How to Select the Lower Instrumented Vertebra in Traditional Growing Rods Index Surgery

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Figure 1
Idiopathic scoliosis treated with traditional growing rods. L2 was the substantially touched vertebra and was selected as the lower instrumented vertebra. After the fourth lengthening, the patient developed a distal adding on and, afterwards, a bilateral rod breakage ocurred. Posterior final fusion was performed at skeletal maturity to fix both complications and improve balance, with 1 level distal extension. The last image shows 2-year follow up after final fusion.
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Figure 2
Nine-year-old female patient who developed a thoracic curve months after a wide rib resection secondary to an Askin tumor. Traditional growing rods were implanted, choosing the lower instrumented vertebra at L2, which corresponded to the substantially touched vertebra. After the fourth lengthening, we decided to stop distractions, and the patient was followed with observation. Additional 4-year follow up with no adding on.