The Centre for Spinal Studies and Surgery, Queen's Medical Centre, Nottingham University Hospital NHS Trust, Nottingham, UK.
Spine Surgery Unit, Department of Orthopaedic Surgery and Traumatology, University Hospital Vall d'Hebron, Barcelona, Spain.
Bone Joint J. 2020 Nov;102-B(11):1560-1566. doi: 10.1302/0301-620X.102B11.BJJ-2020-0412.R3.
To report the mid-term results of a modified self-growing rod (SGR) technique for the treatment of idiopathic and neuromuscular early-onset scoliosis (EOS).
We carried out a retrospective analysis of 16 consecutive patients with EOS treated with an SGR construct at a single hospital between September 2008 and December 2014. General demographics and deformity variables (i.e. major Cobb angle, T1 to T12 length, T1 to S1 length, pelvic obliquity, shoulder obliquity, and C7 plumb line) were recorded preoperatively, and postoperatively at yearly follow-up. Complications and revision procedures were also recorded. Only patients with a minimum follow-up of five years after surgery were included.
A total of 16 patients were included. Six patients had an idiopathic EOS while ten patients had a neuromuscular or syndromic EOS (seven spinal muscular atrophy (SMA) and three with cerebral palsy or a syndrome). Their mean ages at surgery were 7.1 years (SD 2.2) and 13.3 years (SD 2.6) respectively at final follow-up. The mean preoperative Cobb angle of the major curve was 66.1° (SD 8.5°) and had improved to 25.5° (SD 9.9°) at final follow-up. The T1 to S1 length increased from 289.7 mm (SD 24.9) before surgery to 330.6 mm (SD 30.4) immediately after surgery. The mean T1 to S1 and T1 to T12 growth after surgery were 64.1 mm (SD 19.9) and 47.4 mm (SD 18.8), respectively, thus accounting for a mean T1 to S1 and T1 to T12 spinal growth after surgery of 10.5 mm/year (SD 3.7) and 7.8 mm/year (SD 3.3), respectively. A total of six patients (five idiopathic EOS, one cerebral palsy EOS) had broken rods during their growth spurt but were uneventfully revised with a fusion procedure. No other complications were noted.
Our data show that SGR is a safe and effective technique for the treatment of EOS in nonambulatory hypotonic patients with a neuromuscular condition. Significant spinal growth can be expected after surgery and is comparable to other published techniques for EOS. While satisfactory correction of the deformity can be achieved and maintained with this technique, a high rate of rod breakage was seen in patients with an idiopathic or cerebral palsy EOS. Cite this article: 2020;102-B(11):1560-1566.
报告改良自生长棒（SGR）技术治疗特发性和神经肌肉性早发性脊柱侧凸（EOS）的中期结果。
我们对 2008 年 9 月至 2014 年 12 月期间在一家医院接受 SGR 治疗的 16 例 EOS 连续患者进行了回顾性分析。术前记录一般人口统计学和畸形变量（即主要 Cobb 角、T1 至 T12 长度、T1 至 S1 长度、骨盆倾斜、肩倾斜和 C7 铅垂线），术后每年随访一次。还记录了并发症和修正程序。仅包括手术后至少随访 5 年的患者。
共纳入 16 例患者。6 例为特发性 EOS，10 例为神经肌肉或综合征性 EOS（7 例为脊髓性肌萎缩症，3 例为脑瘫或综合征）。他们的平均手术年龄分别为 7.1 岁（SD 2.2）和 13.3 岁（SD 2.6），末次随访时。主要曲线的术前 Cobb 角平均为 66.1°（SD 8.5°），末次随访时改善至 25.5°（SD 9.9°）。T1 至 S1 长度从术前的 289.7mm（SD 24.9）增加到术后即刻的 330.6mm（SD 30.4）。术后 T1 至 S1 和 T1 至 T12 的平均生长分别为 64.1mm（SD 19.9）和 47.4mm（SD 18.8），因此术后 T1 至 S1 和 T1 至 T12 的平均脊柱生长分别为 10.5mm/年（SD 3.7）和 7.8mm/年（SD 3.3）。共有 6 例患者（5 例特发性 EOS，1 例脑瘫 EOS）在生长突增期间发生了断棒，但通过融合手术进行了顺利修正。未观察到其他并发症。
我们的数据表明，SGR 是一种安全有效的技术，可用于治疗神经肌肉性非运动性低张力患者的 EOS。术后可预期显著的脊柱生长，与其他发表的 EOS 技术相当。虽然该技术可以获得并维持满意的畸形矫正，但特发性或脑瘫 EOS 患者的断棒率较高。
2020;102-B（11）：1560-1566.
