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Dual Growing Rods for the Treatment of Early-Onset Scoliosis
Gregory M. Mundis, MD1; Nima Kabirian, MD1; Behrooz A. Akbarnia, MD1
1 San Diego Center for Spinal Disorders, 4130 La Jolla Village Drive, Suite 300, La Jolla, CA 92037. E-mail address for G.M. Mundis: gmundis1@gmail.com. E-mail address for N. Kabirian: nkdehkordi@yahoo.com. E-mail address for B.A. Akbarnia: Akbarnia@ucsd.edu
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Based on an original article: J Bone Joint Surg Am. 2010 Nov 3;92(15):2533-43.

Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. One or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
JBJS Essential Surgical Techniques, 2013 Mar 27;3(1):e6 1-11. doi: 10.2106/JBJS.ST.K.00050
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The dual growing-rod technique involves implantation of a set of two rods and two anchor groups (upper and lower foundations) to exert frequent distractions to allow for spinal growth.

Step 1: (Initial Surgery): Positioning

Pay special attention to the effect of positioning on sagittal alignment.

Step 2: (Initial Surgery): Neuromonitoring

Use multimodality intraoperative neuromonitoring, including SSEPs, MEPs, EMG, and H-Reflexes.

Step 3: (Initial Surgery): Exposure

Avoid broad exposure of uninstrumented levels to prevent the risk of spontaneous fusion.

Step 4: (Initial Surgery): Preparation of Foundations

The foundation is an assembly of at least four anchors at two or three vertebrae along with one or two rods.

Step 5: (Initial Surgery): Choosing the Anchors

Use hooks or pedicle screws for the proximal foundation and use bilateral pedicle screws (a four-anchor construct) for the distal foundation.

Step 6: (Initial Surgery): Rod Contouring and Rod Assembly

Cut two 4.5-mm rods and contour them to the appropriate sagittal and coronal alignment, being careful not to overcorrect in the sagittal and coronal planes.

Step 7 (Initial Surgery): Tandem Connector Attachment

Place a tandem connector at the thoracolumbar junction to allow for future lengthening.

Step 8 (Initial Surgery): Final Implant Assembly

Pass the preassembled rods and tandem connector from caudad to cephalad beneath the fascia, securing them to the foundation and performing the first lengthening.

Step 9 (Initial Surgery): Wound Closure

Gentle handling of the skin and associated deeper tissues is essential to avoid complications.

Steps 1 and 2 (Lengthening): Positioning and Neuromonitoring

These are the same as those for the initial surgery.

Step 3 (Lengthening): Exposure

Make one incision between the two connectors on or in line with the original incision.

Step 4 (Lengthening): Lengthening Inside Versus Outside the Tandem Connector

Lengthening can be performed inside or outside the tandem connector.

Step 5 (Lengthening): Closure

See Step 9 for the initial surgery.


The quantity and quality of research on growth-sparing techniques for early-onset scoliosis have increased substantially in the past three years.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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