List the key steps procedural steps in the placement of dual growing rods

• Two incisions are required: one cephalad at the proximal foundation and one caudally at the distal foundation. These are the only sites of subperiosteal dissection. Rods and tandem connectors are passed smoothly under the fascia

• The proximal foundation consists of bilateral supralaminar and infralaminar hooks (claw formation) in combination with a cross connector. Alternatively four pedicle screws may be used

• The caudal foundation consists of four pedicle screws

• Rods (after appropriate contouring) are passed below the fascia underneath the long skin bridge

• Cephalad and caudal rods are connected via a tandem connector through which lengthening will be performed

• Initial lengthening is performed through the tandem connector at time of index surgery. Subsequent lengthenings are planned at 6 month intervals

• In rigid curves, preoperative traction, apical anterior release, or osteotomy are considered

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