Growing rods linked to worse lowest instrumented vertebrae selections vs. spinal fusion
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Key takeaways:
- Spinal fusion showed more cephalad lowest instrumented vertebrae selections vs. magnetically controlled growing rods.
- A more varied and even distribution of lowest instrumented vertebrae was seen with fusion.
Results showed patients aged 8 to 11 years, known as “tweeners,” undergoing posterior spinal fusion had a more cephalad lowest instrumented vertebrae selections compared with those who received magnetically controlled growing rods.
“This brings awareness to surgeons when deciding between fusion and a growth-friendly approach for these tweener patients,” Michael J. Heffernan, MD, pediatric orthopedic surgeon in the Jackie and Gene Autry Orthopedic Center at Children’s Hospital Los Angeles, told Healio about results presented at the International Meeting on Advanced Spine Techniques. “The [lowest instrumented vertebrae] LIV selection for one approach vs. the other should be at least one of the considerations ... that goes into that decision-making process.”
Using the Pediatric Spine Study Group database, Heffernan and colleagues reviewed data from 159 pediatric patients (aged 8 to 11 years) who either underwent posterior spinal fusion (n = 77) or received magnetically controlled growing rods (MCGR; n = 82). Researchers assessed the relationship between LIV and preoperative spinal height, curve magnitude and implant type, and evaluated the relationship between the last substantially touched vertebrae, stable vertebrae and LIV.
“One of the findings is that larger curves, in general, had a more caudal LIV, which means that it was lower in the spine,” Heffernan said. “Curve magnitude predicts LIV, which intuitively makes sense. The bigger the curve, the more the spine is shifted off to the side in general. To bring things back to the midline, it obligates to go a little bit lower.”
Heffernan said patients who underwent fusion had a significant trend to have a more cephalad LIV vs. patients in the MCGR group, who tended to have less optimal LIV selections. Patients who underwent posterior spinal fusion also had a more varied distribution of LIV, according to Heffernan. While the fusion group had an even distribution of LIV, 43% and 22% of patients in the MGCR group had an LIV at L3 and L4, respectively.
“[These results] will bring awareness to LIV selection in early onset scoliosis and, hopefully, help surgeons make informed decisions for their tweener patients, with the ultimate goal of including less of the spine in surgery,” Heffernan said.
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Heffernan MJ, et al. Paper 3. Presented at: International Meeting on Advanced Spine Techniques; April 10-13, 2024; San Diego.
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