Failure to replace removed growth friendly implants results in deteriorating radiographic outcomes

Area of Science:

• Pediatric Orthopedics
• Spinal Surgery
• Scoliosis Research

Background:

• Early onset scoliosis (EOS) management often requires growth-friendly surgery for children not ready for definitive fusion.
• Limited data exists on outcomes following removal of implants (ROI) in EOS patients with failed growing constructs.

Purpose of the Study:

• To compare outcomes of early re-implantation versus observation after removal of growth-friendly implants in EOS patients.
• To evaluate the impact of re-implantation timing on spinal curve progression.

Main Methods:

• Retrospective analysis of EOS patients from an international registry undergoing implant removal.
• Comparison of early re-implantation (within 12 months) versus observation-only groups.
• Radiographic measurements (coronal Cobb angle) analyzed pre- and post-removal.

Main Results:

• The observation group showed significantly greater coronal Cobb angle increase at two years post-ROI (81° vs 53°, p=0.003).
• Fewer patients in the re-implantation group experienced significant curve progression (30% vs 64%, p=0.04).
• Re-implantation group maintained curve stability, with no significant progression from immediate post-ROI to two years.

Conclusions:

• Prompt re-implantation of growth-friendly implants effectively stabilizes spinal curves in EOS patients post-removal.
• Timely re-implantation is crucial for optimizing outcomes in this patient population.
• Prioritizing re-implantation, when feasible, is recommended despite potential technical difficulties.