Submuscular isola rod with or without limited apical fusion in the management of severe spinal deformities in young children - Preliminary report

Study Design. Retrospective review of the results of submuscular rod placem ent with and without limited apical fusion for the treatment of severe spin al deformities in young children. Objectives. To determine the success of this method for controlling severe deformities while allowing for spinal growth and to compare this method wit h previously reported results. Summary of Background Data. A variety of methods for controlling scoliosis in young children have been reported, but complications including spontaneo us fusion, loss of correction, instrumentation failure, and limited spinal growth are common. Methods. The cases of 29 young children with progressive scoliosis or kypho scoliosis as a result of a variety of diagnoses treated with a submuscular Isola rod and a postoperative orthosis were retrospectively reviewed. Eleve n patients also had a short anterior and posterior apical fusion or convex hemiepiphysiodesis to aid in correction and stabilization of their deformit y. The remaining 18 patients had a submuscular rod only. Results. The mean age at surgery was 6.7 years (range, 1-11 years). The ini tial preoperative mean magnitude of the major curve was 66 degrees (range, 42-112 degrees). After surgery this decreased to a mean of 38 degrees (rang e, 16-70 degrees). The most recent radiographs demonstrated a mean 47 degre es curve (range, 28-79 degrees). The mean number of lengthenings per patien t has been two (range, 0-5). Nine patients have reached a suitable age and have been converted to a posterior spinal fusion and segmental spinal instr umentation. Nine complications have occurred in seven patients (24%). These included five hook displacements and three rod breakages. These were treat ed by hook reinsertion and rod exchange or sleeve and a repeat lengthening. There was one superficial infection treated medically. Conclusion. This technique is useful in the management of severe spinal def ormities in young children who have either failed, or have a contra indicat ion to, orthotic management. Complications are relatively frequent but well tolerated.