A Classification of Growth Friendly Spine Implants

• Published in: Journal of pediatric orthopaedics Vol. 34; no. 3; pp. 260 - 274
• Main Authors: Skaggs, David L, Akbarnia, Behrooz A, Flynn, John M, Myung, Karen S, Sponseller, Paul D, Vitale, Michael G
• Format: Journal Article
• Language: English
• Published: United States by Lippincott Williams & Wilkins 01-04-2014
• Subjects: Bone Nails - classification; Child; Female; Humans; Joint Prosthesis - classification; Male; Pelvis - surgery; Radiography; Scoliosis - diagnostic imaging; Scoliosis - surgery; Spinal Diseases - diagnostic imaging; Spinal Diseases - surgery; Spinal Fusion - instrumentation; Spine - diagnostic imaging; Spine - growth & development; Spine - surgery; Surgical Stapling - classification; Titanium - administration & dosage; Treatment Outcome
• ISSN: 0271-6798; 1539-2570
• DOI: 10.1097/BPO.0000000000000073

BACKGROUND:Various types of spinal implants have been used with the objective of minimizing spinal deformities while maximizing the spine and thoracic growth in a growing child with a spinal deformity.
PURPOSE:The aim of this study was to describe a classification system of growth friendly spinal implants to allow researchers and clinicians to have a common language and facilitate comparative studies. Growth friendly spinal implant systems fall into 3 categories based upon the forces of correction the implants exert on the spine, which are as followsDistraction-based systems correct spinal deformities by mechanically applying a distractive force across a deformed segment with anchors at the top and bottom of the implants, which commonly attach to the spine, rib, and/or the pelvis. The present examples of distraction-based implants are spine-based or rib-based growing rods, vertical expandable titanium rib prosthesis, and remotely expandable devices. Compression-based systems correct spinal deformities with a compressive force applied to the convexity of the curve causing convex growth inhibition. This compressive force may be generated both mechanically at the time of implantation, as well as over time resulting from longitudinal growth of vertebral endplates hindered by the spinal implants. Examples of compression-based systems are vertebral staples and tethers. Guided growth systems correct spinal deformity by anchoring multiple vertebrae (usually including the apical vertebrae) to rods with mechanical forces including translation at the time of the initial implant. The majority of the anchors are not rigidly attached to the rods, thus permitting longitudinal growth over time as the anchors slide over the rods. Examples of guided growth systems include the Luque trolley and Shilla.
CONCLUSIONS:Each system has its benefits and shortcomings. Knowledge of the fundamental principles upon which these systems are based may aid the clinician to choose an appropriate treatment for patients. Having a common language for these systems may aid in comparative research. Vertical expandable titanium rib prosthesis is used with humanitarian exemption. The other devices mentioned in this manuscript are not approved for growing constructs by the Food and Drug Administration and are used off-label.