Program 2016 Book ICEOS Utrecht Holland
10th International Congress on Early Onset Scoliosis NOVEMBER 17 & 18, 2016 • MUNTGEBOUW UTRECHT • UTRECHT HOLLAND
JOINTLY SPONSORED BY:
THE 2016 ICEOS IS PROUDLY ENDORSED BY:
10th INTERNATIONAL CONGRESS ON EARLY ONSET SCOLIOSIS November 17 – 18, 2016 | Muntgebouw Utrecht | Utrecht Holland
PROGRAM BOOK
Table of Contents
Conference Mobile App ............................................................................Inside Front Cover Supporter Acknowledgements ........................................................................................... 2 General ICEOS Information ................................................................................................. 9 Program Committee ......................................................................................................... 11 Faculty .............................................................................................................................. 13 Continuing Medical Education & Disclosures .................................................................... 15 Program Agenda ............................................................................................................... 29 Free Papers....................................................................................................................... 39 ePosters ........................................................................................................................... 92 GSF Donation Pledge Form ............................................................................................... 98 2017 ICEOS Save the Date .......................................................................... Inside Back Cover
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Supporter Acknowledgments ICEOS and the Growing Spine Foundation gratefully acknowledge the following company for its support:
Diamond Supporter
K2M
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Supporter Acknowledgments ICEOS and the Growing Spine Foundation gratefully acknowledge the following company for its support:
Diamond Supporter
NuVasive
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Supporter Acknowledgments ICEOS and the Growing Spine Foundation gratefully acknowledge the following company for its support:
Gold Supporter
Globus Medical, Inc.
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Supporter Acknowledgments ICEOS and the Growing Spine Foundation gratefully acknowledge the following company for its support:
Gold Supporter
Medtronic
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Supporter Acknowledgments ICEOS and the Growing Spine Foundation gratefully acknowledge the following company for its support:
Gold Supporter
Zimmer Biomet
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Supporter Acknowledgments ICEOS and the Growing Spine Foundation gratefully acknowledge the following company for its support:
Gold Supporter
DePuy Synthes
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Supporter Acknowledgments ICEOS and the Growing Spine Foundation gratefully acknowledge the following companies for their support:
Bronze Supporters
OrthoPediatrics Stryker
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General Information Target Audience This course is designed for orthopaedic and neurological surgeons, fellows, and residents who include pediatric spinal deformity surgery in their practices. Nurses, nurse practitioners, physician assistants, and physicians providing non‐operative care of spinal deformities may also benefit from the course. Educational Objectives As a result of this activity, the participants should be better able to: Describe growth of the spine & chest growth, and how to make decisions on treatment of early onset spinal deformity; Diagnose and recognize the natural history of syndromes causing early onset spinal deformity; Describe and minimize treatment complications of infection and neurologic damage; Identify biomechanical issues of immature bone, vertebrae, and ribs which affect treatment of EOS; Describe pulmonary physiology as it relates to EOS. Statement of Need The program is designed to meet the educational needs, reported by spine surgeons in various needs assessment surveys, to receive updates on current thinking regarding the treatment of adult and pediatric spinal deformity, and degenerative and spinal trauma problems. Off‐label Uses Note that specific medicines and medical devices discussed at this meeting may not yet be specifically cleared by the FDA for use in the United States. It is emphasized that package inserts must be referred to for labeling limitations for products used in the United States. Providers This program is jointly sponsored by Scoliosis Research Society (SRS) and the Growing Spine Foundation (GSF). Course Support This program is provided by the Growing Spine Foundation and supported by educational grants. ICEOS thanks the following companies for their generous grant support of the Growing Spine Foundation and ICEOS: NuVasive, K2M, Medtronic, Globus Medical, Zimmer Biomet, and DePuy Synthes. Exhibits The following companies are exhibiting in the Auditorium and Eerste Slagruimte: NuVasive, K2M, Medtronic, Globus Medical, DePuy Synthes, OrthoPediatrics, and Stryker. 9 | P a g e
General Information Company‐supported Surgical Forums (Non‐CME) You are invited to attend the concurrent non‐CME Surgical Forums Thursday, November 17th from 12:30 pm – 1:30 pm and Friday, November 18th from 7:30 – 8:30 am.
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2016 ICEOS Program Committee Chairman Behrooz A. Akbarnia, MD SAN DIEGO, CA | USA Committee John B. Emans, MD Co‐Chair Boston Children's Hospital BOSTON, MA | USA Michael P. Glotzbecker, MD Co‐Chair Boston Children's Hospital BOSTON, MA | USA Lindsay Andras, MD Co‐Chair Elect Children's Hospital of Los Angeles LOS ANGELES, CA | USA Laurel Blakemore, MD Co‐Chair Elect University of Florida GAINSVILLE, FL | USA Alain Dimeglio, MD Member‐at‐Large Lapeyronie Montpellier Hospital MONTPELLIER | FRANCE Ron El‐Hawary, MD, MSc, FRCS(C) CSSG IWK Health Centre HALIFAX, NS | CANADA Hazem B. Elsebaie MD FRCS Member‐at‐Large Cairo University Hospital CAIRO | EGYPT
Local Host René M. Castelein, MD, PhD University Medical Centre Utrecht UTRECHT | NETHERLANDS
John AI Ferguson, FRACS Member‐at‐Large Starship Children's Hospital/Auckland Bone and Joint Surgery AUCKLAND | NEW ZEALAND Ilkka J. Helenius, MD, PhD EPOS Turku University Hospital TURKU, | FINLAND Robert Huang, MD SRS Growing Spine Committee Nemours Dupont Pediatric Center PENSACOLA, FL | USA Gregory M. Mundis, Jr., MD Member‐at‐Large San Diego Center for Spinal Disorders LA JOLLA, CA | USA Colin Nnadi, MBBS, FRCSI, FRCS Member‐at‐Large Oxford University Hospitals Oxford | UNITED KINGDOM Stefan Parent, MD, PhD Member‐at‐Large Hôpital Ste‐Justine Montreal | CANADA Michael Ruf, MD Member‐at‐Large SRH Klinikum Karlsbad‐Langensteinbach REMCHINGEN | GERMANY
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2016 ICEOS Program Committee James O. Sanders, MD Member‐at‐Large University of Rochester Medical Center ROCHESTER, NY | USA Richard M. Schwend, MD Member‐at‐Large Children's Mercy Hospital KANSAS CITY, MO | USA Jianxiong Shen, MD Member‐at‐Large Peking Union Medical College BEIJING | CHINA John T. Smith, MD CSSG University of Utah SALT LAKE CITY, UT | USA Brandon Ramo, MD POSNA Texas Scottish Rite Hospital for Children DALLAS, TX | USA Michael G. Vitale, MD, MPH CSSG New York‐Presbyterian Morgan Stanley Children's Hospital NEW YORK, NY | USA Burt Yaszay, MD Member‐at‐Large Children's Specialists, San Diego SAN DIEGO, CA | USA Muharrem Yazici, MD Member‐at‐Large Hacettepe University ANKARA | TURKEY
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2016 ICEOS Faculty Behrooz Akbarnia, MD San Diego, CA | USA Zaid Al‐Aubaidi, MD Skeikh Khalifa Medical City Kobenhavn S | Denmark Lindsay Andras, MD Children's Hospital of Los Angeles Los Angeles, CA | USA Bert Arets, MD Univeristy Medical Centre Utrecht Utrecht | Holland Laurel Blakemore, MD University of Florida Department of Pediatric Orthopedics Gainsville, FL | USA Robert Campbell, MD The Children's Hospital of Philadelphia Philadelphia, PA | USA René Castelein, MD, PhD University Medical Centre Utrecht Utrecht | Holland Alain Dimeglio, MD Lapeyronie Montpellier Hospital Montpellier | France Jean Dubousset, MD Hopital Saint Vincent‐de‐Paul Paris | France Ron El‐Hawary, MD, MSc, FRCS(C) IWK Health Centre Halifax, NS | Canada Hazem Elsebaie, MD, FRCS Cairo University Hospital Cairo | Egypt
John Emans, MD Boston Children's Hospital Boston, MA | USA David Farrington, MD Hospital Universitario Virgen del Rocío Madrid | Spain John AI Ferguson, FRACS Starship Children's Hospital/ Auckland Bone & Joint Surgery Auckland | New Zealand Michael Glotzbecker, MD Boston Children's Hospital Boston, MA | USA Theodoros Grivas, MD, PhD "Tzanio" General Hospital of Piraeus Piraeus | Greece Carol Hasler, MD University Children’s Basel Basel | Switzerland Azmi Hamzaoglu, MD Florence Nightingale Istanbul | Turkey Ilkka Helenius, MD, PhD Turku University Hospital Turku | Finland Dezsö Jeszenszky, MD, PhD Schulthess Clinic Zyrich Zurich | Switzerland Charles Johnston, MD Texas Scottish Rite Hospital Dallas, TX | USA Lawrence Karlin, MD Boston Children's Hospital Boston, MA | USA
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2016 ICEOS Faculty Gregory Mundis, Jr., MD San Diego Center for Spinal Disorders La Jolla, CA | USA Colin Nnadi, MBBS, FRCSI, FRCS Oxford University Hospitals Oxford | England Stephan Parent, MD, PhD Hôpital Ste‐Justine Montreal | Canada Jonathan Phillips, MD Orlando Health Orlando, FL | USA Brandon Ramo, MD Texas Scottish Rite Hospital for Children Dallas, TX | USA Gregory Redding, MD Seattle Children's Hospital Seattle, WA | USA Michael Ruf, MD SRH Klinikum Karlsbad‐Langensteinbach Remchingen| Germany Suken Shah, MD Alfred I DuPont Hospital for Children Wilmington, DE | USA Jianxiong Shen, MD Peking Union Medical College Beijing | China
David Skaggs, MD Children's Hospital of Los Angeles Los Angeles, CA | USA John Smith, MD University of Utah Salt Lake City, UT | USA Paul Sponseller, MD Johns Hopkins University Baltimore, MD | USA Ralf Stuecker, MD AKK Altonaer Kinderkrankenhaus GmbH Hamburg | Germany Kurt Ullrich, MD University of Hamburg Hamburg | Germany Michael Vitale, MD, MPH New York‐Presbyterian Morgan Stanley Children's Hospital New York, NY | USA Eric Wall, MD Children's Hospital Medical Center Cincinnati, OH | USA Burt Yaszay, MD Children's Specialists, San Diego San Diego, CA | USA Muharrem Yazici, MD Hacettepe University Hospital Istanbul | Turkey
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Continuing Medical Education & Disclosures Target Audience Spine surgeons (orthopaedic and neurological surgeons), residents, fellows, nurses, nurse practitioners, physician assistants, engineers and company personnel. Accreditation Statement This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of the Scoliosis Research Society (SRS) and the Growing Spine Foundation (GSF). SRS is accredited by the ACCME to provide continuing medical education for physicians. Credit Designation Statement SRS designates this live activity for a maximum of 12.75 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. FDA Statement (United States) Some drugs and medical devices demonstrated during this course have limited FDA labeling and marketing clearance. It is the responsibility of the physician to be aware of drug or device FDA labeling and marketing status. Insurance/Liabilities and Disclaimer GSF will not be held liable for personal injuries or for loss or damage to property incurred by participants or guests at the ICEOS including those participating in tours and social events. Participants and guests are encouraged to take out insurance to cover loss incurred in the event of cancellation, medical expenses, or damage to or loss of personal effects when traveling outside of their own countries. GSF cannot be held liable for any hindrance or disruption of the ICEOS proceedings arising from natural, political, social or economic events or other unforeseen incidents beyond its control. Registration of a participant or guest implies acceptance of this condition. The materials presented at this Continuing Medical Education activity are made available for educational purposes only. The material is not intended to represent the only, nor necessarily best, methods or procedures appropriate for the medical situations discussed, but rather is intended to present an approach, view, statement or opinion of the faculty that may be helpful to others who face similar situations. GSF disclaims any and all liability for injury or other damages resulting to any individual attending a scientific meeting and for all claims that may arise out of the use of techniques demonstrated therein by such individuals, whether these claims shall be asserted by a physician or any other person.
