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Comparison of Surgical Techniques in the Treatment of Early-Onset Scoliosis
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Posted on: 04/26/2007
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Early-onset scoliosis is usually managed through the use of back braces or orthotics. However, if the bracing isn't successful or if the child's physical condition doesn't allow for that approach, surgery might be necessary.
In this article, authors report on studies that looked at different techniques aimed at straightening the spine. In the first study, researchers followed children who were placed into one of three groups: Five patients (group 1) had a single growing rod with short anterior and posterior apical fusion; 16 patients (Group 2) had only a single growing rod; and seven patients (group 3) had growing rods and no apical fusion. Almost all children were girls.
The patients were all about the same age: Group 1: 7.0 years (+/- 2.9); group 2: 8.7 years (+/-1.0); and group 3: 7.0 years (+/-3.9). The children in group 3 had their growing rods lengthened every six months, regardless of the curve progression.
Before surgery, the scoliosis curves were: 85 degrees (+/-23 degrees) in group 1; 61 degrees (+/-13) in group 2; and 92 degrees (+/-21) in group 3. After surgery, they were 65 degrees (+/-22), 39 degrees (+/-15), and 26 degrees (+/-18), respectively. The children in group 2 had the lowest complication rate (P=.04). Not all of the children had undergone pulmonary testing before surgery, but all were asymptomatic and were stable on room air pre- and post-operatively.
Another surgery, the vertical expandable prosthetic titanium rib (VEPTR) has also been used in to straighten the spine and increase respiratory ability, most often in patients with extensive thoracic congenital scoliosis and fused ribs. A small study of nine girls and seven boys, mean age 4.5 years (range 1.4-9.5 years), found that curve correction was about 34 degrees at follow-up following surgery in children with scoliosis without rib anomalies, and a mean of 25 degrees in children with congenital scoliosis. This surgery appears to be able to correct curves, or at least stabilize them, adding to the potential of increasing respiratory function.
Thirteen of the children were stable on room air both pre- and post-operatively, but three developed respiratory difficulties, resulting in ventilator support. Ten children experienced complications from the surgery and the authors add that the complication rate may rise in this group as the children grow.
The value of the different available rods are being questioned in many studies. One study of 11 children reported that the subcutaneous Harrington rod produced satisfactory results, but needed several procedures to obtain results. And, several of the patients experienced complications, although none were neurological. In a larger study of 29 children, in which patients were treated with a single growing rod, the researchers felt that they were successful in managing the severe early-onset scoliosis, but only nine children demonstrated definitive spinal fusion.
Another study followed 23 children, who received dual growing rods with periodic lengthening; 16 of the children are still in active treatment. The findings are showing that this is a safe and effective surgery, with a lower complication rate.
After reviewing various study findings, the authors conclude that use of either rod (single or dual) can be effective in controlling scoliosis curves, but that dual growing rods, with frequent lengthening may be superior to the single growing rods. They do, however, caution against anterior and posterior apical fusion because of the number of associated complications.
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References:
George H. Thompson, MD et al. Growing Rod Techniques in Early-Onset Scoliosis. In Journal of Pediatric Orthopedics. April/May 2007. Vol. 27. No. 3. Pp. 354-361.
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