Frequency and management of rod fractures following minimally invasive bipolar fusionless surgery in neuromuscular scoliosis patients.

Introduction: Neuromuscular scoliosis (NMS) is associated with an abnormal muscle tone. Traditional conservative treatments, with the historical practice of early posterior fusion, have proven ineffective. Recently, growth-sparing techniques have gained traction owing to their ability to maximize trunk height.

The Minimally Invasive Bipolar Fixation for Pediatric Spinal Deformities: A Narrative Review.

Growing rod techniques are increasingly used for early-onset scoliosis in children. Unfortunately, they are associated with many complications, particularly neuromuscular scoliosis, favored by the poor general condition of these patients and the fragility of their osteoporotic bones. Furthermore, these interventions are often iterative and usually followed by vertebral fusion at the end of growth.

Pelvic Fixation Technique Using the Ilio-Sacral Screw for 173 Neuromuscular Scoliosis Patients.

Pelvic fixation remains one of the main challenging issues in non-ambulatory neuromuscular scoliosis (NMS) patients, between clinical effectiveness and a high complication rate. The objective of this multicenter and retrospective study was to evaluate the outcomes of a technique that was applied to treat 173 NMS patients. The technique is not well-known but promising; it uses the ilio-sacral screw, combined with either the posterior spinal fusion or fusionless bipolar technique, with a minimum follow-up of two years.

Evidence of spinal stiffening following fusionless bipolar fixation for neuromuscular scoliosis: a shear wave elastography assessment of lumbar annulus fibrosus.

Objectives: There are no established criteria for stiffness after fusionless surgery for neuromuscular scoliosis (NMS). As a result, there is no consensus regarding the surgical strategy to propose at long-term follow-up. This study reports the first use of shear wave elastography for assessing the mechanical response of lumbar intervertebral discs (IVDs) after fusionless bipolar fixation (FBF) for NMS and compares them with healthy controls.

Kyphectomy in myelomeningocele revisited: risk factors for failure.

Purpose: Lumbar kyphosis occurs in approximately 8-20% of patients with myelomeningocele (MMC). The purpose of this article is to analyze the risks and benefits of vertebrectomy and spinal stabilization in MMC children with severe lumbar kyphosis and to establish treatment guidelines.

Methods: This is an IRB-approved retrospective analysis of 59 patients with MMC who underwent kyphectomy and posterior instrumentation in three centers.

Bipolar Fusionless Versus Standard Fusion Surgery in Neuromuscular Scoliosis: A Two-center Comparative Study.

Study Design: Nonrandomized controlled cohort.

Objective: To compare early results between bipolar fusionless construct (BFC) and single posterior fusion (SPF) surgery in neuromuscular scoliosis (NMS).

Background: Surgical treatments for NMS have traditionally been characterized by high complication rates.

Spontaneous induced bone fusion in minimally invasive fusionless bipolar fixation in neuromuscular scoliosis: a computed tomography analysis.

Purpose: Posterior spinal fusion (PSF) at skeletal maturity is still the gold standard in children with neuromuscular scoliosis (NMS) who underwent fusionless surgery. The aim of this computed tomography (CT) study was to quantify the spontaneous bone fusion at the end of a lengthening program by minimally invasive fusionless bipolar fixation (MIFBF), that could avoid PSF.

Methods: NMS operated on with MIFBF from T1 to the pelvis and at final lengthening program were included.

Is Minimally Invasive Bipolar Technique a Better Alternative to Long Fusion for Adult Neuromuscular Scoliosis?

Study Design: Prospective cohort study.

Objectives: To report the results for an alternative technique based on minimally invasive fusion-less surgery. This approach is original in that it corrects deformities by proximal and distal fixation, with reliable pelvic fixation through the use of iliosacral screws on osteoporotic bones.

Intraoperative neuromonitoring in non-idiopathic pediatric scoliosis operated with minimally fusionless procedure: A series of 290 patients.

Background: One of the worst complications of surgery for spinal deformity is postoperative neurological deficit. Multimodal intraoperative neuromonitoring (IONM) can be used to detect impending neurological injuries. This study aimed to analyze IONM in non-idiopathic scoliosis using a minimally invasive fusionless surgical technique.

One-Way Self-Expanding Rod in Neuromuscular Scoliosis: Preliminary Results of a Prospective Series of 21 Patients.