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Continuing Medical Education & Disclosures Disclosure of Conflict of Interest It is the policy of GSF to insure balance, independence, objectivity, and scientific rigor in all of its educational activities. In accordance with this policy, GSF identifies conflicts of interest with instructors, content managers, and other individuals who are in a position to control the content of an activity. Conflicts are resolved by GSF to ensure that all scientific research referred to, reported, or used in a CME activity conforms to the generally accepted standards of experimental design, data collection, and analysis. Disclosures Ali Abbasi Hamid Abbasi Behrooz Akbarnia
Stephen A. Albanese Mark Altena Afshin Aminian
Lindsay Andras
Keith Baldwin
Randal R. Betz
Laurel C. Blakemore
AMW Spine, LLC. ‐ Research Support AMW Spine, LLC. ‐ Research Support Depuy Synthes; Nuvasive, K2M ‐ Royalties; K2M, Nuvasive ‐ Paid Consultant; Nuvasive, Nocimed ‐ Own Stock; Nuvasive ‐ Research Support; Springer ‐ Financial Support Publisher; Spine, Spine Deformity Journal, Journal of Orthopaedic Science ‐ Board Member Spine Deformity Journal ‐ Board Member DePuy Synthes sponsored spine fellowship ‐ Research Support Medicrea ‐ Royalties; Speakers Bureau; Paid Consultant; Paid Employee; Research Support Biomet, Medtronic ‐ Speakers Bureau; Eli Lilly ‐ Owns Stock; Orthobullets ‐ Financial Support Publisher Synthes Trauma; Pfizer ‐ Paid Consultant; Pfizer ‐ Own Stock Journal of Bone and Joint Surgery‐ American: Financial Support DePuy Synthes Spine; Medtronic; Thieme ‐ Recive Royalties; DePuy Synthes Spine ‐ Speakers Bureau; Abyrx; ApiFix; DePuy Synthes Spine; Globus Medical; Medtronic; SpineGuard; Zimmer ‐ Paid Consultant; Advanced Vertebral Solutions; Orthobond ‐ Unpaid Consul K2M ‐ Speaker Bureau; K2M ‐ Paid Consultant; K2m ‐ Research Support; Spine Deformity Journal ‐ Board Member
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Continuing Medical Education & Disclosures Oheneba Boachie‐Adjei
Donita I. Bylski‐Austrow
Patrick J. Cahill
Michelle S. Caird René Castelein
Benny Dahl Robert DiBlasi
Søren Peter Eiskjær
Ron El‐Hawary
Hazem Elsebaie John Emans
Mark Erickson
Frances A. Farley James Farrell David Farrington
Depuy Synthes; K2M ‐ Receive Royalties; Trans1; K2M ‐ Speakers Bureau; Depuy Synthes; K2M; Trans1 ‐ Paid Consultant; K2M ‐ Own Stock; Depuy Synthes; Medtronic; K2M ‐ Research Support SpineForm, LLC ‐ Unpaid Consultant; SpineForm, LLC ‐ Research Support; SpineForm, LLC (patents) ‐ Financial Support; AAOS, Journal of Bone and Joint Surgery ‐ American, Pediatric Orthopaedic Society of North America, Scoliosis Research Society, Spine Deformity ‐ Board Member Journal of Pediatric Orthopaedics ‐ Board Member Medtronic unrestricted research grant (past), K2M unrestricted research grant (ongoing), AO Start‐Up grant ‐ Research Support Medtronic, K2M ‐ Speakers Bureau; K2M, Medtronic ‐ Research Support Mallinkrodt Medical ‐ Speakers Bureau; Mallinkrodt Medical ‐ Paid Consultant; Aerogen Phamaceuticals ‐ Research Support; Medtronic ‐ Speakers Bureau; Medtronic ‐ Paid Consultant; Medtronic ‐ Paid Employee; Medtronic ‐ Research Support; DePuy Synthes Spine; Medtronic; Halifax Biomedical Inc. ‐ Paid Consultant; DePuy Synthes Spine, Medtronic, EOS imaging, CIHR, SRS ‐ Research Support; CSSG, POSNA ‐ Board Member Nuvasive ‐ Own Stock Depuy Synthes‐ Receive Royalties; Medtronic Sofamor Danek, Synthes ‐ Paid Consultant; Journal of Children's Orthopedics ‐ Board Member Biomet ‐ Paid Consultant; POSNA Board of Directors ‐ Financial Support Publisher; POSNA ‐ Board Member Journal of Pediatric Orthopaedics ‐ Board Member K2M ‐ Research Support DePuy‐Synthes ‐ Paid Consultant 17 | P a g e
Continuing Medical Education & Disclosures Tamas Fekete John Ferguson
Nicomedes Fernández‐Baíllo John Flynn
George Frey
Sumeet Garg
Martin Gehrchen Michael Glotzbecker
Azmi Hamzaoglu Daniel Haschtmann John Heflin Ilkka Helenius
Anna K. Hell John A. Heydemann John Hutchinson Viral V. Jain
DePuy Spine ‐ Speakers Bureau K2M, Nile PJK Proximal Fixation ‐ Receive Royalties; K2M ‐ Speaker Bureau; Ellipse Technologies, K2M ‐ Paid Employee; K2M ‐ Own Stock DePuy‐Synthes Spine Medcomtech ‐ Paid Consultant Biomet, Wolter Kluwer Health, Lippincott Williams & Smith ‐ Receive Royalties; AAOS, American Board of Orthopedic Surgery, Inc., Orthopedics Today, Pediatric Orthopaedic Society of North America, Scoliosis Research Society ‐ Board Member Medtronic Sofamor Danek ‐ Receive Royalties; Spine Art ‐ Paid Consultant; Mighty Oak Medical ‐ Own Stock; Tital Spine ‐ Research Support Decision Support in Medicine ‐ Receive Royalties; Medtronic ‐ Paid Consultant; Decision Support in Medicine ‐ Financial Support Publisher; US News & World Report Children's Hospitals Orthopedic Working Group ‐ Board Member K2M, Medtronic ‐ Research Support Depuy ‐ Speakers Bureau; DePuy, A Johnson & Johnson Company, Medtronic ‐ Paid Consultant; Synthes, Via Chest wall and Spinal Deformity Study Group, GSSG, CSSG, HSG ‐ Research Support Medtronic ‐ Unpaid Consultant Swiss National Science Foundation ‐ Research Support Globus Medical, Medtronic Sofamor Danek ‐ Paid Consultant Medtronic, Baxter ‐ Speaker Bureau; Medtronic ‐ Paid Consultant; Medtronic ‐ Research Support; European Spine Journal ‐ Board Member Orthovasive ‐ Research Support Merck ‐ Own Stock Biomet, DePuy Synthes ‐ Speakers Bureau Medtronic Sofamor Danek Spine Form, LLC. ‐ Unpaid Consultant
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Continuing Medical Education & Disclosures Dezsö Jeszenszky Charles Johnston
Lori Karol
Diederik Kempen Patrick Kiely
Joseph Ivan Krajbich Mark Krinock Virginie Lafage
William Lavelle
Heiko Lorenz Scott Luhmann
William G. Mackenzie
David Marks Richard McCarthy
DePuy Spine J&J ‐ Receive Royalties; DePuy Spine J&J ‐ Research Support Medtronic Sofamor Danek, Saunders/Mosby‐Elsevier ‐ Receive Royalties; Saunders/Mosby‐Elsevier, Walters Kluwer ‐ Financial Support; Orthopedics, Journal of Childrens Orthopedics, POSNA, SRS ‐ Board Member Journal of American Academy of Orthopedic Surgeons, Walters Kluwer Publishers ‐ Board Member DePuy Synthes ‐ Research Support AO SPINE MASTERS, MEDTRONIC SPINE SUMMER UNIVERSITY, MEDTRONIC MINIMALLY INVASIVE SPINE, MEDTRONIC SPINE DEFORMITY, EUROSPINE, EFFORT ‐ Speakers Bureau K2m ‐ Speakers Bureau K2m ‐ Speakers Bureau; Stryker Spine ‐ Own Stock International Spine Study Group Foundation Scoliosis Research Society ‐ Research Support Covidien, DePuy, A Johnson & Johnson Company, Medtronic, Vertebral Technologies, Inc ‐ Research Support; SAS ‐ Board Member Orthovasive, Research Grant ‐ Research Support Globus Medical, Lippincot ‐ Receive Royalties; Medtronic, Styker, Orthofix ‐ Speakers Bureau; Medtronic, Styker, Orthofix ‐ Paid Consultant Biomarin ‐ Speaker Bureau; DePuy, A Johnson & Johnson Company ‐ Unpaid Consultant; Journal of Children's Orthopaedics Journal of Pediatric Orthopedics ‐ Board Member Depuy Synthes ‐ Receive Royalties; Stryker, K2M, Medtronic ‐ Speaker Bureau Medtronic ‐ Receive Royalties; Medtronic ‐ Speakers Bureau; Medtronic ‐ Paid Cosultant; Medtronic ‐ Financial Support; Manuscript reviewer for JPO and Spine Deformity ‐ Board Member 19 | P a g e
Continuing Medical Education & Disclosures Lotfi Miladi Kiril Mladenov Gregory Mundis
Peter Newton
Colin Nnadi
Hilali Noordeen
Sara O'Hara
Jean Ouellet
Joshua Pahys Howard Panitch Jeff Pawelek Jonathan H. Phillips
Javier Pizones
Euros : orthopaedic product ‐ Receive Royalties Nuvasive ‐ Speakers Bureau K2M, Nuvasive ‐ Receive Royalties; K2M, Nuvasive ‐ Speakers Bureau; K2M, Medicrea, Misonix, Nuvasive ‐ Paid Consultant; ISGGF, Nuvasive ‐ Research Support DePuy SYnthes Spine ‐ Receive Royalties; DePuy Synthes Spine, K2M ‐ Speakers Bureau; DePuy Synthes Spine, Cubist, K2M ‐ Paid Consultant; ElectroCore ‐ Own Stock; DePuy Synthes Spine and K2M via Setting Scoliosis Straight Foundation, EOS Imaging, Orthopedi Nuvasive ‐ Speakers Bureau; Ellipse technologies ‐ Research Support; European Spine Journal, Spine Deformity Journal ‐ Board Member Ellipse Technologies; K Spine; K2M; Stryker Spine ‐ Speaker Bureau; Ellipse Technologies; K Spine; K2M; Stryker Spine ‐ Paid Consultant; Ellipse Technologies; K Spine; K2M; Stryker Spine ‐ Financial Support; Ellipse Technologies; K Spine; K2M; Stryker Spi Toshiba Medical Ultrasound ‐ Speakers Bureau; Toshiba Medical Ultrasound ‐ Unpaid Consultant; Toshiba Medical Ultrasound ‐ Research Support; Depuy Synthes ‐ Paid Consultant; Depuy Synthes AO Foundation ‐ Research Support DePuy, A Johnson & Johnson Company; Globus Medical ‐ Paid Consultant Philips Respironics ‐ Paid Consultant San Diego Spine Foundation ‐ Board Member Biomet; OrthoPediatrics; Springer ‐ Receive Royalties; OrthoPediatrics ‐ Speaker Bureau; OrthoPediatrics ‐ Paid Consultant; Biomet ‐ Research Support; Spine Advisory Board OrthoPaediatrics ‐ Financial Support; Journal Pediatrics Orthopedics, Journal of So DePuy‐Synthes Spine ‐ Paid Consultant 20 | P a g e
Continuing Medical Education & Disclosures Brandon Ramo Gregory Redding
Joseph Reynolds Samuel Rosenfeld David P. Roye
Amer Samdani
James O. Sanders Vishal Sarwahi
Jeffrey R. Sawyer
Tom Schlösser John Schmidt Frank Schwab
Richard Schwend
Elsevier Publishing‐ Financial Support Publisher Wolters Kluwer Health, Pediatric Pulmonary section editor, UpToDate ‐ Finanacial Support Publisher SpineForm, LLC ‐ Paid Employee; SpineForm, LLC ‐ Own Stock; MediCrea Spine ‐ Unpaid Consultant POSNA, CSSG, CPIRF ‐ Research Support; Biomet, Medtronic, Stryker, International Healthcare Leadership, OMEGA, OMeGA Medical Grants, Cerebral Palsy Foundation, CMO Children of China, CMO Global Health Pass ‐ Financial Support; Journal of Bone and Joint Su Depeuy Synthes Spine ‐ Speakers Bureau; Depuy Synthes; Globus; Misonix; Stryker; Zimmer Biomet; Ethicon; Setting Scoliosis Straight Foundation, Scoliosis Research Society, Children's Spine Study Group ‐ Board Member Nuvasive ‐ Speakers Bureau; Abbott, Abbvie, GE Healthcare ‐ Own Stock Spinal USA‐ Receive Royalties; Medtronic, Spinal USA ‐ Unpaid Consultant; Spinal USA ‐ Research Support Mosby, Wolters Kluwer Health ‐ Lippincott Williams & Wilkins ‐ Receive Royalties; Mosby, Wolters Kluwer Health ‐ Lippincott Williams & Wilkins ‐ financial Support; DePuy, A Johnson & Johnson Company, Nuvasive ‐ Speakers Bureau; Medicrea Spine ‐ Research S AO Spine Young Researcher Award 2015 ‐ Research Support K2M ‐ Paid Employee; K2M ‐ Own Stock; International Spine Study Group Foundation Scoliosis Research Society ‐ Research Support Medtronic ‐ Paid Consultant; K2M ‐ Unpaid Consultant; Medtronic ‐ Financial Support
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Continuing Medical Education & Disclosures Suken A. Shah
David Skaggs
John T. Smith
Brian Snyder Paul D. Sponseller
Peter F. Sturm
Daniel Sucato
George Thompson
DePuy Synthes Spine; Arthrex, Inc; ‐ Receive Royalties; DePuy Synthes, Stryker Spine ‐ Speakers Bureau; DePuy Synthes Spine, K2M; Nuvasive; Stryker ‐ Paid Consultant; Globus Medical ‐ Own Stock; Depuy Synthes, K2M, Setting Scoliosis Straight Foundation, H Biomet Spine, Wolters Kluwer Health ‐ Lippincott Williams & Wilkins ‐ Receive Royalties; Biomet, Medtronic, Johnson & Johnson ‐ Speaker Bureau; ZimmerBiomet; Medtronic; Zipline Medical, Inc.; Orthobullets; Grand Rounds (a healthcare navigation company), G VEPTR 2, DePuy Synthes Spine ‐ Receive Royalties; Nuvasive ‐ Speakers Bureau; Biomet, Ellipse Technologies, Globus Medical, Spineguard, DePuy Synthes, Nuvasive ‐ Paid Consultant; Children's Spine Foundation ‐ Board Member Orthopediatrics ‐ Unpaid Consultant Globus Medical; DePuy, A Johnson & Johnson Company ‐ Receive Royalties; DePuy Synthes Spine ‐ Speakers Bureau; DePuy Synthes Spine, Globus ‐ Paid Consultant; DePuy, A Johnson & Johnson Company ‐ Research Support; Journal of Bone and Joint Surgeryoakstone Nuvasive; Medtronic; DePuy, A Johnson & Johnson Company; Ellipse Technologies; Medtronic Sofamor Danek ‐Paid Consultant; Biomet ‐ Unpaid Consultant; DePuy Spine ‐ Research Support; Journal of Children's Orthopaedics, SRS, POSNA ‐ Board Member Globus Medical, Saunders/Mosby‐Elsevier ‐ Receive Royalties; Saunders/Mosby‐ Elsevier ‐ Financial Support Publisher; OrthoPediatrics ‐ Receive Royalties; JBT Medical Technologies ‐ Paid Employee; Spine Form ‐ Unpaid Consultant; OrthoPediatrics ‐ Own Stock; Medtronics, ogies, OrthoPediatrics, Shriner's Hospital for Children, nuSpine Medical Techno, Stryker ‐ Financial S
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Continuing Medical Education & Disclosures Vidyadhar Upasani Nothing to Disclose Jasmin Matthew Oussama Alaa Oluwabamise Harry Sultan Amjad Thomas Ahmed Emily Mehmet Mariarenata Keith Batoul Andrea Carol Carrie Jose Luis Paloma Teresa Tracey Alim Can Senol Josephine Mehmet Chiara Hasan Thane Nikki Zachary J. Viviana Willy Cameron Aaron Ali David Michelle C. George Jeffrey W.
