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Smaller Intervertebral Disc Volume and More Disc Degeneration After Spinal Distraction in Scoliotic Children

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Smaller Intervertebral Disc Volume and More Disc Degeneration After Spinal Distraction in Scoliotic Children Journal of Clinical Medicine Article Smaller Intervertebral Disc Volume and More Disc Degeneration after Spinal Distraction in Scoliotic Children Sebastian Lippross 1,2,†, Paul Girmond 2,† , Katja A. Lüders 1, Friederike Austein 3 , Lena Braunschweig 1 , Stefan Lüders 4, Konstantinos Tsaknakis 1, Heiko M. Lorenz 1 and Anna K. Hell 1,* 1 Department of Trauma, Orthopedic and Plastic Surgery, University Medical Center Goettingen, 37075 Goettingen, Germany; [email protected] (S.L.); [email protected] (K.A.L.); [email protected] (L.B.); [email protected] (K.T.); [email protected] (H.M.L.) 2 Department of Orthopedic and Trauma Surgery, University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany; [email protected] 3 Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; [email protected] 4 Mahr GmbH, 37073 Goettingen, Germany; [email protected] * Correspondence: [email protected]; Tel.: +49-551-39-8701 † Both authors have contributed equally to the work. Abstract: In recent decades, magnetically controlled growing rods (MCGR) were established to treat progressive early-onset scoliosis. The aim of this investigation was to assess the effect of long-term MCGR with continuous distraction on intervertebral discs in scoliotic children. Magnetic resonance imaging (MRI) of 33 children with spinal muscular atrophy was analyzed by grading intervertebral Citation: Lippross, S.; Girmond, P.; Lüders, K.A.; Austein, F.; disc degeneration (IDD) and measuring intervertebral disc volume. Cohort I (n = 17) were children Braunschweig, L.; Lüders, S.; who had continuous spinal distraction with MCGRs for 5.1 years and MRI before (av. age 8.1) and Tsaknakis, K.; Lorenz, H.M.; Hell, after (av. age 13.4) MCGR treatment. Cohort II (n = 16, av. age 13.7) were patients without prior A.K. Smaller Intervertebral Disc surgical treatment. Lumbar intervertebral disc volume of cohort I did not change during 5.1 years Volume and More Disc Degeneration of MCGR treatment, whereas disc volumes were significantly larger in age- and disease-matched after Spinal Distraction in Scoliotic children without prior treatment (cohort II). Cohort I showed more IDD after MCGR treatment in Children. J. Clin. Med. 2021, 10, 2124. comparison to early MRI studies of the same patients and children without surgical treatment. MRI https://doi.org/10.3390/ data showed a volume reduction and disc degeneration of lower thoracic and lumbar intervertebral jcm10102124 discs in scoliotic children after continuous spinal distraction with MCGRs. These effects were confirmed in the same subjects before and after treatment as well as in surgically untreated controls. Academic Editor: Hyun Woo Kim Keywords: intervertebral disc; volume; disc degeneration; spinal muscular atrophy; scoliosis; growth- Received: 30 March 2021 Accepted: 10 May 2021 friendly implants; MRI Published: 14 May 2021 Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in 1. Introduction published maps and institutional affil- Growth friendly spinal implants (GFSI) have recently become a standard of care for iations. early onset scoliosis (EOS). There are many reports in the literature supporting the idea of early minimally invasive treatment as an effective alternative to casting, bracing or “watch and wait” strategies [1]. It is a well-known problem in pediatric orthopedics and spinal surgery that early deformities tend to progress quickly, which can ultimately result in Copyright: © 2021 by the authors. thoracic insufficiency syndrome, while spinal fusion, which is the most effective method to Licensee MDPI, Basel, Switzerland. control scoliotic curve progression, will lead to the same condition if performed too early. This article is an open access article GFSI have, therefore, evolved, awakening the hope of providing an effective therapeutic distributed under the terms and concept. There are a handful of different constructs used, all based on the same principle: conditions of the Creative Commons hooks or screws may be used to anchor an expandable rod between pedicles, laminae, Attribution (CC BY) license (https:// ribs and/or the pelvic crest. Lengthening rods may either be magnetically controlled or creativecommons.org/licenses/by/ motorized or conventionally expanded by minor repeated surgical procedures. Regardless 4.0/). J. Clin. Med. 2021, 10, 2124. https://doi.org/10.3390/jcm10102124 https://www.mdpi.com/journal/jcm J. Clin. Med. 2021, 10, 2124 2 of 13 of the choice of construct, several studies have demonstrated good deformity control, especially in