Luqué Trolley

Fusing a young child's spine stops it growing, which harms the developing chest and lungs. The Luque trolley tried to avoid this by creating a construct that would guide growth rather than stop it: the spine was wired to rods in a way that was meant to let the vertebrae glide along the rods as the child grew, keeping the curve controlled while permitting continued lengthening. It was, in concept, a "guided growth" system decades ahead of its time, and it aimed to achieve growth without the repeated lengthening operations that traditional growing rods required.

The trolley's downfall was a biological one. Extensively exposing and instrumenting the growing spine tended to cause the spine to fuse itself spontaneously — so-called autofusion — which stopped the very growth the technique was designed to preserve. The classic re-examination of the technique, "the Luque trolley revisited," documented cases requiring revision and highlighted precisely this problem of spontaneous fusion limiting growth. Comparative work with convex epiphysiodesis reached similar conclusions. In short, the spine did not glide and grow as intended; it stiffened, and the concept, in its original form, did not deliver.

The core idea — guiding growth rather than repeatedly operating to lengthen — never entirely went away, and in recent years a modernised version has been studied. Refined "self-growing rod" and modern Luque trolley designs, using gliding implants and less disruptive techniques to reduce autofusion, have been evaluated in animal models and in early clinical series, with some recent prospective work reporting fewer reoperations at three years than other growth-friendly methods. This is genuinely interesting, but it remains a specialist research and early-adoption area, and the evidence base is still small — mostly technique papers, animal studies, and modest series. It would be wrong to present the modern trolley as an established treatment; it is an evolving idea with promising but limited data.

I do not use the Luque trolley in any form. Early-onset scoliosis surgery is a highly specialised paediatric field, and growth-friendly techniques belong with the small number of units that study and perform them. My honest reading is that the original Luque trolley was an ahead-of-its-time idea undone by the biology of the growing spine, and that the modern re-examination is a legitimate but still-developing line of work rather than a settled treatment. Families whose child is being considered for any growth-guidance technique are best served by a specialist early-onset scoliosis unit.

• —Mardjetko SM, et al. Spine. 1992. "The Luque trolley revisited": revision cases and autofusion documented. PMID 1621159
• —Pratt RK, et al. Spine. 1999. Luque trolley with convex epiphysiodesis: spontaneous fusion limited growth. PMID 10457573
• —Alanay A, et al. Spine. 2000. Comment on Luque trolley with convex epiphysiodesis. PMID 11013512
• —Wild A, et al. Biomed Tech (Berl). 2002. New self-lengthening technique for the growing spine. PMID 12494546
• —Ouellet J. Clin Orthop Relat Res. 2011. Surgical technique: modern Luque trolley self-growing rod. PMID 21274761
• —Ouellet JA, et al. Clin Spine Surg. 2017. Modern Luque trolley gliding implant in an immature animal model. PMID 28437353
• —Rosenfeld S, et al. Spine Deform. 2018. Guided growth via segmental sublaminar instrumentation in neuromuscular EOS. PMID 30122398
• —Wijdicks SPJ, et al. Spine J. 2019. Systematic review comparing growth among growth-friendly systems. PMID 30290228
• —Mehdian H, et al. Bone Joint J. 2020. Mid-term results of a modified self-growing rod technique. PMID 33135451
• —Dayer R, et al. Spine Deform. 2025. Modern Luque trolley: fewer reoperations at 3 years vs other growth-friendly techniques. PMID 40437325