen Nachspannungen kann über einen lediglich kleinen Zugang über den Parallelverbindern eine Distraktion der Stäbe durchgeführt und damit das gewünschte korrigierende Wirbelsäulenwachstum erreicht werden.WeiterbehandlungDie Mobilisation der Kinder erfolgt ab dem 1. postoperativen Tag mit einem individuell nach Gipsabdruck angefertigten Korsett für 6 Monate. Um ein weiteres korrigierendes Wachstum der Wirbelsäule zu ermöglichen, muss das eingesetzte Instrumentarium ein- bis zweimal jährlich nachgespannt werden.ErgebnisseVon März 2003 bis Oktober 2005 wurden insgesamt 14 Kinder, welche an einer frühkindlichen Skoliose litten, mit dem StarLock-Implantat operiert. Bei fünf Kindern wurde eine kurzstreckige (3–5 Segmente), bei neun eine langstreckige (6–12 Segmente) Instrumentation vorgenommen. Das durchschnittliche Alter bei der Implantation des StarLock-Instrumentariums betrug 3,5 Jahre (1–7 Jahre). Es handelte sich um zehn Mädchen und vier Jungen. Nachspannungen erfolgten ein- bis zweimal pro Jahr.Die Verkrümmung der Wirbelsäule betrug präoperativ im thorakalen Bereich 65° (42–80°) nach Cobb und im lumbalen Bereich 22° (18–55°). Durch die erste Operation konnten die Skoliosen thorakal auf 26,5° (18–45°) und lumbal auf 15° (10–32°) vermindert werden. Nachspannungen (lediglich bei langstreckigen Instrumentationen) erfolgten alle 6,8 Monate (5–9 Monate), wobei hier jeweils eine Korrektur um 8° (4–15°) erreicht werden konnte.Bei den kurzstreckigen Instrumentationen traten keine Komplikationen auf, bei den langstreckigen waren drei Schrauben- und zwei Stabbrüche zu verzeichnen. Zu Infektionen oder neurologischen Defiziten kam es bei keinem der Kinder, einmal entwickelte sich eine Bursa. Zweimal musste eine Uminstrumentation bzw. Verlängerung der Instrumentationsstrecke durchgeführt werden. Die Nachuntersuchungszeit betrug 4,5 Jahre (3–6 Jahre).AbstractObjectiveThe problem of early-onset scoliosis is the progression of spine curvature. With the StarLock instrumentation a corrected spinal growth can be achieved. Distraction is necessary once or twice a year.IndicationsIdiopathic, congenital and neuromuscular scoliosis.ContraindicationsOstoeoporosis.Arthrogryposis.Kyphosis.Surgical TechniqueThe use of a C-arm (anterior-posterior and lateral view) has to be possible. Pedicle screws are placed at the proximal and distal end of the curvature. Through distraction of the rods which are screwed to each other via parallel connectors, correction of the scoliosis can be achieved.Postoperative ManagementMobilization should be started 1 day postoperatively using an individual corset for 6 months. Distraction has to be done once or twice a year.ResultsFrom March 2003 to October 2005, 14 children with early- onset scoliosis were treated with the StarLock instrumentation. After the first operation, the Cobb angle improved from 65° (42–80°) to 26.5° (18–45°) in the thoracic spine and from 22° (18–55°) to 15° (10–32°) in the lumbar spine. Lenghtenings were done every 6.8 months (5–9 months). The follow-up time was 4.5 years (3–6 years). Complications: three rods and two screws broke. Infections and neurologic deficits were not observed.