Orthopediatrics ‐ Speakers Bureau; Orthopediatrics ‐ Paid Consultant;
Aarnio Abbott Abousamra Ahmad Akinnawo Akoto Aldebeyan Alrashdan Andersen Aoude Auran Ayvaz Bacchin Bachmann Badwan Baioni Barnewolt Bartley Bas Bas Bas Bastrom Baymurat Bekmez Berger‐Groch Berktas Bersanini Bilgili Blinman Bloch Bloom Bompadre Boucharel Brucker Buckland Bumin Bumpas Burke, MS Byram Campbell 23 | P a g e
Continuing Medical Education & Disclosures Richard Robert Anthony Valentina Siobhán Patrick Daniel Mohammed Chukwudi Andrew Luca Fabio Braydon Ethan Marco Micaela Eric H. Gokhan Mario Colleen
Noelia Henry Thomas Meric Mehmet Nicholas A. Esther Milan Tara Niki Enrique Zach Luke Stefano Steven Alexander Sarah Christophe David L. Jaime A. Nicholas Miriam Tiziana Richard Alexandra
Campbell Campbell Capraro Caretti Carr Carry Chan Chehrasan Chukwunyerenwa Clarke colombo Connell Cottrill Crostelli Cyr Davis Demirkiran Di Silvestre Ditro Domingo‐ Montesinos Duah Ember Eenercan Eroglu Feinberg Fernández Filipovič Flynn Fransen Garrido Garza Gauthier Giacomini Gibbons Gibson Gilday Glorion Glos Gomez Gonsalves Gotti Greggi Gross Grzywna 24 | P a g e
Continuing Medical Education & Disclosures Brian Regina Christina Liam Alister Diane Victoria Daniel Johan Johann Martin Sandra L. Claire Pooria Harry M. Timothy Chun Wai Jennifer Mike Francesca Lloydine Megan Ajeya Nima Muayad Sinan Bettina Selhan Lawrence Ozcan Mehmet Burak Brian Steven Nejib Paul D. Gizem Irem Waleed Frank Ismail Aykut William Alexandra Tyler Walter Ozren Swamy
Hanna Hanstein Hardesty Harris Hart Hartman Heagy Hedequist Heemskerk Henckel Herman Hobson Hogg Hosseini Hothi Hresko Hung Hurry Hutton Izzo Jacobs Jeffords Joshi Kabirian Kadhim Kahraman Kaiser Karadereler Karlin Kaya Kaynar Kelly Kenney Khouri Kiely Kinikli Kishta Kleinstück Kocyigit Koeck Kondratyeva Kreitz Krengel Kubat Kurra 25 | P a g e
Continuing Medical Education & Disclosures Nikita Laura‐Ann Julian Milan Xingye Ying David Francisco Michael Chike Elena Adam Massimo José Manuel Dario Gaume Hiroko Allison Oscar H. Osvaldo Anna Lynn Ellie Nicole Daniel Patricia R. Justin Ana Pierre Jorge Mario Jessica Aristide Stephen Francesco John D. Christopher Ayhan Michael Stacie Courtney Matthew Nusret Z. Deniz Emily M. Jonathan
Lakomkin Lambert Leong Leznar Li Li, MD Limon Lirola‐Criado Loebinger Madu Maredi Margalit Mariani Martínez‐Salas Mascello Mathilde Matsumoto Matthews Mayer Mazza McClung McCullough McNulty Michael Miller Miller Mistovich Mitchell Moens Morales Morgan Morigi Morris Motta Mueller Murphy Mutlu Nance Nguyen O'Donnell Oetgen Ok Olgun Olson Oore 26 | P a g e
Continuing Medical Education & Disclosures Ben Sadan Simon Claire Vasiliki Saba Vishwas Peter Heide Silvia Mar Francisco Javier Asger Greval Connie María del Mar Martin María Eric J. Christian Fredrick Oliver D. Martin Carsten Christopher Kenneth J. Michael Pedro Pooria Jose Miguel Tunay Antonio Sebastiaan Lindsay R. Jacob F. Mathew Mark Tom Mathew Jianxiong Maksim Walt John June C. Benjamin T. Jochen Alexandra
Orlik Ozcan Padley Palmer Panagiotopoulou Pasha Patil Pedersen Pérez Pérez Pérez‐Grueso Petersen Poe‐Kochert Pozo‐Balado Prymek Raya Rebich D.O. Refakis Reighard Reinsch Repko Ridderbusch Robbins Rogers Ruf Rubio Salari Sánchez‐Marquez Sanli Scarale Schelfaut Schultz Schulz Schur Schwartz Semple Sewell Shen Shlykov Simmons Skinner Smith Smith Son‐Hing Soroceanu 27 | P a g e
Continuing Medical Education & Disclosures
Alan Tricia Oliver Brendan Ralf Khadija Jesse Dong‐Phuong Hope Michael Stewart Henry Bekir Yavuz Onur Levent Norberto Francesco Stephen Wayne Sebastiaan Regina Yi Kwadwo Qibin Theresa
Spurway St. Hilaire Stokes Striano Stuecker Tayabali Taylor Tran Trevino Troy Tucker Tutu Ucar Ulusoy Ventura Vommaro Wendolowski Whitmore Wijdicks Woon Yang Yankey Ye Yirerong
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Program Agenda Thursday, November 17, 2016 6:45 – 7:30 am
Coffee & Exhibit Viewing
Registration Welcome & Course Overview Behrooz A. Akbarnia, MD Paul D. Sponseller, MD Session 1: EOS: Beyond the Spine Moderator: Alain Dimeglio, MD E‐moderator: Brandon Ramo, MD
7:30 – 7:35
7:35‐9:10 7:35 7:45 8:00 8:10 8:25 8:30 8:40 8:50 9:00
9:10 – 9:25
9:25 – 10:00 10:00‐11:40
Auditorium Eerste Slagruimte Receptie Productieruimte
Productieruimte
Chest Wall Long‐term consequences of rib distraction: Solving one problem and creating another one Carol Hasler, MD Dynamic diaphragmatic measurement – MR and surface techniques Robert Campbell, MD Diaphragm mechanics and the developing chest Greg Redding, MD EOS and the developing lung Bert Arets, MD Discussion Imaging and Growth Spino‐pelvic alignment and posture: Is child a miniature of adult? René Castelein, MD, PhD What is true normal growth of the spine…and how do we measure it Ron El‐Hawary, MD, MSc, FRCS(C) Imaging with EOS, how does 3D help us with early onset deformity outcomes Stefan Parent, MD, PhD Discussion Keynote: EOS and the Developing Lung Introduction: Behrooz A. Akbarnia, MD Productieruimte Jean Dubousset, MD Paris University Auditorium Refreshment Break & Exhibit Viewing Eerste Slagruimte Session 2: Free Papers Moderator: René Castelein, MD, PhD Productieruimte E‐moderator John Al Ferguson, FRACS
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Program Agenda
10:00
10:05
10:10
10:15
10:20
10:25
10:30
10:35
10:40
10:45
Free Paper #14 (See Page 56): Three Dimensional True Spine Length: A Novel Technique for Assessing the Outcomes of Scoliosis Surgery Alan Spurway, Jennifer Hurry, Luke Gauthier, Ben Orlik, Chukwudi Chukwunyerenwa, Waleed Kishta, Ron El‐Hawary Free Paper #16 (See Page 58): Efficacy of Preoperative Halo Gravity Traction in Children with Severe Early Onset Scoliosis Paul D. Kiely, Sandra L. Hobson, Kwadwo Poku Yankey, Henry Duah, Henry Tutu, Theresa Yirerong, Harry Akoto, Oheneba Boachie‐Adjei Free Paper #34 (See Page 82): Risk of Curve Progression in EOS after Surgical Decompression of Chiari Malformation Eric Davis, Michael Glotzbecker, Michael Troy, Lawrence Karlin, John Emans, M Timothy Hresko, Daniel Hedequist Discussion Free Paper #36 (See Page 85): Limiting Pre‐Incision Instrument Uncovered Time via Quality Practice Intervention Decreases VEPTR Implantation Surgical Site Infections Diane Hartman, Robert Campbell, Nikita Lakomkin, John Flynn, Michael Nance, Thane Blinman, Oscar H. Mayer, Howard Pantich, Anthony Capraro, Jesse Taylor, Brian Hanna, Keith Baldwin, Patrick Cahill, Lloydine Jacobs Free Paper #27 (See Page 74): Improvement of Pulmonary Function Measured by Patient‐Reported Outcomes in Patients with Spinal Muscular Atrophy after VEPTR Surgery Michael G. Vitale, Hiroko Matsumoto, John D. Mueller, Patrick J. Cahill, Peter F. Sturm, David P. Roye, John T. Smith Free Paper #21 (See Page 65): Vancomycin Powder Lowers Infection Rate in Growing Rod Surgery in Early Onset Scoliosis: A Preliminary Report R. Justin Mistovich, Connie Poe‐Kochert, Jochen Son‐Hing, Christina Hardesty, George Thompson Discussion Free Paper #12 (See Page 54): Wound Complication Risk Stratification in VEPTR Surgery Anthony Capraro, Richard Campbell, Diane Hartman, Robert Campbell, Nikita Lakomkin, John Flynn, Michael Nance, Thane Blinman, Oscar H. Mayer, Howard Pantich, Jesse Taylor, Brian Hanna, Keith Baldwin, Patrick Cahill Free Paper #19 (See Page 61): Spinal Growth in Patients with Juvenile Idiopathic Scoliosis Treated with Boston Brace Johan Heemskerk, Diederik Kempen, Mark Altena, Sebastiaan Wijdicks, René Castelein
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Program Agenda
10:50
10:55 11:00
11:05
11:10 11:15 11:20
11:25
11:30
11:35 11:40 – 12:30 12:30 – 1:30
Free Paper #26 (See Page 73): Hemoglobin Levels Pre‐ and Post‐Treatment as a Surrogate for Disease Severity in Early Onset Scoliosis Michael Glotzbecker, Joshua Pahys, Patrick Cahill, Jeffery Sawyer, Michael Vitale, Alexandra Grzywna, Patricia Miller Discussion Free Paper # 37 (See Page 86): “Next Day” Exam Reduces Radiation Exposure in Cervical Spine Clearance at a Level 1 Pediatric Trauma Center: A Pilot Study Martin Herman, Jonathan Phillips Free Paper #39 (See Page 88): Growth of the Spine in Early Onset Idiopathic Scoliosis Hong Zhang, Daniel Sucato Free Paper #33 (See Page 81): CT morphometric analysis of central airways in patients with right thoracic scoliosis and abnormal sagittal profile Enrique Garrido, James Farrell, Prashant Valluri Discussion Free Paper #38 (See Page 87): Effectiveness in Casting in Non‐Idiopathic Scoliosis Dong‐Phuong Tran, Charles Johnston Free Paper #8 (See Page 49): Weight Gain After VEPTR Surgery May Be From Nutritional Optimization Rather Than Improvement In Pulmonary Function Ying Li, Maksim Shlykov, Christopher Robbins, Michelle Caird, Frances Farley, Michelle Burke Free Paper #4 (See Page 43): Pulmonary function evaluation in children affected by neuromuscular scoliosis treated for the spine deformity with Magnetically Controlled Growing Rods Luca Fabio Coloumbo, Miriam Gotti, Chiara Bersanini, Francesco Motta, Francesca Izzo, Valentina Caretti Discussion Auditorium Lunch Eerste Slagruimte Company Supported Non‐CME Workshops Challenges in Early Onset Scoliosis René Castelein, MD, PhD Oranjezaal Supported by: K2M
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Program Agenda
1:35 – 1:45
1:45‐2:55
1:45 1:55 2:10 2:20 2:30 2:40 2:50 3:00 – 3:15
3:15‐3:55
3:15
3:20
Hybrid Fixation for the Treatment of Scoliosis David Antekeier, MD Stijlkamer Supported by: Globus Medical MAGEC Best Practices Roundtable Ralf Stuecker, MD, Michael Vitale, MD, MPH, & Productieruimte Suken Shah, MD Supported by: NuVasive Welcome from the Deputy Mayor of Utrecht Things to See and Do in Utrecht Productieruimte Drs. V. (Victor) Everhardt, Deputy Mayor Session 3: Mini‐Symposium— Skeletal Dysplasias and Mucopolysaccharidoses Productieruimte Moderator: Muharrem Yazici, MD E‐moderator: Jianxiong Shen, MD Mucopolysaccharidoses and spinal deformities Ralf Stuecker, MD Molecular genetics and medical treatment of Mucopolysaccharidoses Kurt Ullrich, MD Discussion The spectrum of EOS in skeletal dysplasias Suken Shah, MD The Hamburg experience with EOS in skeletal dysplasia Ralf Stuecker, MD The Dupont‐Nemours experience with cervical spine in skeletal dysplasia Suken Shah, MD Discussion Auditorium Refreshment Break & Exhibit Viewing Eerste Slagruimte Session 4: Free Papers—The Behrooz Akbarnia Award Productieruimte Moderator: Ron El‐Hawary, MD, MSc, FRCS(C) E‐moderator: Michael Vitale, MD, MPH Free Paper #9 (See Page 50): Graduation Protocol After Growing Rod Treatment: Is Removal of Hardware Without New Instrumentation a Realistic Approach? Z. Deniz Olgun, Aykut Kocyigit, Mehmet Eroglu, H. Gokhan Demirkiran, Mehmet Ayvaz, Muharrem Yazici Free Paper #31 (See Page 78): Development of a Risk Severity Score Predicting Surgical Site Infection in Early Onset Scoliosis Michael Vitale, Hiroko Matsumoto, Nicholas Feinberg, John Smith, Amer Samdani, Michael Glotzbecker, Jeffrey Sawyer, David Skaggs, David Roye
