Sliding Growing Rod Technique: Scoliosis Treatment

Early-onset scoliosis (EOS), defined as a spinal curvature appearing before the age of 10, presents a unique challenge in pediatric orthopedics. If left untreated, EOS can not only lead to severe spinal deformity but also impair thoracic development and lung function, potentially causing life-long health issues. The treatment of EOS has evolved significantly over the years, with sliding growing rod techniques emerging as a promising solution that balances the need for deformity correction with the imperative of allowing continued spinal growth.

The Evolution of EOS Treatment

Historically, the treatment of EOS has been complex and often unsatisfactory. Traditional methods included:

1. Casting and bracing, which were often insufficient for severe cases.
2. Early spinal fusion, which corrected the curve but stunted growth, leading to potential long-term complications.
3. Traditional growing rods, which required repeated surgeries every 6-12 months for lengthening.

The limitations of these approaches, particularly the need for multiple surgeries in growing children, spurred the development of more innovative, growth-friendly techniques.

Understanding Sliding Growing Rod Techniques

Sliding growing rod techniques represent a paradigm shift in EOS treatment. The core principle is to create a construct that guides spinal growth while controlling deformity, reducing the need for repeated surgical interventions.

Key Sliding Growing Rod Systems

1. Magnetically Controlled Growing Rods (MCGR)
   • Uses rods with internal magnetic mechanisms.
   • Allows for non-invasive lengthening through external magnetic control.
   • Advantages: Eliminates repetitive surgeries, allows more frequent adjustments.
   • Challenges: Higher initial cost, potential for mechanical failure.
2. Shilla Growth Guidance System
   • Employs fixed anchors at the curve apex and sliding anchors at the ends.
   • Allows vertebrae to slide along the rods as the spine grows.
   • Advantages: Reduces surgeries, allows more natural growth.
   • Challenges: Potential for metal debris, risk of spontaneous fusion.
3. Modern Luque Trolley
   • An update on the classic Luque technique using sliding anchors.
   • Multiple sublaminar wires or bands slide along dual rods.
   • Advantages: Good coronal and sagittal plane control, force distribution.
   • Challenges: Complex initial surgery, potential neurological risks.

Surgical Technique Overview

While specific procedures vary depending on the chosen system, the general surgical approach includes:

1. Preoperative Planning: Detailed imaging and measurements to determine anchor points and implant sizes.
2. Anchor Placement: Strategic positioning of pedicle screws, hooks, or sublaminar bands.
3. Rod Insertion and Mechanism Setup: Careful rod contouring and insertion, with attention to sliding component setup.
4. Initial Correction: Gradual distraction to achieve initial curve correction.

Postoperative care involves regular monitoring, and in some systems like MCGR, periodic non-invasive adjustments.

Outcomes and Challenges

Early results from sliding growing rod techniques have been encouraging:

Positive Outcomes:

• Improved curve correction and maintenance compared to traditional methods.
• Continued spinal growth, supporting thoracic development.
• Reduced need for repeated surgeries, leading to better quality of life for patients.

Challenges:

• Implant-related issues such as rod breakage or anchor dislodgement.
• Risk of surgical site infections or wound problems.
• Potential for unintended spinal fusion, particularly around anchor points.
• In some systems, concerns about metal ion release from sliding components.

Conclusion

Sliding growing rod techniques represent a significant advancement in the treatment of early-onset scoliosis. By allowing for spinal growth while effectively controlling deformity, these innovative methods offer new hope for improved outcomes in young patients facing this challenging condition.

While challenges remain, and long-term studies are needed to fully understand the impact of these techniques, the initial results are promising. As research continues and technologies advance, we can expect further refinements in sliding growing rod systems, potentially revolutionizing the management of pediatric spinal deformities.

The success of these techniques underscores the importance of continued innovation in pediatric orthopedics, combining engineering ingenuity with medical expertise to offer better solutions for young patients with early-onset scoliosis.