the rib construct (rc) has provided secure proximal fixation for management of patients with eos and...
DESCRIPTION
Implant complication of the growing rod Implant prominence Screw pullout ( minimal fixation points ) Hook dislodgment in small weak bones Growing spine study group has put some contraindications for the growing rod use mainly severe kyphosis and MyelodysplasiaTRANSCRIPT
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The Rib Construct (RC) has provided secure proximal fixation for management of patients with EOS and severe thoracic
hyperkyphosis
Alaa Azmi Ahmad – MD Associate Professor of Orthopedic Surgery –Annajah Medical School – Nablus-
Palestine Disclosure –NON
Richard H. Gross –MD
Professor of Orthopedic Surgery – Clemson University –USADisclosure -NON
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Thoracic hyperkyphosis
• Greater than 20 degrees of kyphosis from T1-5• Greater than 40 degrees from T5-12• Greater than 50 degrees of maximum total kyphosisTreating EOS associated with thoracic kyphosis 1- has poor outcome 2- decision making between spine based and rib based proximal fixation has been graded as being among the areas of greatest clinical uncertainty at present for surgeons treating EOS
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Implant complication of the growing rod
• Implant prominence • Screw pullout ( minimal fixation points )• Hook dislodgment in small weak bones • Growing spine study group has put some
contraindications for the growing rod use mainly severe kyphosis and Myelodysplasia
![Page 4: The Rib Construct (RC) has provided secure proximal fixation for management of patients with EOS and severe thoracic hyperkyphosis Alaa Azmi Ahmad – MD](https://reader035.vdocuments.site/reader035/viewer/2022062223/5a4d1b217f8b9ab059995627/html5/thumbnails/4.jpg)
• To have success with the growing rod with kyphosis ( Yazici , ICEOS 2009 )
• Apical 360 degrees fusion • Increase level of fixation from 2 to 3 or 4 • Add sublaminar wires to laminar hooks
proximally • Put Halovest preop. And a brace post op • Do anterior annulotomy to increase flexibility
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• VEPTR
• Can it be a solution ?
• It is 7.3 mm in diameter and bulky for small children • Away from the spine with less control of the
deformity • Rod contouring cannot be done for correction of
kyphosis with cantilever effect
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Methods
Ongoing data collection of surgical management of 13 children with EOS and greater than 20 degrees of kyphosis between T1-5 and/or 70 degrees between T5-12, and at least 24 months of followup was compiled. The (RC) was used for proximal fixation in all cases.
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• 5 syndromic• 5 congenital/structural• 3idiopathic• 9 had prior spine surgery• Average age at initial surgery 84 months• followup averaged 47 months (24-77)
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Pre-Op Post-Op
T1-5 sagital kyphosis 29 26
T5-12 sagital kyphosis 96 56
Thoracic Scoliosis 68 44
Lumbar Scoliosis 39 38
Spine Length 22.9 cm 29.2 cm
Sagital Balance 39 mm 27 mm
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Pre-Operative
Post-Operative
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Complications
• Dislodgments:3 proximal hook, 5 distal anchors
• 1 delayed deep wound infection with removal and subsequent replacement of instrumentation
• 3 rod failures• 1 PJK
• As a group, there were 63 subsequent planned procedures, and 18 unplanned.
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Advantages • minimal neurologic risk, as distraction is not necessary for
kyphosis correction, • and gentle compression of rib hooks reduces kyphogenic effect• reliable correction of >100 degree kyphosis without anterior
release• ability to correct coronal plane malalignment by manipulation
of the construct• improved alignment of previously fused thoracic spine without
osteotomy• osteoporosis is not a contraindication to instrumentation with
the rib construct
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Conclusions
• The RC provides reliable proximal fixation for EOS patients with severe thoracic hyperkyphosis, especially for those with hyperkyphosis from T5-12.