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Program Agenda
3:25
3:30
3:35
3:40
3:45 3:50 3:55‐5:15
5:15 – 6:30
Free Paper #20 (See Page 63): Health‐Related Quality Of Life In Early‐Onset Scoliosis Patients Treated Surgically: EOSQ Scores In Traditional Growing Rod Vs. Magnetically‐ Controlled Growing Rods Muharrem Yazici, H. Gokhan Demirkiran, Z. Deniz Olgun, Gizem Irem Kinikli, Senol Bekmez, Mehmet Berktas Discussion Free Paper #28 (See Page 75): Quality of Life and Burden of Care in Patients with EOS Undergoing Casting Emily Auran, Hiroko Matsumoto, David P. Roye, Michael G. Vitale, Peter F. Sturm, James O. Sanders, Matthew Oetgen, Sumeet Garg, Children's Spine Study Group, Growing Spine Study Group Free Paper #24 (See Page 69): Natural History of Sagittal Spinal Alignment in Children with Achondroplasia John A. Heydemann, Suken A. Shah, Kenneth J. Rogers, William G. Mackenzie, Oussama Abousamra, Tyler Kreitz, Colleen Ditro Free Paper #25 (See Page 72): Juvenile Idiopathic Scoliosis: Brace Treatment to Skeletal Maturity Amanda Whitaker, Alexandra Grzywna, Timothy Hresko, Lawrence Karlin, John Emans, Daniel Hedequist, Michael Glotzbecker Discussion Ask the Faculty Case Discussions: Bring your cases! (Non‐CME) EOS complications and unsolved problems John B. Emans, MD Productieruimte Zaid Al‐Aubaidi, MD John Al Ferguson, FRACS Innovative techniques and solutions Michael Vitale, MD, MPH Stijlkamer Muharrem Yazici, MD Michael Ruf, MD Cervical spine Burt Yaszay, MD Oranjezaal Gregory Mundis, Jr, MD Ilkka Helenius, MD, PhD Auditorium Reception Eerste Slagruimte
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Program Agenda Friday, November 18, 2016 Auditorium Eerste Slagruimte
7:00 – 7:30 am
Coffee / Exhibit Viewing
7:30 – 8:30
Company Supported Non‐CME Workshops Growth Guidance vs. Distraction Richard McCarthy, MD and Ron El‐Hawary, MD Oranjezaal Supported by: Medtronic Neuromuscular Scoliosis: Principles of Management and Complication Prevention Suken A. Shah MD, Paul D. Sponseller MD, and Productieruimte Burt Yaszay MD Supported by: DePuy Synthes Session 5: Free Papers Moderator: Stefan Parent, MD, PhD Productieruimte E‐moderator: Hazem Elsebaie, MD, FRCS Free Paper #11 (See Page 53): Hemivertebra Resection and Transpedicular Short Fusion in Children Younger than 5 Years. A Mid‐Term Follow‐Up Analysis Jose Miguel Sánchez‐Marquez, Mar Pérez, Javier Pizones, Nicomedes Fernández‐Baíllo, Francisco Javier Pérez‐Grueso Free Paper #10 (See Page 51): Traditional Growing Rod Graduates with Various Diagnoses have Similar Clinical and Radiographic Outcomes Jeff Pawelek, Behrooz Akbarnia, Pooria Hosseini, Pooria Salari, David Marks, Suken Shah, David Skaggs, John Emans, Paul Sponseller, George Thompson, Growing Spine Study Group Free Paper #5 (See Page 44): Sliding‐Growing Rod Technique in the Treatment of Early Onset Scoliosis: Clinical and Radiological Outcomes and Effect on Pulmonary Functions Tunay Sanli, Sinan Kahraman, Meric Enercan, Azmi Hamzaoglu, Selhan Karadereller, Ozcan Kaya, Bekir Yavuz Ucar, Nurset Ok, Alim Can Baymurat, Amjad Alrashdan Discussion Free Paper #18 (See Page 60): Five or more Proximal Anchors and including the Upper End Vertebrae (UEV) Protects Against Reoperation in Growth Friendly Constructs Liam Harris, Lindsay Andras, Gregory Mundis, Paul Sponseller, John Emans, David Skaggs, Growing Spine Study Group Free Paper #23 (See Page 68): Spinopelvic Parameters Predict Development of Proximal Junctional Kyphosis in Early Onset Scoliosis Ozren Kubat, Virginie Lafage, Jennifer Hurry, Alexandra Soroceanu, Frank Schwab, David Skaggs, Ron El‐Hawary, Children's Spine Study Group, Growing Spine Study Group
8:35‐10:10
8:35
8:40
8:45
8:50
8:55
9:00
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Program Agenda 9:05 9:10 9:15
9:20
9:25
9:30
9:35
9:40
9:45 9:50 9:55 – 10:15 10:15‐11:50 10:15 10:30
Free Paper #35 (See Page 83): Ventral Rod Migration of Posteriorly Applied Growing Rod Technology for Early Onset Scoliosis Patrick Kiely, Laura‐Ann Lambert Discussion Free Paper #7 (See Page 48): Efficiency and Reliability of Ilio Sacral Screws in Fusionless Surgery for Neuromuscular Scoliosis: Preliminary Results of 100 Patients Lotfi Miladi, Gaume Mathilde, Nejib Khouri, Christophe Glorion Free Paper #22 (See Page 67): Construct Levels to Anchored Levels Ratio and Rod Diameter are Associated with Implant‐Related Complications in Traditional Growing Rods Pooria Hosseini, Behrooz Akbarnia, John Emans, Paul Sponseller, Jeff Pawelek, Stacie Nguyen, Peter Sturm, Growing Spine Study Group Free Paper #32 (See Page 79): Vertebral Column Resection: Indications and Utilization in the EOS Population Anna McClung, Gregory Mundis, Jeff Pawelek, Nima Kabirian, Burt Yaszay, James Sanders, Paul Sponseller, Oheneba Boachie‐Adjei, Behrooz Akbarnia, Daniel Sucato, Growing Spine Study Group Discussion Free Paper #6 (See Page 46): Posterior Hemivertebra Resection and Short Segment Fusion with Pedicle Screw Fixation for Congenital Scoliosis in Children Younger than 5 Year; with minimum 8 years Follow‐up Sinan Kahraman, Ozcan Kaya, Selhan Karadereller, Nurset Ok, Tunay Sanli, Bekir Yavuz Ucar, Meric Enercan, Azmi Hamzaoglu, Alim Can Baymurat, Onur Levent Ulusoy, Ayhan Mutlu, Amjad Alrashdan Free Paper #13 (See Page 55): Sacral‐Alar‐Iliac Fixation in Early Onset Scoliosis Ethan Cottrill, Cameron Brucker, Adam Maragalit, Paul D. Sponseller Free Paper #15 (See Page 15): Total hemivertebra resection by posterior approach in congenital scoliosis and Kyphoscoliosis: results with 7 years mean follow up Marco Crostelli, Osvaldo Mazza, Massimo Mariani, Dario Mascello Discussion Auditorium and Refreshment Break & Exhibit Viewing Eerste Slagruimte Session 6: Cervical Spine Symposium Moderator: Burt Yaszay, MD Productieruimte E moderator: Gregory Mundis, Jr, MD OS Odontoideum Ilkka Helenius, MD, PhD Subaxial Spine Deformity Jonathan Phillips, MD 35 | P a g e
Program Agenda 10:40 10:50 11:10
11:20
11:30 11:40 11:50 – 12:50 12:50‐1:45 12:50
1:05
1:10
1:15
1:20 1:25
Cervical Spine Trauma Gregory Mundis, Jr, MD Discussion Free Paper #40 (See Page 89): Correction of Cervical Kyphosis in Diastrophic Dysplasia John A. Heydemann, Suken A. Shah, Kenneth J. Rogers, Jeffrey W. Campbell, William G. Mackenzie Free Paper #41 (See Page 90): Rigid Segmental Cervical Spine Instrumentation is Safe and Efficacious in Younger Children Ana Mitchell, Vidyadhar Upasani, Carrie Bartley, Peter Newton, Burt Yaszay Free Paper #42 (See Page 91): New Form of Torticollis Associated with Growth‐Friendly Instrumentation Charles Johnston, Brandon Ramo, Lori Karol Discussion Auditorium and Lunch Eerste Slagruimte Session 7: The General Papers Moderator: Zaid Al‐Aubaidi, MD Productieruimte E‐moderator: Ron El‐Hawary, MD, MSc, FRCS(C) The FDA…how are Europe and USA different in introduction of new devices Robert Campbell, MD Free Paper #2 (See Page 40): Surgeon Survey Shows No Adverse Events After MRI In Patients With Magnetically Controlled Growing Rods (MGCR) David Skaggs, Regina Woon, Lindsay Andras, Hailali Noordeen, Suken Shah, Stephen Morris, John Hutchinson, Jeff Pawelek, Charles Johnston, Children's Spine Study Group, Growing Spine Study Group Free Paper #3 (See Page 41): Magnetic Resonance Imaging Safety of Magnetically Controlled Growing Rods in an Invivo Animal Model Mehmet Eroglu, Gokhan Demirkiran, Ismail Aykut Kocyigit, Hasan Bilgili, Mehmet Burak Kaynar, Ali Bumin, Sadan Ozcan, Muharrem Yazici Free Paper #17 (See Page 59): Magnetically Controlled Growing Rods: Observed Length Increases are Lower Than Programmed Sarah Gilday, Peter Sturm, Viral Jain, Mark Schwartz, Donita Bylski‐Austrow, David Glos, Lindsay Schultz, Sara O'Hara Discussion Free Paper #29 (See Page 76): Results of magnetically controlled devices parallel to the spine in children with scoliosis due to spinal muscular atrophy (SMA) Anna K. Hell, Heiko Lorenz, Batoul Badwin
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Program Agenda
1:30
1:35
1:40 1:45‐2:55 1:45 1:51
1:57 2:03 2:15 2:21 2:27 2:33 2:39 2:55‐4:45 2:55 3:01 3:07 3:13
Free Paper #1 (See Page 39): Surface Degradation Linked to Actuator Pin Fracture in Magnetically Controlled Growth Rods (MCGRs) Vasiliki Panagiotopoulou, Stewart Tucker, Harry Hothi, Johann Henckel, Alexander Gibson, John Skinner, Alister Hart, Thomas Ember, Julian Leong Free Paper #30 (See Page 77): Comparison of Newly Implanted versus Converted Magnetically Controlled Growing Rods (MCGR) from the Post‐United States Release Jeffrey R. Sawyer, Chun Wai Hung, Zachary J. Bloom, Hiroko Matsumoto, John T. Smith, Jonathan H. Phillips, Peter F. Sturm, Michael G. Vitale, Children's Spine Study Group Discussion Session 8: What Have We Learned? Moderator: Brandon Ramo, MD Productieruimte E‐moderator: Lindsay Andras, MD Mid‐term results of MCGR: Good things and bad things? Colin Nnadi, MBBD, FRCS Is VCR a technique only for adolescent and adults? Can young children benefit from it? Deszö Jeszenszky, MD Multisegmental instrumentation and growth‐friendly implants: Enemy brothers? Azmi Hamzaoglu, MD Discussion EOS in patients with life‐threatening neuromuscular diseases: Is growth preservation a priority? David Farrington, MD Lessons Learned: Something I wouldn’t do Again Muharrem Yazici, MD Lessons Learned: Something I wouldn’t do Again Charles Johnston, MD Lessons Learned: Something I wouldn’t do Again Paul Sponseller, MD Discussion Session 9: Masters Tips & Tricks Moderator: Michael Vitale, MD, MPH Productieruimte E‐moderator: Michael Ruf, MD When and how to include the pelvis in growth friendly implants David Skaggs, MD Who still needs traditional Growing Rods Laurel Blakemore, MD How to avoid junctional problems John Smith, MD Discussion
