Prospective Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Sep 18, 2018; 9(9): 138-148
Published online Sep 18, 2018. doi: 10.5312/wjo.v9.i9.138
Single rod instrumentation in patients with scoliosis and co-morbidities: Indications and outcomes
Athanasios I Tsirikos, Peter R Loughenbury
Athanasios I Tsirikos, Peter R Loughenbury, Scottish National Spine Deformity Centre, Royal Hospital for Sick Children, Edinburgh EH9 1LF, United Kingdom
Author contributions: Tsirikos AI treated the patients included in this series, and analyzed the data and wrote the paper; Loughenbury PR collected, analyzed the data, and wrote the initial draft of the paper; both authors reviewed the final manuscript including the present revision and agreed to proceed with the submission.
Institutional review board statement: The study was reviewed and approved by the Royal Hospital for Sick Children Institutional Review Board.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. No conflict of interest is to be declared
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Athanasios I Tsirikos, FRCS (Hon), MD, PhD, Senior Lecturer, Senior Scientist, Surgeon, Scottish National Spine Deformity Centre, Royal Hospital for Sick Children, Sciennes Road, Edinburgh EH9 1LF, United Kingdom.
Telephone: +44-131-5360784 Fax: +44-131-6621265
Received: February 9, 2018
Peer-review started: February 10, 2018
First decision: March 9, 2018
Revised: May 20, 2018
Accepted: May 23, 2018
Article in press: May 23, 2018
Published online: September 18, 2018

To present our results on the use of a single rod instrumentation correction technique in a small number of patients with major medical co-morbidities.


This study was a prospective single surgeon series. Patients were treated with single rod hybrid constructs and had a minimum 2-year follow-up. Indications included complex underlying co-morbidities, conversion of growing rods to definitive fusion, and moderate adolescent idiopathic primarily thoracic scoliosis with severe eczema and low body mass index (BMI).


We included 99 consecutive patients. Mean age at surgery was 12.8 years (SD 3.5 years). Mean scoliosis correction was 62% (SD 15%) from 73° (SD 22°) to 28° (SD 15°). Mean surgical time was 153 min (SD 34 min), and blood loss was 530 mL (SD 327 mL); 20% BV (SD 13%). Mean clinical and radiological follow-up was 3.2 years (range: 2-12) post-operatively. Complications included rod failure, which occurred in three of our complex patients with severe syndromic or congenital kyphoscoliosis (3%). Only one of these three patients required revision surgery to address a non-union. Our revision rate was 2% (including a distal junctional kyphosis in a Marfan’s syndrome patient).


The single rod technique has achieved satisfactory deformity correction and a low rate of complications in patients with specific indications and severe underlying medical conditions. In these children with significant co-morbidities, where the risks of scoliosis surgery are significantly increased, this technique has achieved low operative time, blood loss, and associated surgical morbidity.

Keywords: Pediatric scoliosis, Indications, Spinal deformity, Surgery, Spinal fusion, Single rod technique, Outcomes

Core tip: We reviewed 99 pediatric patients treated for scoliosis with a single-rod hybrid technique. They belonged in three groups: Group A included 62 patients with complex deformities and low body mass index (BMI) associated with medical co-morbidities increasing the risk of cardiac, respiratory, neurological complications and intra-operative blood loss; group B included 21 patients treated with growing rod lengthenings who underwent spinal fusion; group C included 16 patients with moderate adolescent idiopathic scoliosis, low BMI, and severe eczema at risk of wound or systemic infection. The single-rod technique has achieved and maintained at follow-up good deformity correction with low surgical time, blood loss, and surgical morbidity.