Growing Rod Surgery for Young Children with Scoliosis
Today, children with severe congenital spinal scoliosis benefit from the use of "growing rods". The surgeon places one or two rods down the spine to help straighten the curved vertebrae. The rods lengthen as the child grows allowing the spine to get longer and the child to get taller. But the technique is still new enough that questions remain about how safe and effective this tool is. This is the first study to report on the use of growing rods for children with progressive congenital scoliosis.
Congenital progressive spinal scoliosis refers to a condition present at birth that gets worse over time. When looking at the spine from the back, the vertebrae should line up straight (one on top of the other) from the base of the skull down to the end of the spine. With scoliosis, the vertebrae curve and rotate forming either a C-shaped curve to the left or right or an S-shaped curve.
The spinal deformity is severe and causes an unacceptable cosmetic appearance but also compromises growth and function of the heart, lungs, and other organs inside the chest and abdomen. Straightening the spine with a brace isn't enough for these children. They usually require surgery with rods and spinal fusion to hold the correction.
The authors of this study are from an international multicenter Growing Spine Study Group. They followed 19 children with congenital spinal deformities who had growing rod surgery. Their goals were to see if the growing rods were safe, maintained the correction over time, and allowed equal growth when compared with spinal segments allowed to grow without the rods.
Children in the study ranged in age from three to almost 11 years old. Half of the children had previous spinal surgeries. Most of the procedures were done to correct other deformities and malformations of the ribs, spinal cord, and/or vertebrae (spinal bones). The growing rod surgery was the first spinal correction surgery for the other half of the group.
Everyone was followed for a minimum of two years. Some children are still in the study six years later. About one-third of the group reached full growth maturity and had a final fusion. They are no longer in this study but will be followed to observe how things hold up over time.
You can see by their ages that these are children who develop scoliosis early in life. This is referred to as early onset scoliosis (EOS). Sometimes the scoliosis is part of another condition such as one of the neuromuscular diseases that can occur. In other cases, the cause is unknown or idiopathic.
Final results from the study showed a mixture of improvements, maintenance, and worsening (loss of spinal length). There were some complications in slightly less than half the group (eight of the 19 children). Implants broke or shifted position, there were a few infections, and a couple lung problems. But there were no neurologic complications (e.g., nerve or spinal cord damage) and that was very good!
Before growing rods were available, children with progressive congenital scoliosis often ended up with fusions that stunted their growth, compressed their lungs, and caused lifelong problems as a result. The results of this study from the Growing Spine Study Group are very encouraging. That's especially good news for the children who could die from poor lung development without surgical treatment.
The growing rods can be used in young children even if they have fused ribs on one or both sides. The risk of serious complications is moderate but as this study showed, there is a low risk of neurologic problems. They found that growth per year for each spinal segment was the same for levels held in place by the growing rods when compared with vertebra that were not stabilized by the rods. The spinal correction was maintained or children had only a small loss of correction.
Hazeem B. Elsebai, MD, et al. Safety and Efficacy of Growing Rod Technique for Pediatric Congenital Spinal Deformities. In Journal of Orthopaedic Pediatrics. January/February 2011. Vol. 31. No. 1. Pp. 1-5.