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Program Agenda 3:23 3:29 3:35 3:41 3:51 3:57 4:03 4:09 4:19 4:25 4:31 4:37 4:45
Temporary insertion of bone anchors Lawrence Karlin, MD Use of traction in EOS Charles Johnston, MD Tethering in the very young? Eric Wall, MD Discussion What are best practices for casting Lindsay Andras, MD Bracing in EOS Theodoros B Grivas, MD Scoliosis specific exercise in EOS Michael Vitale, MD Discussion MCGR tips and tricks (imaging, distraction intervals) Colin Nnadi, MBBD, FRCS Minimizing infection in EOS Michael Glotzbecker, MD Strategies at end of growth Paul Sponseller, MD Discussion / Wrap up Adjourn
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Free Papers Disclaimer: The authors of the abstracts are responsible for any accuracy and incomplete data. Paper #1 Surface Degradation Linked to Actuator Pin Fracture in Magnetically Controlled Growth Rods (MCGRs) Vasiliki Panagiotopoulou, Stewart Tucker, Harry Hothi, Johann Henckel , Alexander Gibson, John Skinner, AlisterHart, Thomas Ember, Julian Leong Summary: Our multi‐disciplinary team of surgeons and engineers will present our work on retrieval analysis of MCGRs. Our aim is to better understand the in vivo performance of these medical devices using our forensic analysis techniques, combining retrieval analysis, clinical data and imaging, in order to identify surgical, implant and patient (SIP) risk factors. Hypothesis: We hypothesize that increased surface degradation attributed to elongation treatments and implantation time, can be a cause for the actuator pin to fracture. Design: This retrieval study involved 15 MCGRs, of a single design, revised from 8 female and 1 male patients; 7 cases were early revisions and 2 for final fusion; these were implanted as either dual or single rod constructs. All patients consented for their implants to be used in this study. Introduction: MCGRs are used for the treatment of severe cases of early onset scoliosis; their main advantage is the non‐invasive lengthening of the rods in Outpatients Clinic using an external controller. However there have been case reports documenting failure of distraction and 22% of MCGRs are subject to unplanned revision. Methods: All retrieved MCGRs were radiographed to determine whether the actuator pin was fractured. We then assessed them macroscopically and microscopically for maximum length of surface degradation. Clinical and imaging data was also collected in order to identify the dominant surgical, implant or patient (SIP) risk factors,. Results: One third of the retrieved MCGRs that we received had a pin fracture. No difference in fracture rate was found between single and dual constructs. Rods with fractured pin had signs of increased surface degradation (Figure 1) compared to the MCGRs with intact pin, although not significantly different (p=0.1818). In dual rod constructs where only one MCGR had the pin fractured, the surface degradation was increased on the component with pin fracture, but no significant difference was documented (p=0.3333). We found no correlation between time of implantation and surface degradation (p=0.6889). Conclusions: We found a trend towards increased surface degradation on the MCGRs with fractured pin compared to the MCGRs with intact pin, however the cause of failure appears to be multifactorial with SIP risk factors.
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Free Papers Disclaimer: The authors of the abstracts are responsible for any accuracy and incomplete data.
Author disclosures: Vasiliki Panagiotopoulou: none. Stewart Tucker: none. Harry Hothi: none. Johann Henckel: none. Alexander Gibson: none. John Skinner: none. Alister Hart: none. Thomas Ember: none. Julian Leong: none. Paper #2 Surgeon Survey Shows No Adverse Events After MRI In Patients With Magnetically Controlled Growing Rods (MGCR) David Skaggs, Regina Woon, Lindsay Andras, Hailali Noordeen, Suken Shah, Stephen Morris, John Hutchinson, Jeff Pawelek, Charles Johnston, Children's Spine Study Group, Growing Spine Study Group Summary: These are the first reported cases of MRI use in humans with MCGR. There were no adverse events observed. MCGR rods lengthened as expected following MRI. MRIs of the cervical spine were able to be interpreted, but MRIs of the thoracolumbar spine could not be interpreted due to MCGR artifact. Hypothesis: MRI following implantation of magnetically controlled growing rods (MCGR) is not associated with any adverse events. 40 | P a g e
Free Papers Disclaimer: The authors of the abstracts are responsible for any accuracy and incomplete data. Design: Survey of surgeons. Introduction: Magnetically controlled growing rods in the treatment of early onset scoliosis (EOS) significantly decreases the number of procedures compared to traditional growing rods. MRIs are contraindicated in patients with MCGRs as per the FDA. MRIs are often clinically indicated in the EOS population. An in‐vitro study conducted by Budd et al. demonstrated there were no detrimental effects of MRI on MCGR, but there are no in‐vivo studies on this topic. Methods: Pediatric spine surgeons who are members of the Growing Spine Study Group, Children’s Spine Study Group, or early international users of this technology were surveyed regarding MRI use after MCGR surgery. Results: 118 surgeons were surveyed. Four surgeons reported 10 patients had an MRI with an implanted MCGR. Loss of fixation (0%, 0/9), movement of implants (0%, 0/9), unintended lengthening/shortening (0%, 0/9) or heating of MCGR (0%, 0/10) were not observed. No problems were observed with function of the MCGR following MRI and a mean of 2.1 mm was obtained at the next lengthening (range, 0.5‐3mm). Eight patients had MRIs of the cervical and thoracolumbar spine. All cervical spine MRIs could be interpreted without excessive artifact (100%, 4/4). Four patients had MRIs of the thoracolumbar spine but these were considered uninterpretable as a result of artifact from the MCGR (0%, 0/4). Conclusions: Perhaps MRIs should not be contraindicated in patients with MCGRs, as no adverse events were noted, and MRIs of the cervical spine were clinically useful. Author disclosures: David Skaggs: Biomet Spine; Johnson & Johnson, Biomet; Medtronic; Zipline Medical, Inc.; Orthobullets; Grand Rounds Greensunmedical; Wolters Kluwer Health ‐ Lippincott Williams & Wilkins, Spine Deformity and Journal of Children's Orthopaedics: Editorial or Governing Board. Regina Woon: none. Lindsay Andras: Biomet; Medtronic; Eli Lilly; Orthobullets. Hilali Noordeen: Ellipse Technologies; K Spine; K2M; Stryker Spine. Suken Shah: DePuy Synthes Spine; Arthrex, Inc; K2M; Nuvasive; Stryker; Globus Medical; DePuy Synthes Spine via Setting Scoliosis Straight Foundation; Ethicon Endosurgery; K2M via Setting Scoliosis Straight Foundation. Stephen Morris: none. John Hutchinson: Biomet; DePuy Synthes. Jeff Pawelek: San Diego Spine Foundation. Charles Johnston: Medtronic Sofamor Danek; Saunders/Mosby‐Elsevier; Orthopedics; Journal of Childrens Orthopedics; POSNA; SRS. Children's Spine Study Group: DePuy Synthes Research Grant. Growing Spine Study Group: Growing Spine Foundation Research Grant Nuvasive Research Grant. Paper #3 Magnetic Resonance Imaging Safety of Magnetically Controlled Growing Rods in an Invivo Animal Model Mehmet Eroglu, Gokhan Demirkiran, Ismail Aykut Kocyigit, Hasan Bilgili, Mehmet Burak Kaynar, Ali Bumin, Sadan Ozcan, Muharrem Yazici Summary: Magnetically controlled growing rod (MCGR) is increasingly used in the treatment of early onset scoliosis. However, MRI requirement in patients with MCGR is of concern. This study investigated MRI safety of the MCGRs in an animal model and indicated that lower magnet MRI is safe in an animal model with MCGRs with no adverse effects regarding the MCGR or the animal. 41 | P a g e
Free Papers Disclaimer: The authors of the abstracts are responsible for any accuracy and incomplete data. Hypothesis: MRI is safe in an animal model with MCGRs and it causes no serious adverse effects regarding the patient and the MCGR. Design: Experimental Animal Study Introduction: Growing rod treatment through serial operations results in adverse effects on the patient and high treatment costs. MCGRs can be lengthened noninvasively in an outpatient setting and with lower treatment costs. When MRI investigation is required, the interaction between MCGRs and MRI is an issue of concern in patients with MCGRs. This study investigated MRI compatibility of MCGRs in an invivo setting. Methods: The study was conducted on three sheep. A standard posterior approach was used. One polyaxial pedicle screw at the ends was placed. Two sheep were instrumented unilaterally and one bilaterally with MCGRs. Temperature change was measured using MR‐ compatible sensors. Thoracic and lumbar MRIs were obtained using a 0.3T MRI unit. MRI waves were applied for 45 minutes and temperature changes were recorded every 3 minutes. The lengths of the MCGRs were measured and anteroposterior and lateral spine radiographs were obtained pre‐ and postoperatively. Results: No displacement in the positions of the MCGRs occurred. The lengths of the MCGRs did not change compared to the preoperative length. The ability of the MCGRs to elongate were not impaired after MRI scanning. There was a mean increase in the temperature of the MCGRs by 1.45°C (0.5‐2.4°C). The MCGRs had a strong scattering effect on MRI of the related segments. Conclusions: This study indicated that lower magnet MRI is safe in an animal model with MCGRs, with no displacement of the rods and no changes in their length, no significant heating, and no adverse effects on the lengthening mechanism but with a significant scattering effect on visualization of the surrounding tissues. Further investigations are needed to clarify the exact distance where an MRI investigation of distant organs may be done without scattering.
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Free Papers Disclaimer: The authors of the abstracts are responsible for any accuracy and incomplete data.