Operative Behandlung der „early-onset“-Skoliose mit dem StarLock-Instrumentarium@@@Surgical Treatment of Early-Onset Scoliosis with the StarLock Implant System

OBJECTIVE The problem of early-onset scoliosis is the progression of spine curvature. With the StarLock instrumentation a corrected spinal growth can be achieved. Distraction is necessary once or twice a year. INDICATIONS Idiopathic, congenital and neuromuscular scoliosis. CONTRAINDICATIONS Ostoeoporosis. Arthrogryposis. Kyphosis. SURGICAL TECHNIQUE The use of a C-arm (anterior-posterior and lateral view) has to be possible. Pedicle screws are placed at the proximal and distal end of the curvature. Through distraction of the rods which are screwed to each other via parallel connectors, correction of the scoliosis can be achieved. POSTOPERATIVE MANAGEMENT Mobilization should be started 1 day postoperatively using an individual corset for 6 months. Distraction has to be done once or twice a year. RESULTS From March 2003 to October 2005, 14 children with early- onset scoliosis were treated with the StarLock instrumentation. After the first operation, the Cobb angle improved from 65 degrees (42-80 degrees ) to 26.5 degrees (18-45 degrees ) in the thoracic spine and from 22 degrees (18-55 degrees ) to 15 degrees (10-32 degrees ) in the lumbar spine. Lenghtenings were done every 6.8 months (5-9 months). The follow-up time was 4.5 years (3-6 years). COMPLICATIONS three rods and two screws broke. Infections and neurologic deficits were not observed.ZusammenfassungOperationszielDurch Implantation des StarLock-Instrumentariums bei frühkindlichen Skoliosen sollen eine weitere Progredienz der Wirbelsäulenverkrümmung verhindert und ein korrigierendes Wirbelsäulenwachstum ermöglicht werden. Hierfür werden uni- oder bilateral zwei Stäbe, welche proximal bzw. distal mit Pedikelschrauben an der Wirbelsäule verankert werden, über Parallelverbinder verschraubt. Das korrigierende Wachstum der Wirbelsäule wird durch einbis zweimaliges Nachspannen im Jahr erreicht.IndikationenKongenitale Skoliose.Idiopathische „early-onset“-Skoliose.Neurogene „early-onset“-SkolioseKontraindikationen Osteoporose.Arthrogrypose.Hyperkyphose.OperationstechnikUnter Bildverstärkerkontrolle im anterior-posterioren und seitlichen Strahlengang werden an zuvor festgelegten Wirbelkörpern am proximalen und distalen Ende der Verkrümmung Pedikelschrauben gesetzt. Mit Hilfe unterschiedlicher Backen können die Stäbe an diesen verankert und über Parallelverbinder miteinander verschraubt werden. Bei den ein- bis zweimal jährlich notwendigen Nachspannungen kann über einen lediglich kleinen Zugang über den Parallelverbindern eine Distraktion der Stäbe durchgeführt und damit das gewünschte korrigierende Wirbelsäulenwachstum erreicht werden.WeiterbehandlungDie Mobilisation der Kinder erfolgt ab dem 1. postoperativen Tag mit einem individuell nach Gipsabdruck angefertigten Korsett für 6 Monate. Um ein weiteres korrigierendes Wachstum der Wirbelsäule zu ermöglichen, muss das eingesetzte Instrumentarium ein- bis zweimal jährlich nachgespannt werden.ErgebnisseVon März 2003 bis Oktober 2005 wurden insgesamt 14 Kinder, welche an einer frühkindlichen Skoliose litten, mit dem StarLock-Implantat operiert. Bei fünf Kindern wurde eine kurzstreckige (3–5 Segmente), bei neun eine langstreckige (6–12 Segmente) Instrumentation vorgenommen. Das durchschnittliche Alter bei der Implantation des StarLock-Instrumentariums betrug 3,5 Jahre (1–7 Jahre). Es handelte sich um zehn Mädchen und vier Jungen. Nachspannungen erfolgten ein- bis zweimal pro Jahr.Die Verkrümmung der Wirbelsäule betrug präoperativ im thorakalen Bereich 65° (42–80°) nach Cobb und im lumbalen Bereich 22° (18–55°). Durch die erste Operation konnten die Skoliosen thorakal auf 26,5° (18–45°) und lumbal auf 15° (10–32°) vermindert werden. Nachspannungen (lediglich bei langstreckigen Instrumentationen) erfolgten alle 6,8 Monate (5–9 Monate), wobei hier jeweils eine Korrektur um 8° (4–15°) erreicht werden konnte.Bei den kurzstreckigen Instrumentationen traten keine Komplikationen auf, bei den langstreckigen waren drei Schrauben- und zwei Stabbrüche zu verzeichnen. Zu Infektionen oder neurologischen Defiziten kam es bei keinem der Kinder, einmal entwickelte sich eine Bursa. Zweimal musste eine Uminstrumentation bzw. Verlängerung der Instrumentationsstrecke durchgeführt werden. Die Nachuntersuchungszeit betrug 4,5 Jahre (3–6 Jahre).AbstractObjectiveThe problem of early-onset scoliosis is the progression of spine curvature. With the StarLock instrumentation a corrected spinal growth can be achieved. Distraction is necessary once or twice a year.IndicationsIdiopathic, congenital and neuromuscular scoliosis.ContraindicationsOstoeoporosis.Arthrogryposis.Kyphosis.Surgical TechniqueThe use of a C-arm (anterior-posterior and lateral view) has to be possible. Pedicle screws are placed at the proximal and distal end of the curvature. Through distraction of the rods which are screwed to each other via parallel connectors, correction of the scoliosis can be achieved.Postoperative ManagementMobilization should be started 1 day postoperatively using an individual corset for 6 months. Distraction has to be done once or twice a year.ResultsFrom March 2003 to October 2005, 14 children with early- onset scoliosis were treated with the StarLock instrumentation. After the first operation, the Cobb angle improved from 65° (42–80°) to 26.5° (18–45°) in the thoracic spine and from 22° (18–55°) to 15° (10–32°) in the lumbar spine. Lenghtenings were done every 6.8 months (5–9 months). The follow-up time was 4.5 years (3–6 years). Complications: three rods and two screws broke. Infections and neurologic deficits were not observed.