syndromic, neuromuscular and/or congenital disease [2]. J. Clin. Med. 2021, 10, x FOR PEER REVIEW 2 of 13 While the overall impression of this method, which has been used for several decades now, is positive, there is some doubt that the benefits outweigh the complications. GFSI is frequentlycontrolled or associated motorized or with conventionally heterotopic expanded ossification by minor and repeated autofusion surgical ofproce- the spine [3–5]. One ofdures. the concernsRegardless raisedof the choi ince the of discussionconstruct, several is the stud effecties have of GFSI demonstrated on the morphologygood de- of vertebrae andformity discs control, [6]. especially The evaluation in syndromic, of suchneuromuscular changes and/or is somewhat congenital disease difficult [2]. because of several factors,While such the overall as a heterogeneous impression of this EOS method, population which has been with used many for several underlying decades diseases, genetic now, is positive, there is some doubt that the benefits outweigh the complications. GFSI predispositions,is frequently associated multiple with heterotopic additional ossification problems and and autofusion disabilities. of the Inspine addition, [3–5]. measurements ofOne morphologic of the concerns changes, raised in i.e.,the discussion vertebral is or the disc effect shape, of GFSI or on even the morphology estimation of of biomechanical propertiesvertebrae and like discs stiffness [6]. The ev ofaluation the spine, of such have changes mostly is somewhat been difficult based onbecause plain of X-rays, with all theseveral limitations factors, such that as a two-dimensional heterogeneous EOS population imaging with have many when underlying attempting diseases, the evaluation of three-dimensionalgenetic predispositions, phenomena multiple additional [7]. Hasler problems et al. and [6 disabilities.] have described In addition, some meas- of the changes seen urements of morphologic changes, i.e., vertebral or disc shape, or even estimation of bio- inmechanical lumbar properties vertebrae like on stiffness radiographs of the spine, after have GFSI mostly treatment been based and on plain Lippross X-rays, et al. [8] reported reducedwith all the vertebral limitations body that two-dimensional volume using imaging magnetically have when controlled attempting growingthe evalua- rods (MCGR). To ourtion knowledge,of three-dimensional few data phenomena have been [7]. Hasl publisheder et al. [6] on have intervertebral described some disc of the changes after GFSI treatmentchanges seen [ 9in] lumbar and no vertebrae data afteron radiographs MCGRs, after despite GFSI treatment disc mobility and Lippross ultimately et al. determining [8] reported reduced vertebral body volume using magnetically controlled growing rods spinal(MCGR). flexibility. To our knowledge, To shed few light data on have some been aspectspublished of on the intervertebral emerging disc technique changes of MCGRs, we conductedafter GFSI treatment a prospective [9] and no study data after on MCGRs, a homogenous despite disc cohort mobility of ultimately patients deter- with spinal muscular atrophymining spinal (SMA) flexibility. and spinalTo shed deformity. light on some Almost aspects of all the SMA emerging patients technique suffer of from EOS, and MCGRsMCGRs, we have conducted become a prospective a standard study treatment on a homogenous for many cohort [10 ,of11 patients]. This with investigation spi- evaluates intervertebralnal muscular atrophy disc (SMA) volume, and spinal disc deformity. height and Almost disc all degenerationSMA patients suffer of from children before and EOS, and MCGRs have become a standard treatment for many [10,11]. This investigation afterevaluates an averageintervertebral of 5.1disc yearsvolume, of disc MCGR height and treatment disc degeneration in comparison of children with before age- and disease- matchedand after an controls average of without 5.1 years surgery. of MCGR Therefore,treatment in comparison this study with design age- allowsand disease- us to examine solely thematched effect controls of MCGRs without (Figure surgery.1 )Therefore, on intervertebral this study design discs allows in children us to examine with spinal muscular atrophysolely the (SMA).effect of MCGRs (Figure 1) on intervertebral discs in children with spinal mus- cular atrophy (SMA). Figure 1. Bilateral rib-to-pelvis fixation with magnetically controlled growing rods (MCGR) in a 5-year-old spinal muscular atrophy type II girl with progressive scoliosis. Posterior anterior (p.a.) (A) and lateral (B) sitting radiographs before the surgical intervention. Deformity correction (C/D) after surgical treatment. Implant exchange after maximal distraction after 3 years of treatment. 4-year follow-up (E/F) with second MCGRs.
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