Blog Topic: Talking Points for Early-Onset Scoliosis Patients: Magnetically-Controlled Growing Rods vs. Shilla Growth-Guidance

8-23-2022

 

In the surgical treatment of Early-Onset Scoliosis (EOS) the options boil down to two main constructs:

 

Distraction-Based: this encompasses both Traditional Growing Rods (TGR) and Magnetically-Controlled Growing Rods (MCGR)

            Growth-Guidance: this is also called the “Shilla Procedure”

 

We will not go into detail about these two spine constructs, but ask you go back in this blog to older posts to get the information you are interested in obtaining for you or your child.

The below table is a breakdown of the similarities and differences between Shilla Growth Guidance and Magnetically-Controlled Growing Rods.  This table can be used to stimulate and augment discussions with pediatric spine surgeons about the two constructs, and which is more appropriate for their child.

 

Blog Topic: Blood Management During Spine Deformity Surgery

8-22-2022

 

In 2022, spine deformity surgery usually requires a long incision and temporary retraction of muscles from the spine.  This extensive exposure of the spine helps to loosen up the spine (to get better correction), insert pedicle screws to grip the spine and place the long rods, which moves the spine in space and maintains the correction in its new position (while the spine fusion develops).

 

 

This type of exposure, and the amount of time required for these surgeries (4-6 hours), creates the opportunity to have significant blood loss. Does the amount of blood loss in surgery matter? The answer is “yes”. There is a convincing amount of published research which documents lower complications and better patient outcomes when the blood loss from surgery is low.

 

 

 

During surgical procedures in the operating rooms there are various methods to minimize or stop bleeding, from intravenous medications to topical materials to surgical technique.  In spine deformity surgery, some of these are effective and easy to do, while others are not as effective or require changes in the execution of surgery.   

So how do we minimize blood loss during pediatric spinal deformity surgery? Here are a few of methods we utilize on a daily basis:

Meticulous surgical technique: During surgery it is important to identify any and all bleeding.  Electrocautery is used to stop the bleeding.

Use of tranexamic acid: This medication is given by vein, through an IV, during surgery and has been demonstrated to decrease bleeding.

Topical hemostatic agents: These materials are applied on the surfaces of muscle and bone which coagulates bleeding.

Use of red blood cell scavenging: During surgery we suction blood out of the wound and this type machine collects, filters and spins down to concentrate the blood.  We can then give this concentrated back to the patient.

 

Blog Topic: The Use of Internal Distraction in Severe Scoliosis

8-7-2022

In severe scoliosis, the use of traction has demonstrated an ability to improve the spinal deformity before surgery was actually performed.  There are three main methods:

1.    1. Preoperative halo-gravity traction

2.    2.   Intraoperative halo-femoral traction

3.    3. Intraoperative Internal Dis-Traction

This post will focus on #3: Intraoperative Internal Dis-Traction

To demonstrate this treatment we will use the case of a 13 year old female who has severe scoliosis measuring 105 degrees.  Treatment thus far has been observation.  She had been having daily back pain which prevented her from playing athletics. 

Due to the severe scoliosis a total spine MRI was ordered and a thoracic syrinx was diagnosed (treated nonoperatively).

I call her type of scoliosis: neurogenic.  Many surgeons will call this neuromuscular but I don’t think it is correct to included this type of patient into the same group as cerebral palsy, spina bifida, spinal muscle atrophy, etc….diagnoses.

The image, below far right, is a push prone.  This image demonstrates that when a force is exerted on the spine the scoliosis improves from 105 degrees to 77 degrees.

On the below right sidebender (right side radiograph) the deformity decreases to 82 degrees.

Next are a picture and radiograph taken in surgery, which both demonstrate Intraoperative Internal Dis-Traction.  After exposure of the spine multiple osteotomies (posterior column osteotomies or PCOs) are done to make the spine more flexible, and allow more correction of the scoliosis.

Then a few screws are placed in the lower part of the spine (red circle), then hooks are placed on 4 ribs on the concave side of the scoliosis (yellow circle).  These two foundations are then connected by a rod and then distraction can be done to improve the scoliosis, which you can see it is much better than it was before surgery.

After this rod is placed the remainder of all the pedicle screws are inserted.  Distraction is done multiple times to gradually improve the scoliosis.  It is important to have spinal cord monitoring as the Dis-Traction can make the spinal cord not work normally.

In surgery the right rod is placed, then the Dis-Traction rod is removed, and a new left rod is placed.  During the rod placements more and more and more correction is safely obtained.

The below radiographs demonstrated the postoperative correction, improved from 105 degrees to 38 degrees.

Overall a nice correction in both the front and side views of the spine.