Department of Orthopedic Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200, Aarhus, Denmark.
Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, DK-8200, Aarhus, Denmark.
Int Orthop. 2020 Sep;44(9):1773-1783. doi: 10.1007/s00264-020-04604-y. Epub 2020 Jun 3.
This study aims to describe a novel minimal invasive early-onset scoliosis (EOS) growth rod concept, the Cody Bünger (CB) Concept, which combines concave interval distraction and contralateral-guided growth with apical control and to investigate the 3D deformity correction, the spinal growth, and the pulmonary development.
A series of 38 children with progressive EOS and growth potential, receiving a highly specialized surgical treatment, including primary and conversion cases. Mean age was 10.2 years (4.4-15.8) with a mean follow-up of 5.6 years, and they underwent 168/184 open/magnetic lengthening procedures. Outcomes were as follows: scoliosis, kyphosis, and lordosis angles; apical rotation; spinal length; apical translation; coronal and sagittal vertical alignment; complications; and pulmonary function in a subgroup.
Scoliosis improved from mean 76° (46-129) to 35° (8-74) post-op and was 42° (13-83) at end of treatment. Apical rotation was reduced by 30% but was partially lost during treatment. Thoracic kyphosis initially decreased by mean 15° and was partially lost during treatment. Lordosis was largely unaltered during treatment. Mean T1-S1 height increased from 30.7 cm (22.7-39.2) to 34.6 cm (27.8-45.1) postop and further increased to 38.5 cm (30.1-48.1) during treatment. This corresponded to a T1-S1 growth rate of 12 mm/year, and positive growth rates were found in all height parameters evaluated. Frontal balance and apical translation improved, whereas sagittal balance was unaltered. Complications occurred in 22/38 patients, and 11/38 had an unintended reoperation. Pulmonary function (FVC and FEV) increased but the relative lung function was unchanged.
The new growth rod concept provided 3D correction and spinal growth at complication rates comparable with other growth-friendly techniques for EOS, while pulmonary function was preserved. Single magnetic rod distraction was incorporated successfully, replacing surgical elongations.
本研究旨在描述一种新的微创早期脊柱侧凸（EOS）生长棒概念，即 Cody Bünger（CB）概念，它结合了凹侧间隔牵伸和对侧引导生长，以及顶椎控制，并研究三维畸形矫正、脊柱生长和肺发育情况。
对 38 名患有进展性 EOS 和生长潜能的儿童进行了一项高度专业化的手术治疗，包括原发性和转换性病例。平均年龄为 10.2 岁（4.4-15.8 岁），平均随访 5.6 年，他们接受了 168/184 次开放式/磁力延长手术。结果如下：脊柱侧凸、后凸和前凸角度；顶椎旋转；脊柱长度；顶椎平移；冠状面和矢状面垂直平衡；并发症；以及亚组的肺功能。
脊柱侧凸从术前的平均 76°（46-129）改善到术后的 35°（8-74），治疗结束时为 42°（13-83）。顶椎旋转减少了 30%，但在治疗过程中部分丢失。胸后凸最初减少了 15°，但在治疗过程中部分丢失。前凸在治疗过程中基本不变。T1-S1 高度从 30.7cm（22.7-39.2）增加到术后 34.6cm（27.8-45.1），在治疗过程中进一步增加到 38.5cm（30.1-48.1）。这对应于 T1-S1 的年生长率为 12mm，所有评估的高度参数均有正生长率。额状面平衡和顶椎平移得到改善，而矢状面平衡保持不变。38 例患者中有 22 例发生并发症，11 例患者进行了不必要的再次手术。肺功能（FVC 和 FEV）增加，但相对肺功能保持不变。
新型生长棒概念在并发症发生率与其他 EOS 友好型技术相当的情况下，提供了三维矫正和脊柱生长，同时保留了肺功能。成功地纳入了单磁棒牵伸，取代了手术延长。
