Abstract
Purpose
Is there any relationship between lengthening intervals and rod fracture in traditional growing rod (TGR) surgery?
Methods
A multicenter EOS database was queried for patients who had: (1) dual growing rods for EOS; (2) minimum 2-year follow-up; (3) a minimum of 2 lengthenings; and (4) revision surgery due to rod fracture. Of 138 patients who met the criteria: 56 patients experienced at least one-rod fracture (RF group) and 82 patients had no rod fractures (NRF group). In addition to each patient’s lengthening intervals, demographics, construct details, and radiographic parameters were compared.
Results
RF and NRF patients had a mean pre-op age of 5.7 years (range 1.3–10.7) and 7.3 years (range 1.6–12.8), respectively (p < 0.001). There was no significant association between etiologies and rod fracture or between BMI and rod fracture (p = 0.979). There was no significant difference between lengthening intervals between the RF and NRF groups (p > 0.05). RF and NRF patients had statistically similar mean pre-op major curve size and max kyphosis (p = 0.279; p = 0.619, respectively). Stainless steel rods fractured more frequently compared with Titanium rods (SS 49.2 % vs. Ti 38 %; p = 0.004). Rod fracture occurred more in rods smaller than 4 mm (p = 0.011).
Conclusions
Lengthening intervals were not statistically different in RF and NRF groups and there was no association between lengthening interval and rod fracture in TGR cases. It was shown that patients who had rod fracture were younger and were more likely to have SS rods with smaller than 4 mm diameter.
Similar content being viewed by others
References
Lawrence Lenke LK (2015) Rigid spine text book. Under Publication, USA
Moe JH, Kharrat K, Winter RB, Cummine JL (1984) Harrington instrumentation without fusion plus external orthotic support for the treatment of difficult curvature problems in young children. Clin Orthop Relat Res 185:35–45
Akbarnia BA, Marks DS, Boachie-Adjei O, Thompson AG, Asher MA (2005) Dual growing rod technique for the treatment of progressive early-onset scoliosis: a multicenter study. Spine 30(17 Suppl):S46–S57
Thompson GH, Akbarnia BA, Kostial P, Poe-Kochert C, Armstrong DG, Roh J et al (2005) Comparison of single and dual growing rod techniques followed through definitive surgery: a preliminary study. Spine 30(18):2039–2044
Akbarnia BA, Breakwell LM, Marks DS, McCarthy RE, Thompson AG, Canale SK et al (2008) Dual growing rod technique followed for three to 11 years until final fusion: the effect of frequency of lengthening. Spine 33(9):984–990
Atici Y, Akman YE, Erdogan S, Sari S, Yavuz U, Carkci E et al (2015) The effect of growing rod lengthening technique on the sagittal spinal and the spinopelvic parameters. Euro Spine J Off Publ Euro Spine Soc Euro Spinal Deform Soc Euro Sect Cervical Spine Res Soc 24(6):1148–1157
Shah SA, Karatas AF, Dhawale AA, Dede O, Mundis GM Jr, Holmes L Jr et al (2014) The effect of serial growing rod lengthening on the sagittal profile and pelvic parameters in early-onset scoliosis. Spine 39(22):E1311–E1317
Yang JS, McElroy MJ, Akbarnia BA, Salari P, Oliveira D, Thompson GH et al (2010) Growing rods for spinal deformity: characterizing consensus and variation in current use. J Pediatr Orthop 30(3):264–270
Yang JS, Sponseller PD, Thompson GH, Akbarnia BA, Emans JB, Yazici M et al (2011) Growing rod fractures: risk factors and opportunities for prevention. Spine 36(20):1639–1644
Choi E, Yazsay B, Mundis G, Hosseini P, Pawelek J, Alanay A et al (2016) Implant complications after magnetically controlled growing rods for early onset scoliosis: a multicenter retrospective review. J Pediatr Orthop. doi:10.1097/BPO.0000000000000803
Elsebai HB, Yazici M, Thompson GH, Emans JB, Skaggs DL, Crawford AH et al (2011) Safety and efficacy of growing rod technique for pediatric congenital spinal deformities. J Pediatr Orthop 31(1):1–5
Akbarnia BA, Emans JB (2010) Complications of growth-sparing surgery in early onset scoliosis. Spine 35(25):2193–2204
Bess S, Akbarnia BA, Thompson GH, Sponseller PD, Shah SA, El Sebaie H et al (2010) Complications of growing-rod treatment for early-onset scoliosis: analysis of one hundred and forty patients. J Bone Joint Surg Am 92(15):2533–2543
Behrooz A, Akbarnia MY, Thompson George H (2011) The growing spine textbook. Springer-Verlag, Berlin Heidelberg
Agarwal AAA, Jayaswal A, Goel V (2014) Smaller interval distractions may reduce chances of growth rod breakage without impending desired spinal growth: a finite element study. Spine Deform 2:430–436
Williams BA, Matsumoto H, McCalla DJ, Akbarnia BA, Blakemore LC, Betz RR et al (2014) Development and initial validation of the classification of early-onset scoliosis (C-EOS). J Bone Joint Surg Am 96(16):1359–1367
Harrington PR (2002) Treatment of scoliosis: correction and internal fixation by spine instrumentation. June 1962. J Bone Joint Surg Am 84-a(2):316
Mineiro J, Weinstein SL (2002) Subcutaneous rodding for progressive spinal curvatures: early results. J Pediatr Orthop 22(3):290–295
Klemme WR, Denis F, Winter RB, Lonstein JW, Koop SE (1997) Spinal instrumentation without fusion for progressive scoliosis in young children. J Pediatr Orthop 17(6):734–742
Cheung KKK, Samartzis D, Alanay A, Ferguson J, Nnadi C, Helenius I, Yazici M, Demirkiran G, Akbarnia B (2015) What are the effects of changing the frequency of distraction in magnetically-controlled growing rod lengthening in early-onset scoliosis? 50th Annual Meeting and Course of the Scoliosis Research Society (SRS). Minneapolis, Minnesota
Akbarnia BA, Breakwell LM, Marks DS, McCarthy RE, Thompson AG, Canale SK et al (2008) Dual growing rod technique followed for three to eleven years until final fusion: the effect of frequency of lengthening. Spine 33(9):984–990
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Source of funding
This study was supported by a research grant from the Growing Spine Foundation.
Conflict of interests
Conflict of interests (COI) is explained in the coauthors’ COI electronic forms.
IRB
This study was Institutional Review Board approved at each participating institution prior to initiation.
Rights and permissions
About this article
Cite this article
Hosseini, P., Pawelek, J.B., Nguyen, S. et al. Rod fracture and lengthening intervals in traditional growing rods: is there a relationship?. Eur Spine J 26, 1690–1695 (2017). https://doi.org/10.1007/s00586-016-4786-8
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00586-016-4786-8