SpringerLink
Log in

Hybrid Distraction-Based Growing Rods

  • Chapter
  • First Online:
The Growing Spine

  • 1160 Accesses

Abstract

This chapter describes the indications, surgical technique, and benefits of distraction-based growth-friendly implants with rib anchors (hybrid distraction-based growing rods (HGRs)) in the management of early-onset scoliosis. This technique is described both for use in the management of early-onset scoliosis involving the thoracic spine and for deformities of the cervicothoracic region. The use of ribs for growing rod anchors has the benefit of avoiding proximal spine dissection and intentional fusion of the upper thoracic spine. One of the goals of growing rods is to allow for continued thoracic growth, and avoiding areas of thoracic fusion may be beneficial. Additionally, as ribs are mobile, a theoretical benefit of rib anchors is motion preservation, as opposed to spontaneous autofusion observed frequently after extended treatment with rigid standard growing rod constructs.

Hooks from standard spinal instrumentation systems can be used as rib anchors with this technique. Benefits of using standard spinal hooks over specialized rib implants include no special equipment, training, or institutional approval is needed, and multiple ribs at a time may be used for load sharing. In most cases, a thoracotomy, elevation of the scapula, or dissection of tissue between ribs is not indicated. Distraction of the concavity of scoliosis leads to expansion of the hemithorax and harmonious separation between ribs. Neuromonitoring of the upper extremities is indicated when distracting on rib anchors and positioning the arms in adduction is recommended if there is a particular concern for brachial plexus injury.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 149.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 199.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free ship** worldwide - see info
Hardcover Book
USD 279.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free ship** worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Campbell RM, Hell-Vocke AK. Growth of the thoracic spine in congenital scoliosis after expansion thoracoplasty. J Bone Joint Surg Am. 2003;85:409–20.

    Article  Google Scholar 

  2. Campbell RM, Smith MD, Mayes TC, Mangos JA, Willey-Courand DB, Kose N, et al. The characteristics of thoracic insufficiency syndrome associated with fused ribs and congenital scoliosis. J Bone Joint Surg Am. 2003;85:399–408.

    Article  Google Scholar 

  3. Corona J, Miller DJ, Downs J, Akbarnia BA, Betz RR, Blakemore LC, et al. Evaluating the extent of clinical uncertainty among treatment options for patients with early-onset scoliosis. J Bone Joint Surg Am. 2013;95:e67.

    Article  Google Scholar 

  4. Meza BC, Shah SA, Vitale MG, Sturm PF, Luhmann SJ, Anari JB. Proximal anchor fixation in magnetically controlled growing rods (MCGR): preliminary 2-year results of the impact of anchor location and density. Spine Deform. 2020;8(4):793–800.

    Article  Google Scholar 

  5. Johnson MA, Cahill PJ, Qiu C, Lott C, Mayer OH, Flynn JM, et al. Comparison of T1-S1 spine height of postoperative rib-based implant patients with age-matched peers. J Pediatr Orthop. 2020;40(7):344–50.

    Article  Google Scholar 

  6. Harris L, Andras LM, Mundis GM, Sponseller PD, Emans JB, Skaggs DL. Five or more proximal anchors and including upper end vertebra protects against reoperation in distraction-based growing rods. Spine Deform. 2020;8(4):781–6.

    Article  Google Scholar 

  7. Gomez JA, Kubat O, Tovar Castro MA, Hanstein R, Flynn T, Lafage V, et al. The effect of spinopelvic parameters on the development of proximal junctional kyphosis in early onset: mean 4.5-year follow-up. J Pediatr Orthop. 2020;40(6):261–6.

    Article  Google Scholar 

  8. El-Hawary R, Chukwunyerenwa CK, Gauthier LE, Spurway AJ, Hilaire TS, McClung AM, et al. Distraction-based surgeries increase thoracic sagittal spine length after ten lengthening surgeries for patients with idiopathic early-onset scoliosis. Spine Deform. 2020;8(2):303–9.

