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Topic:

Early Onset Scoliosis

Issue:

Spine

Category:

Developmental

Title:

Do Pedicle Screws That Terminate in the Costovertebral Joint Compromise Proximal Anchor Fixation in a Dual Growing Rod Construct?

Author:

Henstenburg, Jeffrey MD; Hori, Yusuke MD; Rogers, Kenneth J. PhD; Petfield, Joseph L. MD; Shah, Suken A. MD; Gabos, Peter G. MD

Journal:

Journal of Pediatric Orthopaedics

Date:

February 2024

Reference:

44(2): p e151-e156, DOI: 10.1097/BPO.0000000000002559

Level Of Evidence:

III

# of Patients:

35

Study Type:

Retrospective cohort study

Location:

Single institution

Summary:

This study investigates whether placing pedicle screws that terminate in the costovertebral joint (CVJ) increases the risk of proximal anchor failure in dual growing rod (GR) constructs used for early-onset scoliosis (EOS).

Methods:

Retrospective review of patient demographics, radiographic parameters, and implant constructs, specifically looking at the location of proximal pedicle screws (whether they terminate within the CVJ) and rates of proximal screw pullout or failure.

Exclusions:

Patients with skeletal dysplasia or a history of previous posterior instrumentation were excluded from the study.

Results:

Demographics: Average age at surgery was 7.96 years (range: 4.0 to 15.2 years), with a follow-up of 3.7 years (range: 2.0 to 7.7 years). Etiology: 14% had idiopathic EOS, 14% congenital EOS, 34% neuromuscular EOS, 29% syndromic scoliosis, and 9% other causes. Screw Placement: Out of 195 proximal pedicle screws, 19 (10%) terminated within the costovertebral joint (CVJ). 37% of patients had at least one CVJ screw. Proximal Pullout: 2 patients (6%) experienced unilateral proximal pullout. Both of these patients had screws terminating within the CVJ on the affected side. Both constructs had 2 screws on the affected side and 3 on the unaffected side. No failures occurred in the remaining 17 CVJ screws.

Conclusions:

Placing pedicle screws that terminate in the CVJ is common and does not appear to significantly contribute to proximal screw pullout. However, when constructs use only two proximal screws, one of which terminates within the CVJ, unilateral implant failure may occur. Modifications to the construct should be considered in these cases to mitigate failure risks.

Relevance:

Limitations:

Perspective:

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