Spring-Mediated Cranioplasty in Sagittal Synostosis: Does Age at Placement Affect Expansion?

Purpose: The aim of this study is to evaluate the effect of timing of surgery and spring characteristics on correction of scaphocephalic deformity in patients undergoing spring-mediated cranioplasty (SMC) for sagittal craniosynostosis. Methods: The authors conducted a review of patients with sagittal craniosynostosis who underwent SMC at a tertiary referral center between July 2011 and March 2017, with a primary outcome measure of head shape, both preoperatively and postoperatively, determined by cephalic index (CI). Patient demographics and operative details including timing of surgery and spring characteristics were collected. Differences in CI preoperation and postoperation were compared using Wilcoxon signed-rank test. Ordinary least-squares linear regression was used to assess the impact of timing, number of springs, maximum single spring force, and total spring force on postoperative change in CI. Results: Thirty-six subjects (12 males and 24 females) were included in the study. Mean age at spring placement was 3.9 months (range: 1.9–9.2) with a mean follow-up of 1.4 years (range: 0.3–5.2). The mean number of springs used was 3 (range: 2–4). The mean maximum single spring force was 9.9 Newtons (N) (range: 6.9–13.0) and the mean total spring force was 24.6 N (range: 12.7–37.0). Mean CI increased from 70 ± 0.9 preoperatively to 77 ± 1.0 postoperatively (P 

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