Author disclosures: Mehmet Eroglu: none. Gokhan Demirkiran: none. Ismail Aykut Kocyigit: none. Hasan Bilgili: none. Mehmet Burak Kaynar: none. Ali Bumin: none. Sadan Ozcan: none. Muharrem Yazici: DePuy Synthes. Paper #4 Pulmonary function evaluation in children affected by neuromuscular scoliosis treated for the spine deformity with Magnetically Controlled Growing Rods Luca Fabio Coloumbo, Miriam Gotti, Chiara Bersanini, Francesco Motta, Francesca Izzo, Valentina Caretti Summary: Since November 2012 we treated 10 children affected by neuromuscular desease with magnetically controlled growing rods (MCGR). Patients are lengthened at intervals of 3 months . At every lengthening, they performed a spirometry. We matched data with a group in conservative treatment.We observed an higher FEV1 and FVC in treated group. We also found a weak correlation between FEV1 and FVC variation and Cobb angle variation . After implantation of MCGR, the pulmonary function stopped worsening. Hypothesis: Control if the pulmonary function improve after surgery treatment with mcgr in children affected by neuromuscular desease Design: Match the spirometry data between the surgical group and a conservative contro group same age with the same pathology Introduction: When spine deformity worsen rapidly in patients affected by neuromuscular desease we treated theme with magnetically controlled growing rods (MCGR). The lack of 43 | P a g e
Free Papers Disclaimer: The authors of the abstracts are responsible for any accuracy and incomplete data. repeated surgeries and anaesthesias is beneficial in children with neuromuscular disease and impaired pulmonary function that we supposed improve after surgery. Methods: Since November 2012 we treated with MCGR 10 children affected by neuromuscular scoliosis (7 by Spinal Muscular Atrophy type II ‐ SMA II ‐ 3 by metabolic myopathy). Children were 6.8±1.2 years old. Each implant was done with 2 rods sub‐ muscular tunnelled. Patients are lengthened at intervals of 3 months with distraction approximately of 3.5 mm (ultrasound monitoring). At every lengthening, they performed a spirometry. We matched data with a group of children affected by neuromuscular scoliosis (6 by SMA II and 2 by metabolic myopathy) in conservative treatment Results: All children showed at each timepoint a restrictive pulmonary pattern at spirometry. After implantation of MCGR, the pulmonary function stopped worsening: with lengthening following the protocol described, the forced vital capacity (FVC) (one‐way ANOVA, p=0.42) and the forced expiratory volume in the first second (FEV1) (one‐way ANOVA, p=0.63) did not further decrease. Comparing data between children treated with MCGR and control group, at the same age, we observed an higher FEV1 (age‐class 3, 44% vs 24%, p=0.04) and FVC in treated group (age‐class 3, 43% vs 24%, p=0.04) (Figure1: black points MCGR group, red points control group). We also found a weak correlation between FEV1 and FVC variation and Cobb angle variation (both R2=0.19, p=0.06). Conclusions: With MCGR we reduced morbidity and complications due to surgery. We found a better pulmonary function in children after MCGR compared to control group
Author disclosures: Luca Fabio Coloumbo: none. Miriam Gotti: none. Chiara Bersanini: none. Francesco Motta: none. Francesca Izzo: none. Valentina Caretti: none. Paper #5 Sliding‐Growing Rod Technique in the Treatment of Early Onset Scoliosis: Clinical and Radiological Outcomes and Effect on Pulmonary Functions Tunay Sanli, Sinan Kahraman, Meric Enercan, Azmi Hamzaoglu, Selhan Karadereller, Ozcan Kaya, Bekir Yavuz Ucar, Nurset Ok, Alim Can Baymurat, Amjad Alrashdan Summary: A new surgical strategy called Sliding‐Growing Rod Technique(SGRT) provides and maintains satisfactory curve corrections on both planes, allows self growth of the spine with 44 | P a g e
Free Papers Disclaimer: The authors of the abstracts are responsible for any accuracy and incomplete data. a rate of 1.23 mm growth per month, decreases the number of repeated lengthening procedures,and shown to have low complication rates and improved pulmonary functions Hypothesis: SGRT will maintain correction of EOS deformity on both planes and reduce the number of lengthening procedures and avoid spontaneous fusion Design: Retrospective Introduction: Traditional growing rods(TGR) used for the treatment of EOS had various drawbacks including repeated lengthening procedures,implant failure,junctional kyphosis and spontaneous fusion.The aim of this study is to assess whether SGRT which provides dynamic fixation in contrast to TGR;works,decrease the complication rates and improve the pulmonary functions Methods: 16(10F/6M)pts with mean age 6.7(5‐10)yrs were evaluated.Technique included placement of pedicle screws to the proximal,distal,apical,strategic and intermediate vertebrae with muscle‐sparing technique.Following rod placement and correction,the most proximal and distal two segments were fixed and fused;the rest of the set screws were kept loose(unlocked)to allow vertical spinal growth.Sliding foundation was placed either below the most proximal or above the most distal fixed and fused segments and self‐lengthening was achieved by side to side connectors.Preop,f/up,final x‐rays and pre/postop PFTs were evaluated Results: Mean f/up was 30.6 months(24‐45). Ave MT curve of 56.9&[deg] was corrected to 23&[deg] with a %60 correction rate. Ave TL/L curve of 43.1&[deg] was corrected to 13.5&[deg] with a %71.7 correction rate.Preop TK of 34.4&[deg] and LL of 57&[deg] was maintained at 33.4&[deg] and 56.4&[deg] respectively.Mean increase in T1‐T12 length was 0.85mm and 1.23mm per month in T1‐S1 height.None of the pts had neurological impairment.There were no rod breakage,infection or spontaneous fusion. Only 2 screws in 1 patient were revised for loosening. Set screw dislodgement was found in 5 pts;among them only 2 had correction loss.SGRT prevented 59 planned lengthenings. Mean %predict FVC of 74,7 improved to 86 and FEV1 of 81 improved to 88,7 at final f/up Conclusions: In contrast to TGR, SGRT is a dynamic growing system which allows self growth of the spine and maintains correction on both planes.SGRT demonstrated low complication rates, decreased the number of planned lengthenings, avoided spontaneous fusion and improved the pulmonary functions
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Author disclosures: Tunay Sanli: none. Sinan Kahraman: none. Meric Enercan: none. Azmi Hamzaoglu: Medtronic. Selhan Karadereller: none. Ozcan Kaya: none. Bekir Yavuz Ucar: none. Nurset Ok: none. Alim Can Baymurat: none. Amjad Alrashdan: none. Paper #6 Posterior Hemivertebra Resection and Short Segment Fusion with Pedicle Screw Fixation for Congenital Scoliosis in Children Younger than 5 Year; with minimum 8 years Follow‐up Sinan Kahraman, Ozcan Kaya, Selhan Karadereller, Nurset Ok, Tunay Sanli, Bekir Yavuz Ucar, Meric Enercan, Azmi Hamzaoglu, Alim Can Baymurat, Onur Levent Ulusoy, Ayhan Mutlu, Amjad Alrashdan Summary: Surgical outcomes of 10 patients with congenital deformity who were younger than 5 years at the time of surgery were evaluated retrospectively. Posterior hemivertebra resection and short segment fusion prevented development of the secondary structural curves, did not demonstrate any adding‐on, crankshaft deformity and did not cause any iatrogenic spinal canal stenosis or growth retardation after minimum 8 years of f/up Hypothesis: Posterior hemivertebrectomy and short segment fusion at an early age before the secondary structural changes occur will prevent any adding‐on and crankshaft deformity and will allow more mobile spine Design: Retrospective Introduction: The aim of this study is to evaluate the surgical outcomes of posterior hemivertebra resection and short segment fusion with pedicle screw fixation in congenital scoliosis in children younger than 5 years with minimum 8 years f/up Methods: 10(6F/4M) patients who were operated younger than 5 years and had at least 8 years f/up were included. All pts underwent hemivertebrectomy and pedicle screw fixation at ave age of 3y4m (1y7m to 4y4m). Main and compensatory curves, correction rates and 46 | P a g e
Free Papers Disclaimer: The authors of the abstracts are responsible for any accuracy and incomplete data. sagittal parameters were measured on pre/post and f/up x‐rays.Preop and final CT scans were compared to evaluate vertebral body and spinal canal parameters Results: Mean f/up was 8y5m (8‐11years). 7 pts had single and 3 pts had double hemivertebra (ipsilateral,consecutive). 5 pts had pure scoliosis and 5 patients had kyphoscoliosis deformity due to posterolateral hemivertebra.Preop main curve of 29.1&[deg] was corrected to 4.4&[deg] and 5.3&[deg] at final f/up with %81 correction rate. Preop proximal compensatory curve of 12.6&[deg] was corrected to 4.1&[deg] and 3&[deg] at final f/up.Distal compensatory curve of 8.1&[deg] improved to 2.3&[deg] and 1.6&[deg] at final f/up. Local kyphosis of 24.4&[deg] improved to 3.8&[deg] in kyphoscoliosis group with a %84 correction rate at final f/up. Normal sagittal alignment was restored and maintained (mean SVA:+4.2 mm) in all pts. There were no adding‐on, crankshaft deformity, pseudoarhtrosis, vascular or neurological complications. Comparison of preop/final CT scans,showed proportional increase for all vertebral body and spinal canal parameters and did not show any iatrogenic spinal canal stenosis or growth retardation Conclusions: Early surgical treatment of congenital scoliosis/kyphoscoliosis due to hemivertebra before the structural changes occur, provided and maintained satisfactory correction on both planes without developing adding‐on, crankshaft deformity and iatrogenic spinal stenosis
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Author disclosures: Sinan Kahraman:none. Ozcan Kaya:none. Selhan Karadereller:none. Nurset Ok:none. Tunay Sanli:none. Bekir Yavuz Ucar:none. Meric Enercan:none. Azmi Hamzaoglu: Medtronic. Alim Can Baymurat:none. Onur Levent Ulusoy:none. Ayhan Mutlu:none. Amjad Alrashdan:none. Paper #7 Efficiency and Reliability of Ilio Sacral Screws in Fusionless Surgery for Neuromuscular Scoliosis: Preliminary Results of 100 Patients Lotfi Miladi, Gaume Mathilde, Nejib Khouri, Christophe Glorion Summary: We reviewed radiographic data and complications of 100 cases of neuromuscular scoliosis operated with the same fusionless technique extended to the pelvis using ilio sacral screws. The results showed 61% correction of spinal deformities and 83% of pelvic obliquity with only 21% global complication rate. There were no neurologic complications, no rod breakage and no need for fusion conversion. Patient’s quality of life was improved by this technique as post‐operative bracing was not used. Hypothesis: An original technique to reduce complications rate of pelvic fixation in neuromuscular scoliosis. Design: Retrospective review. Introduction: The poor general status and the weakness of pelvic bone in neuromuscular patients predispose to mechanical complications. Various pelvic fixations are already described in the literature but the complication rate is high. We report the preliminary results of a strong and stable original method. Methods: 100 patients with neuromuscular scoliosis underwent the same fusionless surgery extended to the pelvis. Age at surgery was 11+6y. Mean follow‐up was 3+1y(1+6y to 5+1y).Diagnoses included 61 cerebral palsy, 22 spinal muscular atrophy, 10 muscular dystrophy and 7 other neurological etiologies. Cobb angle and pelvic obliquity were measured before initial surgery, and at final follow‐up. Complications were reviewed. The technique relies on a bipolar bilateral sliding construct from T1 to the pelvis performed thought a minimally invasive approach. The proximal fixation is made on the first 5 thoracic 48 | P a g e
Free Papers Disclaimer: The authors of the abstracts are responsible for any accuracy and incomplete data. vertebras by 8 hooks in double claw configuration. The pelvic fixation uses ilio sacral screws on each side connected to the spinal rods by specific connectors. The rods system is composed of 2 pre curved telescopic rods on each side, bounded together by 2 dominos connectors and 3 cross links. Rod lengthening procedures have been performed in a mean interval of 1y+2. No post‐operative bracing was needed. Results: At last follow‐up, mean Cobb angle improved from 88.66° to 34.88° which correspond to 60.66% correction. Mean pelvic obliquity improved from 26.72° to 4.50°which correspond to 83.16% correction. Complications have occurred in 21 patients included 7 implants related events,7 wounds dehiscence, 3 deep wound infections, 2 digestive and 2 pulmonary complications. 10 patients required unplanned surgery. There were no neurologic complications and no rod breakage. Conclusions: This technique is safe and effective, providing a significant correction of spinal deformities and pelvic obliquity with a lower complications rate. It preserves spinal and thoracic growth and improves patient’s quality of life. Author disclosures: Lotfi Miladi: Euros : Orthopaedic Product. Gaume Mathilde:none. Nejib Khouri:none. Christophe Glorion:none. Paper #8 Weight Gain After VEPTR Surgery May Be From Nutritional Optimization Rather Than Improvement In Pulmonary Function Ying Li, Maksim Shlykov, Christopher Robbins, Michelle Caird, Frances Farley, Michelle Burke Summary: Previous authors have concluded that an increase in weight percentile (WP) in children with thoracic insufficiency syndrome (TIS) after Vertical Expandable Prosthetic Titanium Rib (VEPTR) surgery represents improvement in nutritional status, possibly secondary to improved pulmonary function. In our study, we did not find a change in WP after VEPTR insertion. We did not find any correlation between WP and nutrition labs or pulmonary function. Weight gain after VEPTR surgery may instead be secondary to nutritional optimization in high‐risk patients. Hypothesis: VEPTR surgery does not result in a change in weight percentile (WP). WP does not correlate with pulmonary function. Design: Prospective comparative study. Introduction: Children with TIS often have failure to thrive (WP &[le]5). A previous study showed an increase in WP after VEPTR surgery. Weight gain was hypothesized to be secondary to improved pulmonary function. The purpose of our study was to evaluate whether (1) WP increases after VEPTR insertion, and (2) WP correlates with nutrition labs and pulmonary function. Methods: We queried a prospective institutional VEPTR database to identify patients with a minimum follow‐up of 2 years. Demographic data, nutrition labs, radiographic data, and pulmonary function tests (PFTs) were recorded. Results: We analyzed 35 patients (21 males, 14 females) with congenital (27), neuromuscular (4), and syndromic/structural (4) scoliosis. Mean age at VEPTR insertion was 5.2 years. Average follow‐up was 6.0 years. Mean preoperative weight was 17.1 kg and mean weight at final follow‐up was 32.0 kg. Gastrostomy tube (G‐tube) and WP data are 49 | P a g e
Free Papers Disclaimer: The authors of the abstracts are responsible for any accuracy and incomplete data. shown in the Table. Although all children gained weight, the PREOP&[le]5 group was more likely to have an increase in WP (P = 0.014). Ninety‐four percent of the children with a decrease in WP were in the PREOP>5 group. Overall, there was no change in the number of patients with a WP &[le]5. A larger percentage of children who maintained or increased their WP had a G‐tube (42% vs 19%) but this was not significant. Eleven patients (73%) who had failure to thrive at final follow‐up did not have a G‐tube. We noted a positive correlation between change in WP and change in the space‐available‐for‐lung ratio at 6 months postoperatively (P = 0.02). No other correlations were found between WP and nutrition labs, radiographic measures, or PFTs. Conclusions: We did not find a change in WP after VEPTR insertion. We did not find a persistent correlation between WP and nutrition labs or pulmonary function. Weight gain after VEPTR surgery may be secondary to nutritional optimization in high‐risk patients and should be further studied. Children who do not have failure to thrive at presentation also require attention.