Background: Fusionless techniques for the treatment of neuromuscular early-onset scoliosis (EOS) are increasingly used to preserve spinal and thoracic growth and to postpone posterior spinal fusion (PSF). These techniques have greatly improved thanks to magnetically controlled growing rods, which allow the avoidance of repeated surgery. However, the surgery-related complication rate remains high.

Optimal ilio-sacral screw trajectory in paediatric patients : a computed tomography study.

Pelvic fixation during procedures performed to treat spinal deformities in paediatric patients remains challenging. No computed tomography studies in paediatric have assessed the optimal trajectory of ilio- sacral screws to prevent screw malposition. We used pelvic computed tomography from 80 children divided into four groups : females <10 and ≥10 years and males <10 and ≥10 years.

Minimally Invasive Fusionless Surgery for Scoliosis in Spinal Muscular Atrophy: Long-term Follow-up Results in a Series of 59 Patients.

Background: Treatment of spinal muscular atrophy (SMA) scoliosis has evolved in the last decade, with the emergence of fusionless surgical techniques that allow correction of the deformity before the end of growth spurt. These techniques are expected to delay definitive spine fusion and preserve trunk growth.

Purpose: The aim was to evaluate long-term clinical, radiologic, and respiratory outcomes of a minimally invasive fusionless surgery (MIFLS) in SMA scoliosis.

Fracture mechanisms in Ti and Co-Cr growing rods and impact on clinical practice.

The widely used treatment of early onset scoliosis based on fusionless spinal instrumentation with growing rods suffers from severe complications due to premature rod failure. Only few studies have explored the fracture mechanisms in single rod constructs, while clinical practice urgently needs guidance. The objectives of this study are (i) to determine the failure mechanisms in Ti-6Al-4V alloy, Ti Cp 2 and Co-Cr alloy rods, and (ii) to propose strategies to reduce the risk of rod fracture.

Minimally Invasive Surgery for Neuromuscular Scoliosis: Results and Complications at a Minimal Follow-up of 5 Years.

Study Design: A prospective study.

Objective: The aim of this study was to report the results of an alternative technique to growing rods (GR) for neuromuscular scoliosis using a minimally invasive fusionless surgery with a minimum of 5 years' follow-up.

Summary Of Background Data: Conservative treatment is not effective in progressive neuromuscular scoliosis.

One-way self-expanding rod for early-onset scoliosis: early results of a clinical trial of 20 patients.

Purpose: Progressive early-onset scoliosis raises major challenges for surgeons, as growth must be preserved. With traditional growing rods, the need for repeated surgery is associated with numerous complications, high costs, and heavy psychosocial burden on the patient and family. We assessed the safety and efficacy of a new one-way self-expanding rod (OWSER).

Ilio-sacral screw pelvic fixation when correcting spinal deformities with or without pelvic obliquity: our experience over 40 years.

Ilio-sacral screw fixation for treatment of spinal deformities with pelvic obliquity was used from more than 40 years in our department of pediatric orthopedics. Despite trying all the other systems published in the literature, the authors came back to iliosacral screw to address the pelvic fixation. Keeping the same anatomical and biomechanical principles, with no damage of the SI joint, they improve the technology over time, to allow an easy use.

Outcomes of growing rods in a series of early-onset scoliosis patients with neurofibromatosis type 1.

Objective: Early-onset scoliosis (EOS) is not uncommon in patients with neurofibromatosis type 1 (NF1). Despite conservative treatment, spinal deformities progress and require early surgical intervention. To avoid potential interference with chest and trunk growth, growing rods (GRs) have been used effectively in EOS of various etiologies.

Biomechanical cadaver study of proximal fixation in a minimally invasive bipolar construct.

Study Design: Biomechanical human cadaver study.

Objective: To determine the three-dimensional intervertebral ranges of motion (ROMs) of intact and hook-instrumented thoracic spine specimens subjected to physiological loads, using an in vitro experimental protocol with EOS biplane radiography. Pedicle screws are commonly used in thoracic instrumentation constructs, and their biomechanical properties have been widely studied.

Outcomes at Skeletal Maturity of 34 Children With Scoliosis Treated With a Traditional Single Growing Rod.

Study Design: Retrospective case series.

Objectives: To analyze the outcomes at skeletal maturity of patients treated with a single traditional growing rod (GR). To compare results of patients according to whether posterior spinal fusion (PSF) was performed at treatment completion.