Abstract
There is much variability in graduating from an early onset program or even defining the criteria for being a graduate. Graduates are generally skeletally mature, but the outcomes, timing of graduation, final instrumentation, and follow-up all vary significantly. Evaluation of relevant literature reveals information about current practices, outcome measures, and the successes and failures following completion of treatment. Multicenter databases have vastly improved the available data in the last few years. Graduates should be skeletally mature. Removing instrumentation without planned replacement has been largely unsuccessful. Final fusion procedures are often complex and challenging. Universally, 20% of patients who undergo a final fusion procedure require additional surgery at a mean time of 2 years after their graduation surgery. Careful consideration is required for deciding when and how to complete a growing spine program. Families should be counseled that there is a high rate of reoperation following graduation and that long-term follow-up is necessary regardless of the procedure.
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References
Flynn JM, Tomlinson LA, Pawelek J, Thompson GH, McCarthy R, Akbarnia BA, et al. Growing rod graduates: lessons learned from ninety-nine patients who completed lengthening. J Bone Joint Surg Am. 2013;95(19):1745–50.
Jain A, Sponseller PD, Flynn JM, Shah A, Thompson GH, Emans JB, et al. Avoidance of “final” surgical fusion after growing-rod treatment for early-onset scoliosis. J Bone Joint Surg Am. 2016;98(13):1073–8.
Helenius IJ, Sponseller PD, McClung A, Pawelek JB, Yazici M, Emans JB, et al. Surgical and health-related quality-of-life outcomes of growing rod “graduates” with severe versus moderate early-onset scoliosis. Spine. 2019;44(10):698–706.
Jeans KA, Johnston CE, Stevens WR Jr, Tran D-P. Exercise tolerance in children with early onset scoliosis: growing rod treatment “graduates.”. Spine Deform. 2016;4(6):413–9.
Studer D, Büchler P, Hasler CC. Radiographic outcome and complication rate of 34 graduates after treatment with vertical expandable prosthetic titanium rib (VEPTR): a single Center report. J Pediatr Orthop. 2019;39(10):e731–6.
Cahill PJ, Marvil S, Cuddihy L, Schutt C, Idema J, Clements DC, et al. Autofusion in the immature spine treated with growing rods. Spine. 2010;35(22):E1199–203.
Akbarnia BA. Management themes in early onset scoliosis. J Bone Joint Surg Am. 2007;89(Suppl 1):42–54.
Mubarak SJ, Morin WD, Leach J. Spinal fusion in Duchenne muscular dystophy-fixation and fusion to the sacropelvis? J Pediatr Orthop. 1993;13(6):752–7.
Blakemore LC, Scoles PV, Poe-Kochert C, Thompson GH. Submuscular Isola Rod with or without limited apical fusion in the management of severe spinal deformities in young children: preliminary report. Spine. 2001;26(18):2044–8.
Thompson GH, Arkbarnia BA, Kostial P, Poe-Kochert C, Armstrong DG, Roh J, et al. Comparison of single and dual growing rod techniques followed through definitive surgery: a preliminary study. Spine. 2005;30(18):2039–44.
Karol LA, Johnston CE, Mladenov K, Schchet P, Walters P, Browne RH. Pulmonary function following early thoracic fusion in non-neuromuscular scoliosis. J Bone Joint Surg Am. 2008;90(6):1272–81.
Cheung JPY, Yiu K, Kwan K, Cheung KMC. Mean 6-year follow-up of magnetically controlled growing rod patients with early onset scoliosis: a glimpse of what happens to graduates. Neurosurgery. 2019;84(5):1112–23.
Sawyer JR, de Mendonca RG, Flynn TS, Samdani AF, El Hawary R, Spurway AJ, et al. Complications and radiographic outcomes of posterior spinal fusion and observation in patients who have undergone distraction-based treatment for early onset scoliosis. J Pediatr Orthop. 2020;40(10):942–6.
Murphy RF, Barfield WR, Emans JB, Akbarnia B, Thompson G, Sponseller P, et al. Prospectively collected surgeon indications for discontinuation of a lengthening program for early-onset scoliosis. Spine Deform. 2020;8(1):129–33.
Pizones J, Martín-Bruitrago MP, Márquez JMS, Fernandez-Baillo N, Baldon-Martin M, Perez-Grueso FJS. Decision making of graduation in patients with early-onset scoliosis at the end of distraction-based programs: risks and benefits of definitive fusion. Spine Deform. 2018;6(3):308–13.
Poe-Kochert C, Shannon C, Pawelek JB, Thompson GH, Hardesty CK, Marks DS, et al. Final fusion after growing rod treatment for early-onset scoliosis: is it really final? J Bone Joint Surg Am. 2016;98(22):1913–7.
Du JY, Poe-Kochert C, Thompson GH, Hardesty CK, Pawelek JB, Flynn JM, et al. Pediatric spine study group. Risk factors for reoperation following final fusion after the treatment of early-onset scoliosis with traditional growing rods. J Bone Joint Surg Am. 2020;102(19):1672–8.
Kocyigit IA, Olgun ZD, Demirkiran HG, Ayvaz M, Yazici M. Graduation protocol after growing-rod treatment: removal of implants without new instrumentation is not a realistic approach. J Bone Joint Surg Am. 2017;99(18):1554–64.
Shen TS, Schairer W, Widmann R. In patients with early-onset scoliosis, can growing rods be removed without further instrumentation? An evidence based review. HSS J. 2019;15(2):201–4.
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Hardesty, C.K., Poe-Kochert, C., Sawyer, J.R., Thompson, G.H. (2022). Growing Spine Graduates. In: Akbarnia, B.A., Thompson, G.H., Yazici, M., El-Hawary, R. (eds) The Growing Spine. Springer, Cham. https://doi.org/10.1007/978-3-030-84393-9_49
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DOI: https://doi.org/10.1007/978-3-030-84393-9_49
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