Author disclosures: Ying Li: none. Maksim Shlykov: none. Christopher Robbins: none. Michelle Caird: Editorial Board of Journal of Pediatric Orthopaedics. Frances Farley: Editorial Board of Journal of Pediatric Orthopaedics. Michelle Burke: none. Paper #9 Graduation Protocol After Growing Rod Treatment: Is Removal of Hardware Without New Instrumentation a Realistic Approach? Z. Deniz Olgun, Aykut Kocyigit, Mehmet Eroglu, H. Gokhan Demirkiran, Mehmet Ayvaz, Muharrem Yazici Summary: Outcomes of a prospective treatment decision made at the commencement of growing rod treatment: remove all hardware and leave the spine free of implants when patients reached 14 years of age Hypothesis: It is possible to remove hardware and leave the spine free of instrumentation after growing rod treatment when the patient has reached appropriate skeletal maturity (14 years of age) Design: Prospective non‐randomized Introduction: The growing rod (GR) remains an effective and proven option in the treatment of early‐onset scoliosis (EOS). A treatment decision was made in 2004, proposing to remove all hardware and leaving the spine free of implants when patients reached 14 yrs of age. This study summarizes the actual outcomes with this intended approach. Methods: Patients whose chronological age was 14 years by January 2016 and who had undergone regular lengthenings every 6 to 9 months during their GR treatment were 50 | P a g e
Free Papers Disclaimer: The authors of the abstracts are responsible for any accuracy and incomplete data. included. If curve correction was adequate and interval changes did not require extension of instrumentation, GR were removed and the patients were observed (g1). If correction was inadequate and/or extension of fusion was required, final instrumented fusion was performed after GR removal (g2). For patients who still had significant growth remaining at age 14, lengthening was continued (g3). Results: 26 patients were included in the study. Mean age at index operation was 82 mo. There were 10 patients in g1, 9 in g2, and 7 in g3. Demographics and Cobb data can be found in Table 1. Of the 10 patients in g1 whose implants were removed with no additional spinal instrumentation, 9 had significant worsening of deformity after a mean follow‐up of 26.5 mo. Conclusions: Despite the surgeons' initial intentions to remove all hardware and observe patients when they turned 14, the results of this study showed that only 10 of the initially included 26 patients fulfilled the criteria for this approach. In 9 (90%) of these patients, deformity worsened after removal, indicating that prolonged GR treatment does not always result in spontaneous, reliable fusion. Removal of spinal hardware without new instrumentation is not realistic as a graduation protocol following GR treatment. The results of this study suggest that at the conclusion of growing rod treatment, implants present should be retained, or if extension is required, another procedure undertaken.
Author disclosures: Z. Deniz Olgun: none. Aykut Kocyigit: none. Mehmet Eroglu: none. H. Gokhan Demirkiran: none. Mehmet Ayvaz: none. Muharrem Yazici: DePuy Synthes. Paper #10 Traditional Growing Rod Graduates with Various Diagnoses have Similar Clinical and Radiographic Outcomes Jeff Pawelek, Behrooz Akbarnia, Pooria Hosseini, Pooria Salari, David Marks, David Skaggs, John Emans, Paul Sponseller, George Thompson, Growing Spine Study Group Summary: Early‐onset scoliosis patients across all etiologies have similar clinical and radiographic outcomes after completion of traditional growing rod treatment. 51 | P a g e
Free Papers Disclaimer: The authors of the abstracts are responsible for any accuracy and incomplete data. Hypothesis: Traditional growing rod patients have different clinical and radiographic outcomes upon completion of treatment. Design: Multicenter review of retrospective and prospective data. Introduction: Early‐onset scoliosis (EOS) encompasses a diverse population of patients with multiple etiological diagnoses. Traditional growing rod (TGR) surgery has been described to be effective in treating specific underlying diagnoses within EOS (e.g. cerebral palsy, Marfan syndrome, congenital spine anomalies). However, no published literature has compared outcomes between the various etiologies in patients who completed TGR treatment. This study compared results between etiological categories in TGR graduates. Methods: A retrospective review of a multicenter EOS database was performed. Patients were included if they had minimum 2‐year follow up after index surgery, completion of TGR treatment, and post‐graduation radiographs. 202 out of 232 TGR graduates met inclusion criteria. Patients were categorized by etiology per C‐EOS: congenital, neuromuscular, syndromic, and idiopathic Results: There were 28 congenital, 65 neuromuscular, 57 syndromic, and 52 idiopathic patients. Age, gender, ethnicity, and BMI were similar between groups at time of index surgery; however, the neuromuscular group had a statistically significant higher percentage of non‐ambulatory patients. Mean length of follow‐up and number of lengthenings across groups were not significantly different. Major curve correction and increase in T1‐S1 and T1‐ T12 were statistically similar from pre‐index surgery to post‐graduation between groups (Table 1). Furthermore, the incidence of implant‐related complications and surgical site infections was similar. Conclusions: Coronal deformity correction and amount of spinal and thoracic height gain were similar across all etiologies after completion of TGR treatment. Incidence of implant and wound complications were also similar between etiologies. While EOS patients necessitate varying degrees of medical and surgical management based on their disease and health status, TGR graduates of all etiologies have similar clinical and radiographic outcomes.
Author disclosures: Jeff Pawelek: San Diego Spine Foundation. Behrooz Akbarnia: Depuy Synthes; Nuvasive, K2M; Nocimed; Spine, Spine Deformity Journal, Journal of Orthopaedic Science. Pooria Hosseini: none. Pooria Salari: none. David Marks: Depuy Synthes; Stryker, K2M, Medtronic. Suken Shah: DePuy Synthes Spine; Arthrex, Inc; K2M; Nuvasive; Stryker; 52 | P a g e
Free Papers Disclaimer: The authors of the abstracts are responsible for any accuracy and incomplete data. Globus Medical; DePuy Synthes Spine via Setting Scoliosis Straight Foundation; Ethicon Endosurgery; K2M via Setting Scoliosis Straight Foundation. David Skaggs: Biomet Spine; Johnson & Johnson, Biomet; Medtronic; Zipline Medical, Inc.; Orthobullets; Grand Rounds Greensunmedical; Wolters Kluwer Health ‐ Lippincott Williams & Wilkins, Spine Deformity and Journal of Children's Orthopaedics: Editorial or Governing Board. John Emans: Depuy Synthes; Medtronic; Journal of Children's Orthopedics. Paul Sponseller: Depuy Synthes; Globus Medical; Journal of Bone and Joint Surgery; Oakstone Medical; Journal of Bone and Joint Surgery. George Thompson: OrthoPediatrics; Spine Form; Medtronic; nuSpine Medical Techno; Stryker; Ogies; Wolters Kluwer Health ‐ Lippincott Williams & Wilkins; Journal of Pediatric Orthopedics. Growing Spine Study Group: Growing Spine Foundation Research Grant Nuvasive Research Grant Paper #11 Hemivertebra Resection and Transpedicular Short Fusion in Children Younger than 5 Years. A Mid‐Term Follow‐Up Analysis. Jose Miguel Sánchez‐Marquez, Mar Pérez, Javier Pizones, Nicomedes Fernández‐Baíllo, Francisco Javier Pérez‐Grueso Summary: Restrospective analysis of early hemivertebra resection and short fusion for children under the age of 5, with a 7.6‐year follow‐up. Early surgery allowed for a good coronal correction initially which was difficult to maintain at final follow‐up, especially in the lumbosacral junction. Sagittal plane correction was excellent in thoracolumbar deformities and was maintained over time. Early surgery prevented the development of severe deformities and secondary structural curves, however results were more challenging in the lumbosacral group compared with thoracolumbar deformities. Hypothesis: Early hemivertebra (HV) resection and short fusion is the ideal treatment for congenital deformities. Design: Retrospective analysis of a consecutive cohort of patients with congenital scoliosis secondary to a single HV. Introduction: Despite the successful published results regarding this surgical technique, literature lacks of mid‐term results especially on very young children. Methods: Inclusion criteria: patients under 5 years of age, operated on by HV resection and transpedicular short fusion, and follow‐up longer than 5 years. Preoperative, postoperative (1‐yr), final radiographic parameters, and complications were recorded. Results: Twenty‐three patients met inclusion criteria, 14 had thoracolumbar (TL) HV, while 9 were lumbosacral (LS) HV. Mean age was 3.5&[plusmn]1.7 years. Mean follow‐up was 7.6 years (4.7‐13.7). Mean preoperative Cobb angle was 40.3&[deg]&[plusmn]6.7, which corrected postoperatively (65%) to 14&[deg]&[plusmn]6.4, and final (50%) (19.9&[deg]&[plusmn]10.7). TL curves corrected more than LS curves (TL=‐ 29&[deg]&[plusmn]7.9, 68% vs. LS=‐20&[deg]&[plusmn]9.2, 59%, P=0.043); and showed less loss at final follow‐up (TL=2.3&[deg]&[plusmn]4.6, 56% vs. LS=7&[deg]&[plusmn]7.7, 39%; P=0.186). The compensatory cranial curve improved spontaneously from 25.3&[deg]&[plusmn]14.8 to 13.5&[deg]&[plusmn]12, and final 19.9&[deg]&[plusmn]10.7. The LS‐group had a bigger preoperative compensatory curve, which corrected less with 53 | P a g e
Free Papers Disclaimer: The authors of the abstracts are responsible for any accuracy and incomplete data. surgery and lost more correction at final follow‐up (P=0.016). Preoperative coronal balance was 14.3&[plusmn]12 mm, it was corrected to 8.9&[plusmn]10.7 mm, but worsened to 12.8&[plusmn]10.8 mm at final follow‐up. Segmental kyphosis was corrected (TL:‐ 14.2&[deg]&[plusmn]8.6 vs. LS:‐2&[deg]&[plusmn]4 vs. P=0.018), and maintained over time. Four patients required revision surgery due to curve progression or instrumentation failure. Conclusions: Early hemivertebra resection and transpedicular short fusion allowed for a good coronal correction initially which was difficult to maintain at mid‐term follow‐up, especially in the LS junction. Sagittal plane correction was excellent in TL deformities and was maintained over time. Early surgery prevented the development of severe deformities and secondary structural curves, however results were more challenging in the LS‐group compared with TL deformities. Author disclosures: Jose Miguel Sánchez‐Marquez: none. Mar Pérez: DePuy‐Synthes Spine. Javier Pizones: DePuy‐Synthes Spine. Nicomedes Fernández‐Baíllo: DePuy‐Synthes Spine Medcomtech. Francisco Javier Pérez‐Grueso: K2M Paper #12 Wound Complication Risk Stratification in VEPTR Surgery Anthony Capraro, Richard Campbell, Diane Hartman, Robert Campbell, Nikita Lakomkin, John Flynn, Michael Nance, Thane Blinman, Oscar H. Mayer, Howard Pantich, Jesse Taylor, Brian Hanna, Keith Baldwin, Patrick Cahill Summary: Wound complication is a significant concern with VEPTR implantation. This study retrospectively analyzes wound complication risk parameters in the largest available single institution series of VEPTR complications. Results demonstrate univariate associations between wound complications and 9 parameters. Multivariate analysis identified 4 independent predictors of wound complications: risk of patient age, gender, diaper use with lower back incision, and bilateral procedure. These variables were used to construct a predictive model for risk stratification. Hypothesis: Patient specific pre‐ and intra‐operative parameters predict VEPTR implant wound complications. Design: Single‐center retrospective analysis of a prospectively collected registry. Introduction: VEPTR implants effectively corrects several skeletal deformities, including EOS. Unfortunately, VEPTR surgeries have a high rate of wound complications, often resulting in operative treatment. This creates an imperative to quantify patients' risk. This VEPTR complication risk stratification study analyzes the largest series of complications in VEPTR implant surgery across a comprehensive list of parameters. Methods: A prospective registry of patients ages 0‐18 who underwent a VEPTR implantation between Jan. 2011 and Sep. 2015 at a single institution was retrospectively reviewed. Various patient and surgical factors were retrospectively analyzed. The outcome variable was any wound complication requiring re‐operation including infection or wound dehiscence. Parameter analysis was performed through binary logistic regression with a backwards stepwise approach. Threshold for significance was 0.10. Results: 122 patients underwent 140 surgeries; 22 resulted in complications. Mean age at surgery was 5.2yrs. The following variables were included in the multivariate analysis, based 54 | P a g e
Free Papers Disclaimer: The authors of the abstracts are responsible for any accuracy and incomplete data. on univariate significance: male gender, diapered patient with lower back incision, bilateral procedure, > 3 incisions, left iliac incision, right iliac incision, patient age &[le] 4 and operative time > 150 mins. There was also a correlation between complications and hospital length of stay. Multivariate analysis identified the following independent predictors: age of 4 or less, OR= 4.9 (1.5‐15.4); p value 0.007, male gender, OR= 3.0 (1.0‐ 9.1); p = 0.05, diapered patient with lower back incision, OR= 2.9 (.76‐11.64) p value= 0.117,and bilateral procedure, OR= 8.5 (2.0‐36.3);p = 0.004,(Fig. 1). The percent correctly predicted by the model was 84.3%. Conclusions: A risk stratification model can predict wound complications in patients undergoing VEPTR implant surgery. This is beneficial for patient counseling and possibly for identification of patients who may benefit from additional prophylaxis and/or increased vigilance in post‐op monitoring. Author disclosures: Anthony Capraro: none. Richard Campbell: none. Diane Hartman: none. Robert Campbell: none. Nikita Lakomkin: none. John Flynn: Biomet‐ IP Royalties; Wolters Kluwer Health ‐ Lippincott Williams & Wilkins; AAOS; American Board of Orthopedic Surgery, Inc.; Orthopedics Today; Pediatric Orthopaedic Society of North America; Scoliosis Research Society. Michael Nance: none. Thane Blinman: none. Oscar H. Mayer: Bristol‐Myers Squib, Santhera Pharma, Catabasis Pharma. Howard Pantich: Philips Respironics, Jesse Taylor: none. Brian Hanna: none. Keith Baldwin: Synthes Trauma; Pfizer; Journal of Bone and Joint Surgery. Patrick Cahill: AAOS; Journal of Bone and Joint Surgery ‐ American; Pediatric Orthopaedic Society of North America; Scoliosis Research Society; Spine Deformity. Paper #13 Sacral‐Alar‐Iliac Fixation in Early Onset Scoliosis Ethan Cottrill, Cameron Brucker, Adam Maragalit, Paul D. Sponseller Summary: Sacral‐alar‐iliac (SAI) fixation is increasingly used for the treatment of scoliosis. This retrospective review of 24 patients with early onset scoliosis (EOS) compares the use of SAI screws to traditional methods of pelvic fixation. While SAI screws and traditional fixation methods effectively correct major curvature, only SAI screws were shown to correct pelvic obliquity with statistical significance in patients with EOS at a 2‐year minimum follow‐up. Additionally, SAI screws were shown to trend to more stable pelvic fixation. Hypothesis: SAI screws offer better clinical outcomes compared to traditional pelvic fixation methods in patients with EOS at a 2‐year minimum follow‐up. Design: Retrospective Introduction: SAI screws have steadily grown in popularity for the treatment of scoliosis. The objective of this study was to compare clinical outcomes in patients with EOS treated with SAI screws vs. other pelvic fixation methods at a 2‐year minimum follow‐up. Methods: We retrospectively reviewed patients with EOS from 2000‐2014. Inclusion criteria were posterior spinal instrumentation with pelvic fixation before ten years of age and an associated 2‐year minimum follow‐up. Clinical and radiographic parameters were collected. Data were analyzed using student t‐tests at a significance p0.05). Median follow‐up duration for MCGR and TGR groups were 21 and 93 mo, respectively (p0.05) (Table 1). Analyses adjusted for number of lengthenings revealed that scores of economic burden and overall satisfaction of MCGR group remained significantly higher; moreover, physical activity score become significantly higher for MCGR group (Table). Conclusions: HQRL data obtained from MCGR and TGR reveal superior outcomes in the financial burden and patient satisfaction, and possibly physical activity when controlled for number of lengthenings, for MCGR. However, in all other domains, both techniques score similarly, indicating that the TGR is far from being obsolete at this time.
