Introduction: 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.
Results: The quantity and quality of research on growth-sparing techniques for early-onset scoliosis have increased substantially in the past three years.
What to watch for: IndicationsContraindicationsPitfalls & Challenges.