Safety and effectiveness of halo gravity traction combined with traditional growing rods in severe early-onset scoliosis with neurofibromatosis type 1.

Neurofibromatosis type 1 (NF-1) scoliosis can be difficult to treat without early detection. Correcting deformities while considering long-term growth in early-onset scoliosis (EOS) treatment is important. This study was performed to establish the safety and effectiveness of halo gravity traction (HGT) with traditional growing rods (TGRs) in NF-1 EOS. We retrospectively reviewed a cohort of 15 children (7 boys and 8 girls; mean age, 5.61 years) diagnosed with NF-1 EOS from October 2016 to March 2021. All patients underwent HGT before growing rod implantation. The growing rods were lengthened every 9-12 months, with a follow-up of 2-7 years. Cobb angle, thoracic kyphosis (TK), trunk shift (TS), sagittal vertebral axis and T1-S1 height were measured before operation, after traction, after operation and at last follow-up. Complications were also recorded. Fifteen patients with NF-1 EOS were treated with an average traction weight of 10.00 kg. After 29.20 days of HGT, the Cobb angle improved from 99.10° to 62.60°, TK from 79.33° to 55.04°, TS from 31.05 to 17.71 mm, sagittal vertebral axis from 42.07 to 25.63 mm and T1-S1 height from 27.50 to 29.70 cm (P < 0.05 for all). Postoperatively, compared with post-traction, the Cobb angle was 52.40° (P = 0.002) and TK was 44.54° (P = 0.004). No complications occurred during traction. Growing rod dislocation occurred in one patient and growing rod breakage in one patient. HGT combined with TGRs was well-tolerated and effective for treating severe NF-1 EOS. It significantly corrected the Cobb angle and TK, restored trunk balance, and increased spinal height with few complications.

Robot-assisted Temporary Hemiepiphysiodesis With Eight-plates for Lower Extremity Deformities in Children.

PURPOSE: This study was performed to compare the radiographic results of robot-assisted and traditional methods of treating lower extremity deformities (LEDs). METHODS: From January 2019 to February 2022, 55 patients with LEDs were treated by temporary hemiepiphysiodesis with eight-plates. They were divided into a robot group and a freehand group. The fluoroscopy time and operation time were recorded. The accuracy of screw placement was measured after the operation using the following parameters: coronal entering point (CEP), sagittal entering point (SEP), and angle between the screw and epiphyseal plate (ASEP). The limb length discrepancy (LLD) and femorotibial angle (FTA) were measured before the operation, after the operation, and at the last follow-up. Patients were followed up for 12 to 24 months, and the radiographic results of the 2 groups were compared. RESULTS: Among the 55 patients with LEDs, 36 had LLD and 19 had angular deformities. Seventy-six screws were placed in the robot group and 85 in the freehand group. There was no difference in the CEP between the 2 groups ( P >0.05). The robot group had a better SEP (2.96±1.60 vs. 6.47±2.80 mm) and ASEP (3.46°±1.58° vs. 6.92°±3.92°) than the freehand group ( P <0.001). At the last follow-up, there was no difference in the LLD or FTA improvement between the two groups ( P >0.05). The incidence of complications was significantly lower in the robot group than in the freehand group (0/27 vs. 5/28, P <0.05). CONCLUSION: Robot-assisted temporary hemiepiphysiodesis with eight-plates is a safe and effective method for treating LEDs in children. Robotic placement of screws is superior to freehand placement with respect to the entering position and direction. Although the correction effect for LLD and angular deformity is similar, screw dislocation is less common when using robot assistance. LEVELS OF EVIDENCE: Level-III. Retrospective comparative study.