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Kyphosis and Early-Onset Spine Deformity PowerPoint Presentation

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Description : Check out this medical presentation on Orthopaedics, which is titled "Kyphosis and Early-onset Spine Deformity (EOSD)", to know about kyphosis and early-onset spine deformity (EOSD).

Tags : Orthopaedics, Kyphosis, Early-onset Spine Deformity, EOSD

Published on : Aug 18, 2021 | Views : 1545 | Downloads : 2

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Slide 1-

Top 3 Articles That Changed My Approach to EOS Kyphosis Kyphosis Pulmonary Outcome & T1-12 Length Top 10 List = too long
Slide 2-

Kyphosis and Early-onset Spine Deformity (EOSD) A Problem Seeking a Solution ?? C.E. Johnston MD ICEOS Warsaw 2014 Disclosures : Medtronic (research support, financial support/other) Elsevier (financial)
Slide 3-

“Hyperkyphosis” – Effect on Treatment Complicates growth-friendly management (casts, brace, surgical) if apex above T8 1000
Slide 4-

ppt slide no 4 content not found
Slide 5-

Non-flexible Kyphosis – Major Cause of Proximal Anchor Failure Schroerlucke et al (GSSG), 2012 Spine 90 pts, f/u 5-7yr complic*/ #pts K- <10o thor kyph 12/26 N 10-40o 16/35 K+ >40o 34/29 *- implant related Infection rate: K+ 28% N 2.8% K- 12%
Slide 6-

Implant complications vs preop th kyph Survival curve
Slide 7-

Proximal Anchor Failure / Kyphosis What about VEPTR ? Reinker et al: Can Veptr Control Progression of Early-onset Kyphoscoliosis ?CORR 2011 14 pts, 5.8 yr f/u Selection : rx plan altered to specifically treat problematic thoracic kyphosis ….normal kyphosis initially, hyperkyphosis during rx
Slide 8-

T2-12 mean kyph 68o 91o @ f/u No change in T1-5… partial p.j.k. problem Scoliosis curves not improved (3-16 expansions) Thoracic length increase 2.6 cm (-1 – 7.5) 7/14 req’d revision of proximal cradle Cradle below 3rd rib Insufficient distal anchor point ( above L3) Rib-rib constructs ineffective …..extend to pelvis if possible, 2nd device on opposite side Reinker et al, 2011
Slide 9-

PJK w/ VEPTR Distracting upper Th ribs doesn’t necessarily move upper Th spine congruently, creates +ve sagittal balance subsidence
Slide 10-

Flatback 2o repeated distractions (esp. with pelvic anchors in ambulatory patients JT Smith, Bilateral Rib-to-Pelvis Technique. CORR 469, 2011 9/05 8/96
Slide 11-

Kyphosis – biomechanically not good for distraction-based methods Posterior pull-off forces large (use wires above) Cantilever plowing (screws) possible - ? Hooks/wires better? Distraction creates kyphosis Rod contour can become inappropriate as lengthening proceeds, worsens as more kyphosis occurs
Slide 12-

Anti-kyphosis construct – match radius of curvature of 2 rod segments to sagittal plane “Veptr” concept Exacerbated by distraction of L-S segments -> +ve sagittal balance
Slide 13-

5 yo congenital myopathy ROS benign, no significant respiratory episodes x 4 yr Pft unable to obtain Sat 99% RA, RR 14
Slide 14-

Initial xrays traction
Slide 15-

Ideal growing rod candidate ? Anti-kyphosis construct proximally Fuse proximal anchors @ initial procedure – minimal distraction Dominoes proximal (rod contour issue during lengthening) Sublaminar backup for upper claw
Slide 16-

2 yrs po (3 lengthenings) T1-12=24 cm #4
Slide 17-

Last f/u before fusion age 11 1 broken rod revision, T1-12 = 28 cm
Slide 18-

Non-flexible Kyphosis – Major Cause of Proximal Anchor Failure Preop HGT to decrease deformity (Emans SRS 07) Instrument into cervical lordosis (not chest wall) Fuse upper anchors first, include T1-4/5 prn, then distract for correction @ 1st lengthening (not chest wall) What’s Changed ?
Slide 19-

Preop Traction x 2mo Lengthen x4
Slide 20-

Over-interpretation of Karol et al Worst PFT’s at f/u were in patients fused to T1-2……but all were fused T1/2 –> low Th or L levels = entire T spine up to T1/2
Slide 21-

Are we sure we know what we’re doing? JBJS 96-A ; Aug 2014
Slide 22-

Dede, Motoyama et al JBJS 2014 Pulmonary and radiographic outcomes of VEPTR Age 4.8 yr /11 expansions/ 6 yr f/u T1-12=14.9 cm ……NOT NEARLY ENOUGH (Karol et al JBJS ‘08)
Slide 23-

Dede, Motoyama et al JBJS 2014 Pulmonary and radiographic outcomes of VEPTR Th kyphosis (57 -> 66 all patients) +ve sagittal imbalance high Th kyphosis Inverse correlation between hyperkyphosis and FVC %pred Similar outcomes reported by Reinker and Lattig Counterpoint – most severely involved congenital spine/chest wall cases
Slide 24-

TSRH GR “Graduates” paper #20 T1-12cm MTdeg Preop 13.9 98 Last surg 22.8 48 Last f/u 23.9 42 Complication (rod/anchor): 7 in 4 patients PFT 1st(6+9) f/u (13+0) FEV1 (L) .71 1.45 FEV1 (%) 61 46.5 FVC (L) .75 1.73 FVC (%) 62 49 Conclusions: in spite of what appears to be satisfactory thoracic length gain and curve correction during 7 year of surgical management with acceptable complication rate, pulmonary outcomes are diminished by % pred outcomes criteria.
Slide 25-

Have pulmonary outcomes affected my practice ? Surgical lengthening and expansions worrisome lack of “improvement” Re-assessment of early intervention in favor of delaying tactics Emphasizes lack of clinically important outcome data re TIS and natural hx, especially severe congenital cases
Slide 26-

2 y.o. male w/ J-L Start rx asap? Mother age 22 – no rx Asymptomatic T1-12 = 18.1 cm Grandmother age 49 – no rx Respiratory sx - ? Age, BMI T1-12 = 18.7 cm
Slide 27-

Sagittal plane (kyphosis) problems –> use HGT + fuse in prox anchors before start More severe chest wall deformities (rib anchors): Constant surveillance for kyphosis Better nat’l hx info before start Avoid ineffective serial surgeries
Slide 28-

ppt slide no 28 content not found
Slide 29-

Arthrogryposis Early vs Late Rx Vigorous early prophylactic intervention results in CT lung vol 605cc
Slide 30-

Hypoplastic thorax TIS likely -> expansion technique Inflexible deformity Extra Anchors, more distraction, but….. Thorax expanded, curve larger, length ? 1/03, T1-12 = 14.5 8/05, T1-12 = 14.9 6/10, T1-12 = 15.6
Slide 31-

Cong Scoli w/ rib fusions age 7 / 20 operations Price of “early” surgery
Slide 32-

FVC (pred) & Lung compliance
Slide 33-

TSRH Growing Rod “Graduates” 5 idiopathic-like, 1 cong, 1 amb n-m 74 mo 1st surgery ; 44 mo delay in 4/7 8 procedures (incl. initial), 1 unplanned, 6 lengthenings f/u age 13 yr (156 mo) 5 definitive fusion 1-2.5 yr, 2 obs after last lengthen 3 yrs
Slide 34-

Initial Rx – Traction x 2 mos.