Staging growing rod insertion results in increased postoperative complications than the equivalent unstaged procedure
Bibliographic record
Abstract
Aims: Anchor-related complications are the leading cause for unplanned surgery in early-onset scoliosis (EOS). One strategy to reduce unplanned surgery is staging implant insertion. This study compares the outcomes of staged versus unstaged growing rod (GR) insertion, focusing on complication rates. Methods: This retrospective cohort study examined 48 EOS patients who received GR surgery at a single institution (Hospital for Sick Children, Toronto, Canada) between January 2006 and July 2023. Patients were grouped according to staged and unstaged GR insertion. Radiological measurements were obtained preoperatively, post-insertion, and one-year follow-up to determine radiological change between and within each group. Complications were recorded until posterior spinal fusion (PSF) or most recent follow-up if no PSF was performed, and compared between groups. Results: Overall, 24 patients received staged and 24 patients received unstaged dual GR insertion. The mean follow-up time for patients was 53.1 months (SD 33.1). Patients who underwent unstaged insertion had greater Cobb angle correction (46.6% (SD 15.9%) vs 31.5% (SD 13.3%), p < 0.001). There were no significant differences in kyphosis correction (p = 0.118) or thoracic height growth (p = 0.348) between groups. Staged patients experienced a higher complication rate compared to unstaged patients within the first year following insertion (38% vs 12%). Differences in proximal junctional kyphosis (PJK) development between staged (17%) and unstaged (29%) patients were not significant (p = 0.303). The mean insertion-associated length of stay was longer in staged patients (10.7 days (SD 4.2)) compared to unstaged patients (5.8 days (SD 4.0), p < 0.001). Conclusion: Staged and unstaged GR insertion results in acceptable coronal correction and comparable radiological parameters. However, staged insertion may not be superior to unstaged insertion given the increased length of stay and rate of complications associated with the procedure.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".