Abstract
Introduction
Congenital and neuromuscular scoliosis occurring in children younger than 5 years have a high likelihood of progressing and end in severe curves. The concepts of treatment have changed with the emergence of distraction systems as VEPTR (vertical expandable prosthetic titanium rib) and growing rods. The aim of this study is to compare the clinical outcomes and complications that occur with the two systems used in the Instituto de Ortopedia Infantil Roosevelt.
Methods
An observational study of the transversal, comparative cut was designed by evaluating spinal surgeries performed between 2008 and 2012 at the Instituto de Ortopedia Infantil Roosevelt, including patients in whom implantation of an elongation system was performed and then underwent a program of periodic lengthening with VEPTR technique or growing rods. The number of elongations performed analyzed the surgical time, postoperative Cobb angle, bleeding, and complications. For quantitative variables, measures of central tendency and dispersion measures and confidence intervals were obtained; for those qualitative variables, ratios and confidence intervals at 95% were obtained. Statistical differences between groups were evaluated using the Student t test, Mann–Whitney U, Pearson chi-square, and Fisher exact tests depending on the nature of the variable. Analyses were performed using SPSS statistical software Statistics Version 21.
Results
A total of 40 patients met the selection criteria, 17 patients with growing rods and 23 patients with VEPTR system. The composition of the two groups had similar clinical characteristics. No significant differences in mean elongations number, bleeding, and implantation time were observed; however, the average correction of the deformity with the growing rods system (50.89 degrees) was 15.89 degrees higher than with the VEPTR (30.0 degrees) system. The complications were more frequent with VEPTR system: for the growing rod system six patients (35%) had complications, while for the VEPTR system was 10 patients (43%). However, complications because of the failures in the implanted materials were more frequent in patients with rods 35.3%, compared with 4.3% in the VEPTR, and clinical complications were more frequent in the VEPTR 43%, compared with 11.8% in growing rods.
Conclusion
When comparing different elongation systems of the spine, used to treat the congenital and neuromuscular scoliosis in children younger than 5 years, we conclude from this study that the correction of the scoliotic curve is higher with the growing rods system, but with more complications related with implant failures and minor clinical complications compared with VEPTR; these results are similar to those found in the literature.