Shen Tony S, Schairer William, Widmann Roger
Hospital for Special Surgery New York, 535 E 70th St, New York, NY 10021 USA.
HSS J. 2019 Jul;15(2):201-204. doi: 10.1007/s11420-019-09671-5. Epub 2019 Feb 27.
Early-onset scoliosis (EOS) is defined by the presence of spinal deformity in children 10 years of age or younger. Left untreated, patients with EOS are at high risk for thoracic insufficiency and early demise. This article provides a critical review of a recent prospective cohort study of children with EOS: "Graduation Protocol After Growing-Rod Treatment: Removal of Implants without New Instrumentation Is Not a Realistic Approach," by Kocyigit and colleagues ( 2017;99(18):1554-1564). Treatment for EOS requires deformity correction while accommodating the growing spine. Dual growing rod implantation is a well-described technique that consists of the placement of two telescoping rods anchored to vertebrae proximal and distal to the apex of the curve. Multiple lengthening procedures are then performed as the child grows. Management of the endpoint of growing rod treatment remains controversial, with high complication rates associated with final fusion. As an alternative to final fusion or implant retention, Kocyigit and colleagues examined the removal of growing rods without spinal fusion and found that this procedure resulted in substantial worsening of the deformity in nine out of ten patients. This treatment group was terminated on ethical grounds. We believe this important result demonstrates that the removal of implants without fusion is an unacceptable treatment strategy that leads to poor outcomes.
早发性脊柱侧弯（EOS）的定义是10岁及以下儿童出现脊柱畸形。若不治疗，EOS患者发生胸廓功能不全和过早死亡的风险很高。本文对近期一项关于EOS患儿的前瞻性队列研究进行了批判性综述：Kocyigit及其同事发表的《生长棒治疗后的毕业方案：无新器械取出植入物并非现实方法》（2017；99(18):1554 - 1564）。EOS的治疗需要在适应脊柱生长的同时矫正畸形。双生长棒植入是一种广为人知的技术，包括在弯曲顶点近端和远端的椎体上放置两根可伸缩的棒。随着患儿生长，需进行多次延长手术。生长棒治疗终点的管理仍存在争议，最终融合相关的并发症发生率很高。作为最终融合或植入物保留的替代方法，Kocyigit及其同事研究了无脊柱融合取出生长棒的情况，发现该手术导致十分之九的患者畸形严重恶化。该治疗组基于伦理原因终止。我们认为这一重要结果表明，无融合取出植入物是一种不可接受的治疗策略，会导致不良后果。
