Our Summary

This research paper focuses on treatment methods for early-onset scoliosis, a condition where the spine develops a curve before the age of five. If not treated, this condition can progress and become severe, potentially leading to respiratory failure in adulthood. There are different surgical techniques used to correct the curve and promote the normal growth of the spine.

The first method uses a rod or rib made of titanium, attached to the spine to straighten it. This method often requires multiple surgeries to lengthen the rod as the child grows. A newer version of this procedure uses a magnetic system to extend the rod, reducing the need for more surgeries.

The second method uses the natural growth of the spine to correct the curve. A device is attached to the spine which moves with it as it grows.

These methods are effective in controlling and correcting the curvature caused by early-onset scoliosis and helping the spine to grow normally. However, they can have complications such as infection, the breaking of the rod, spine fixation pull out, and spinal stiffness. Also, while these methods can help the spine to grow, they don’t always improve lung function. This is because the expansion of the chest doesn’t guarantee better lung function, as the flexibility of the rib cage can be affected.

FAQs

  1. What is early-onset scoliosis and what are its potential long-term effects?
  2. What are the current surgical techniques used to treat early-onset scoliosis?
  3. What are the risks or complications associated with these surgical techniques for early-onset scoliosis?

Doctor’s Tip

One helpful tip a doctor might tell a patient about pediatric scoliosis surgery is to closely follow post-operative care instructions to optimize healing and recovery. This may include proper wound care, physical therapy exercises, and regular follow-up appointments to monitor progress and address any potential complications. It is important for the patient and their caregivers to communicate any concerns or changes in symptoms to the medical team to ensure the best possible outcomes.

Suitable For

Patients who are typically recommended pediatric scoliosis surgery are those with early-onset scoliosis, which covers a variety of etiologies with onset before the age of 5 years. These patients may have progressive and severe spinal deformities that threaten respiratory development and may result in respiratory failure in adulthood. Surgery is recommended for patients who have not responded to conservative treatment options and who are at risk for worsening deformity and respiratory compromise.

Surgical techniques for pediatric scoliosis may involve posterior distraction of the spine with growing rods or vertical expandable prosthetic titanium ribs, or using spinal growth force to lengthen the assembly with techniques such as the Luque Trolley or Shilla method. However, these techniques have a high rate of complications, including infection, rod breakage, and spinal fixation pull out. It is important for patients and their families to weigh the potential benefits of surgery in controlling the scoliotic deformity and restoring spinal growth against the risks of complications.

Timeline

  • Before pediatric scoliosis surgery:
  1. Patient is diagnosed with early-onset scoliosis before the age of 5 years.
  2. Progression and severity of the scoliosis threaten respiratory development and may result in respiratory failure in adulthood.
  3. Various surgical techniques are considered based on the etiology of the scoliosis.
  4. Surgical options include posterior distraction of the spine with growing rods or vertical expandable prosthetic titanium rib (VEPTR), or using spinal growth force with techniques like Luque Trolley or Shilla.
  5. The decision is made to undergo surgical treatment to control the scoliotic deformity and potentially restore spinal growth.
  • After pediatric scoliosis surgery:
  1. The surgery is performed to correct the spinal deformity and promote spinal growth.
  2. Complications such as infection, rod breakage, spinal fixation pull out, and spinal stiffness may occur.
  3. Respiratory function may or may not improve after surgery, as thoracic expansion does not always lead to improved respiratory function.
  4. Long-term monitoring and follow-up are necessary to assess the efficacy of the surgery and address any complications that may arise.
  5. Rehabilitation and physical therapy may be needed to help the patient recover and regain strength after surgery.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with pediatric scoliosis surgery?
  2. How long will the recovery process be after surgery?
  3. Will my child need additional surgeries in the future for lengthening or adjustments?
  4. What are the long-term effects of spinal fusion on spinal growth and development?
  5. How will the surgery impact my child’s respiratory function and overall health?
  6. What type of spinal instrumentation will be used in the surgery and why?
  7. How successful have previous surgeries been in terms of controlling the scoliotic deformity?
  8. What kind of post-operative care and physical therapy will be needed for my child?
  9. Are there any alternative treatments or less invasive options available for pediatric scoliosis?
  10. What is the expected outcome and prognosis for my child after surgery?

Reference

Authors: Odent T, Ilharreborde B, Miladi L, Khouri N, Violas P, Ouellet J, Cunin V, Kieffer J, Kharrat K, Accadbled F; Scoliosis Study Group (Groupe d’étude de la scoliose); French Society of Pediatric Orthopedics (SOFOP). Journal: Orthop Traumatol Surg Res. 2015 Oct;101(6 Suppl):S281-8. doi: 10.1016/j.otsr.2015.07.004. Epub 2015 Sep 16. PMID: 26386889