    Article  Google Scholar 

  9. Cahill PJ, Mahmoud MA, MacAlpine EM, Tatad AM, Campbell RM, Flynn JM. Correlation between surgical site infection and classification of early onset scoliosis (C-EOS) in patients managed by rib-based distraction instrumentation. Spine Deform. 2020;8(4):787–92.

    Article  Google Scholar 

  10. Shetty AP, Nikhil KV, Renjith KR, Vijayanand KSS, Kanna PRM, Rajasekaran S. Proximal anchor constructs and its influence on surgical outcome in growth rod technique; a comparison between rib hooks and pedicle screws. Spine Deform. 2019;7(6):979–84.

    Article  Google Scholar 

  11. Lorenz HM, Braunschweig L, Badwan B, Groenefeld K, Hecker MM, Tsaknakis K, et al. High correlation between achieved and expected distraction using magnetically controlled growth rods (MCGR) with rib to pelvis fixation in Pediatric spine deformity. J Pediatr Orthop. 2019;39(5):e334–e8.

    Article  Google Scholar 

  12. Larson AN, Baky FJ, St. Hilaire T, Pawelek J, Skaggs DL, Emans JB, et al. Spine deformity with fused ribs treated with proximal rib- versus spine-based growing constructs. Spine Deform. 2019;7(1):152–7.

    Article  Google Scholar 

  13. Joukhadar N, Kubat O, Heflin J, Yasin MS, McClung A, Flynn T, et al. Superior extension of upper instrumented vertebrae in distraction-based surgery: a surrogate for clinically significant proximal junctional kyphosis. Spine Deform. 2019;7(2):371–5.

    Article  Google Scholar 

  14. Baky FJ, Larson AN, St. Hilaire T, Pawelek J, Skaggs DL, Emans JB, et al. The effect of expansion thoracostomy on spine growth in patients with spinal deformity and fused ribs treated with rib-based growing constructs. Spine Deform. 2019;7(5):836–41.

    Article  Google Scholar 

  15. El-Hawary R, Sturm P, Cahill P, Samdani A, Vitale M, Gabos P, et al. What is the risk of develo** proximal junctional kyphosis during growth friendly treatments for early-onset scoliosis? J Pediatr Orthop. 2017;37(2):86–91.

    Article  Google Scholar 

  16. Chen Z, Li S, Qiu Y, Zhu Z, Chen X, Xu L, et al. Evolution of the postoperative sagittal spinal profile in early-onset scoliosis: is there a difference between rib-based and spine-based growth-friendly instrumentation. J Neurosurg Pediatr. 2017;20(6):561–6.

    Article  Google Scholar 

  17. El-Hawary R, Samdani A, Wade J, Smith M, Heflin JA, Klatt JW, et al. Rib-based distraction surgery maintains total spine growth. J Pediatr Orthop. 2016;36(8):841–6.

    Article  Google Scholar 

  18. Ramirez N, Olivella G, Rodriguez O, Marrero P, Smith J, Garg S, et al. Incidence of complications in the management of non-ambulatory neuromuscular early-onset scoliosis with a rib-based growing system: high- versus low-tone patients. Eur J Orthop Surg Traumatol. 2020;30(4):621–7.

    Article  Google Scholar 

  19. Heflin JA, Cleveland A, Ford SD, Morgan JV, Smith JT. Use of rib-based distraction in the treatment of early-onset scoliosis associated with neurofibromatosis type 1 in the young child. Spine Deform. 2015;3(3):239–45.

    Article  Google Scholar 

  20. Gray H. Anatomy of the human body. Philadelphia: Lea & Febiger; 1918.

    Book  Google Scholar 

  21. Wilson TA, Rehder K, Krayer S, Hoffman EA, Whitney CG, Rodarte JR. Geometry and respiratory displacement of human ribs. J Appl Physiol. 1987;62(5):1872–7.

    Article  CAS  Google Scholar 

  22. Yamaguchi KT, Skaggs DL, Mansour S, Myung KS, Yazici M, Johnston C, et al. Are rib versus spine anchors protective against breakage of growing rods? Spine Deform. 2014;2(6):489–92.

