Surgical Strategy to Correct Coronal Decompensation in an Autofused Growing Rod “Graduate”: A Case Report

Management of patients implanted with growing rods who reach skeletal maturity (growing rod “graduates”) often poses challenging situation for spine surgeons. A 14-year-old female was implanted with traditional growing rods (TGR) – and presented to us with a coronally decompensated deformity. Imaging investigations revealed lumbosacral take-off due to a hemivertebra at the lumbosacral junction distal to the construct and “adding on” of the curve proximal to the construct. Autofusion of the spine was noted intraoperatively – correction was achieved whilst retaining the TGR, and using separate proximal and distal extensions of the construct to correct the deformity, connecting these to the previously implanted TGR. Improvement was noted in lumbosacral take-off angle, coronal shift, and T1 tilt, with no implant-related complications at final follow-up. The case describes a rational thought process and surgical strategy to deal with a challenging presentation of a patient with implanted TGR reaching skeletal maturity.