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Author disclosures: Muharrem Yazici: DePuy Synthes. H. Gokhan Demirkiran: none. Z. Deniz Olgun: none. Gizem Irem Kinikli: none. Senol Bekmez: none. Mehmet Berktas: none. Paper #21 Vancomycin Powder Lowers Infection Rate in Growing Rod Surgery in Early Onset Scoliosis: A Preliminary Report R. Justin Mistovich, Connie Poe‐Kochert, Jochen Son‐Hing, Christina Hardesty, George Thompson Summary: Vancomycin powder (VP) results in a statistically significant decrease in infection rates per procedure in early onset scoliosis (EOS) surgery. Hypothesis: Intra‐wound VP decreases surgical site infections (SSI) in EOS surgery Design: Retrospective Cohort Study Introduction: VP is safe in children yet there is no data on its use to reduce SSI in EOS surgery. Methods: Using our IRB‐approved pediatric spine database, we performed a retrospective review of our EOS program from 2010‐2016. In 2010, we modified our growing spine care path and later added vancomycin powder. Therefore, we have a standardized perioperative protocol that was divided into a control group without VP and an experimental group with VP. Inclusion criteria were initial insertions, revisions, lengthenings, and final fusions. This 65 | P a g e
Free Papers Disclaimer: The authors of the abstracts are responsible for any accuracy and incomplete data. preliminary study focused on the incidence all SSI with a minimum of 90‐day follow up to capture all acute SSIs. We excluded patients who had SSI prior to 2010. However, patients with surgeries before 2010 and no prior infections were included for subsequent procedures. Results: 36 patients with 191 procedures met inclusion criteria. Seven patients had VP for all procedures, 13 patients were mixed (initial surgeries without VP) and 16 patients never received VP. There were 14 patients (39%) that developed a SSI (12 acute and 2 late). Two patients had multiple infections, though not on consecutive procedures. There were 85 procedures and 12 infections in the control group (14% per procedure). Many control group infections occurred in later procedures (Table 1). There were 106 procedures in the VP group with 5 infections (4.7% per procedure). This decrease in SSI per procedure was statistically significant (p=0.038, 95% CI). The number needed to treat with vancomycin to prevent a SSI was 11. Within the vancomycin group, there were 40 procedures in patients where vancomycin powder used for every procedure. This subgroup had 2 infections (5%). Similarly, there were 3 infections (4.5%) in 66 procedures in patients having a history of earlier surgeries without vancomycin powder. Conclusions: The use of vancomycin powder results in a reduction in SSI by 66% (RRR) and is statistically significant. It appears to be effective even when previous surgeries have been performed without its use.
Author disclosures: R. Justin Mistovich: none. Connie Poe‐Kochert: none. Jochen Son‐Hing: none. Christina Hardesty: none. George Thompson: none.
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Free Papers Disclaimer: The authors of the abstracts are responsible for any accuracy and incomplete data. Paper #22 Construct Levels to Anchored Levels Ratio and Rod Diameter are Associated with Implant‐ Related Complications in Traditional Growing Rods Pooria Hosseini, Behrooz Akbarnia, John Emans, Paul Sponseller, Jeff Pawelek, Stacie Nguyen, Peter Sturm, Growing Spine Study Group Summary: In addition to patient characteristics consideration of length of construct to number of anchored levels ratio and rod diameter should be a part of preoperative planning to minimize implant‐related complications. Hypothesis: Anchor type and configuration are associated with implant‐related complications in traditional growing rod (TGR) surgery for early‐onset scoliosis (EOS). Design: Multicenter review of retrospective and prospective data. Introduction: IRC are among the most common adverse events in TGR. The current study hypothesized that anchor type and configuration is associated with IRC. Methods: Patients with: 1) age ≤10 years at surgery; 2) spine‐based dual TGR; 3) minimum 2‐year follow up; and 4) available imaging. Cephalad and caudal foundations were grouped based on number of instrumented levels and anchor type. All radiographs were reviewed and IRC was defined as rod fracture, anchor pull out, prominence, and loosening. Based on results a “Construct Levels / Anchored Levels” (CL/AL) ratio was calculated, which is the number of levels spanned by instrumentation divided by the number of levels with bone‐ anchor fixation. Receiver operating characteristic curve was used to define CL/AL threshold. Results: 274 patients divided to complicated (n=140) and non‐complicated (n=134) groups. Mean follow up was 6.3 years (2.1‐18.0 years). No significant differences in age, gender, BMI, ambulatory status, etiology, primary curve size, T1‐S1 height, coronal and sagittal balance, and rod material were observed between two groups. Comparative analysis showed that connector type, presence and location of crosslinks, number of levels instrumented, number and type of anchors, presence of pelvic fixation, and mirroring of cephalad and caudal foundations were not different (Table 1). However, maximum kyphosis and rod diameter were significantly different. CL/AL ratio threshold was 3.5. Multivariate analysis of kyphosis, rod diameter and CL/AL ratio showed a significant association with IRC (p20° is treatment in a brace for 18‐ 20 a day (81%). MRI was obtained in the majority (97%) of patients and demonstrated abnormalities in 29 patients (16%). 23/29 intraspinal anomalies required operative intervention and were excluded. Family history of scoliosis was positive for 48% of patients, 29% with a history of surgical correction. Of the positive family history of surgical correction, 40% of children underwent surgery. Noncompliance was 72% in the operative group and 25% in the nonoperative group. Overall, patients who underwent surgical correction (46%) had a greater mid‐thoracic Cobb angle (p2 mm at the kyphotic apex, plotted from the posterior dorsal cortex of the apical lamina on axial CT. A review of CT imaging was conducted to assess for unidentified evidence of VRM. VRM was demonstrated in 3 patients, 1 of whom demonstrated rods positioned within the spinal canal. Hypothesis: Where advanced imaging such as computed tomography is available in posteriorly applied growing rods, it should be examined for evidence of ventral rod migration(VRM). Design: Retrospective observational cohort study Introduction: Growing rod technology has a known high incidence of complications. However, we describe the identification of a rare complication, in an asymptomatic patient with early onset scoliosis treated using modern growing rod technology. This patient experienced ventral rod migration of a single rod (in her dual growing rod construct) 2 years after her index surgery. Post‐ operative CT imaging demonstrated the rod resided within the thoracic portion of her spinal canal. Methods: A retrospective review of all radiographic imaging was conducted for the growing rod cohort within a tertiary paediatric Orthopaedic Spinal Centre in Ireland. Between 2007‐ 2015, 90 patients were treated with contemporary growing rod systems. We defined VRM as ventral movement >2 mm at the kyphotic apex, plotted from the posterior dorsal cortex of the apical lamina on axial CT. In patients identified as having objective evidence on imaging of VRM, we examined patient characteristics and tried to identify factors potentially contributing to the development of this complication. 83 | P a g e
Free Papers Disclaimer: The authors of the abstracts are responsible for any accuracy and incomplete data. Results: 90 patients were treated with growing rods for early onset scoliosis between 2007 and 2015. Mean age at initial implantation was 8.62 years; mean follow‐up was 36 months. CT imaging was available for 30 patients. There was evidence of VRM in 3 patients. In 1 patient, the rod a had breached the apical lamina and resided within the spinal canal. The mal‐positioning of this rod is considered a significant factor in a deleterious routine rod lengthening procedure that culminated with a complete cord injury for the patient. Conclusions: Ventral rod migration is a potentially catastrophic complication of posteriorly applied growing rods. The use of advanced imaging in patients with posteriorly applied growing rods to screen for rare complications is a controversial area. VRM is a potentially quiescent complication and one we believe should be screened for in osteoporotic and severely kyphotic patients.
Author disclosures: Patrick Kiely: AO Spine Masters; Medtronic; Eurospine. Laura‐Ann Lambert: none.
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Free Papers Disclaimer: The authors of the abstracts are responsible for any accuracy and incomplete data. Paper #36 Limiting Pre‐Incision Instrument Uncovered Time via Quality Practice Intervention Decreases VEPTR Implantation Surgical Site Infections Diane Hartman, Robert Campbell, Nikita Lakomkin, John Flynn, Michael Nance, Thane Blinman, Oscar H. Mayer, Howard Pantich, Anthony Capraro, Jesse Taylor, Brian Hanna, Keith Baldwin, Patrick Cahill, Lloydine Jacobs Summary: Increased preoperative instrument exposure has been hypothesized to contribute to a greater risk of postoperative surgical site infection (SSI) in spine surgery. As such, a quality practice intervention (QPI) was implemented to reduce the instruments uncovered time (IUT) for VEPTR implantation. Reductions in IUT were significantly associated with decreased incidence of SSIs. In a multivariate logistic regression model controlling for significant confounders, IUTs exceeding 100 minutes were associated with 8.5 times the odds of developing a SSI. Hypothesis: Reductions in preoperative IUT via a QPI are associated with reduced incidence of SSIs following VEPTR implantation. Design: A retrospective review of prospectively collected data. Introduction: Increased IUT, often equivalent to the anesthesia ready time (ART), has been associated with a greater risk of SSIs following adult spine surgery. The relationship between IUT, ART, and other variables remains unexplored in VEPTR implantation which often requires prolonged ART for line placement. The purpose of this study was to examine the effect of a QPI to minimize IUT and the impact on postoperative SSIs. Methods: A consecutive series of 187 VEPTR implant procedures performed between February 2007 and September 2015 was identified, with QPI begun in August 2013. Patient demographics, hospital length of stay, underlying diagnoses, ART, IUT, and perioperative variables were collected via retrospective registry review. The primary outcome measure was the presence of postoperative culture proven SSIs based on CDC criteria. A Student's t‐ test was performed to assess changes in IUT and ART following the QPI. Chi‐squared and binary logistic regression analysis were used to identify significant risk factors for SSIs. Results: A total of 16 procedures (8.6%) resulted in SSIs. Patients' mean IUT decreased from 120 to 42 minutes following the QPI (p