    Article  Google Scholar 

  23. Akbarnia BA, Yaszay B, Yazici M, Kabirian N, Blakemore LC, Strauss KR, et al. Biomechanical evaluation of 4 different foundation constructs commonly used in growing spine surgery: are rib anchors comparable to spine anchors? Spine Deform. 2014;2(6):437–43.

    Article  Google Scholar 

  24. Sankar WN, Skaggs DL, Yazici M, Johnston CE, Shah SA, Javidan P, et al. Lengthening of dual growing rods and the law of diminishing returns. Spine (Phila Pa 1976). 2011;36(10):806–9.

    Article  Google Scholar 

  25. Mardjetko SM, Hammerberg KW, Lubicky JP, Fister JS. The Luque trolley revisited: review of nine cases requiring revision. Spine (Phila Pa 1976). 1992;17(5):582–9.

    Article  CAS  Google Scholar 

  26. Karol LA, Johnston C, Mladenov K, Schochet P, Walters P, Browne RH. Pulmonary function following early thoracic fusion in non-neuromuscular scoliosis. J Bone Joint Surg Am. 2008;90(6):1272–81.

    Article  Google Scholar 

  27. Skaggs DL, Sankar WN, Albrektson J, Wren TAL, Campbell RM. Weight gain following vertical expandable prosthetic titanium ribs surgery in children with thoracic insufficiency syndrome. Spine (Phila Pa 1976). 2009;34(23):2530–3.

    Article  Google Scholar 

  28. Newton PO, Perry A, Bastrom TP, Lenke LG, Betz RR, Clements D, et al. Predictors of change in postoperative pulmonary function in adolescent idiopathic scoliosis: a prospective study of 254 patients. Spine (Phila Pa 1976). 2007;32(17):1875–82.

    Article  Google Scholar 

  29. Joiner ERA, Andras LM, Skaggs DL. Mechanisms and risk factors of brachial plexus injury in the treatment of early-onset scoliosis with distraction-based growing implants. J Bone Joint Surg Am. 2013;95(21):e161.

    Article  Google Scholar 

  30. Skaggs DL, Choi PD, Rice C, Emans J, Song KM, Smith JT, et al. Efficacy of intraoperative neurologic monitoring in surgery involving a vertical expandable prosthetic titanium rib for early-onset spinal deformity. J Bone Joint Surg Am. 2009;91(7):1657–63.

    Article  Google Scholar 

  31. Sankar WN, Acevedo DC, Skaggs DL. Comparison of complications among growing spinal implants. Spine (Phila Pa 1976). 2010;35(23):2091–6.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Children’s Orthopaedic Center, Children’s Hospital Los Angeles, Los Angeles, CA, USA

    Lindsay M. Andras

  2. Spine Center of Excellence, Cedars-Sinai Health System, Los Angeles, CA, USA

    Kenneth D. Illingworth & David L. Skaggs

Authors
  1. Lindsay M. Andras
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kenneth D. Illingworth
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. David L. Skaggs
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to David L. Skaggs .

Editor information

Editors and Affiliations

  1. Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, USA

    Behrooz A. Akbarnia

  2. Rainbow Babies & Children’s Hospital, Case Western Reserve University, Cleveland, OH, USA

    George H. Thompson

  3. Department of Orthopedics and Traumatology, Hacettepe University Faculty of Medicine, Sihhiye, Ankara, Turkey

    Muharrem Yazici

  4. IWK Health Center, Dalhousie University, Halifax, NS, Canada

    Ron El-Hawary

Rights and permissions

Reprints and permissions

Copyright information

© 2022 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Andras, L.M., Illingworth, K.D., Skaggs, D.L. (2022). Hybrid Distraction-Based Growing Rods. In: Akbarnia, B.A., Thompson, G.H., Yazici, M., El-Hawary, R. (eds) The Growing Spine. Springer, Cham. https://doi.org/10.1007/978-3-030-84393-9_45

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-84393-9_45

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-84392-2

  • Online ISBN: 978-3-030-84393-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation