Proximal Anchor Constructs and Its Influence on Surgical Outcome in Growth Rod Technique; A Comparison Between Rib Hooks and Pedicle Screws

Abstract

Study DesignRetrospective. ObjectivesTo compare outcomes and complications of all-pedicle screw against hybrid constructs as proximal anchors in traditional growth rod technique. Summary of Background DataTraditional distraction-based growth rods, although the preferred technique in treating progressive curves in early-onset scoliosis (EOS) is not free from complications. Surgical outcome and implant-related complications can be influenced by the choice of construct, but there is a paucity of evidence in literature comparing different constructs with these techniques. MethodsA retrospective review was performed of 28 consecutive patients with progressive EOS treated between 2009 and 2015 with growth rod technique. Patients were divided into two groups; Standard group (SG), where all pedicle screw construct was used; and Hybrid group (HG), where proximal rib hooks and distal pedicle screws were used. Pre- and postoperative clinical and radiologic parameters and complications were recorded and compared. ResultsThere were 13 patients (8 females, 5 males) in SG and 15 patients (13 females, 2 males) in HG. There was statistically significant improvement in scoliosis correction and length gain after initial surgery in both groups, where patients in SG showed better correction than HG. However, neither the radiologic parameters nor the complication rates showed any statistically significant difference between the two groups. ConclusionData from our study indicate that the proximal anchors, whether spine-based or rib-based, do not differ much in their outcome and complication rates, and the success of growing-rod technique depends largely on the security of cephalad and caudal foundations. Level of EvidenceLevel IV.