Blog Topic: Surgical Treatment of Congenital Scoliosis

 

When is surgery necessary?

               This is not a simple answer, mainly because there is a wide spectrum of deformities, from number of areas involved, type of problems, location, magnitude, progression, and age of patient, to name a few of the considerations.  Each patient is unique, so the decision of when surgery is a reasonable option is also unique.  Small magnitude, non-progressive deformities usually don’t require surgery, whereas large magnitude, progressive deformities more typically require surgery.

Small deformity                    Large deformity

No surgery needed                 Surgery needed

 

 

The basic concepts of surgical treatment of congenital scoliosis:

1.      Delay surgery as long as possible to permit vertical growth of the spine.  This can minimize the number of surgeries needed by the end of growth.  In addition, we like to avoid surgery, if possible, until after 4-5 years of age, at a minimum.

2.      Identify the areas of concerns and quantify the problem

3.      Only address the problem area(s).  This means to resect, fuse, and control the problem area(s) only.

4.      Fuse as few vertebra as necessary: this again permits more vertical growth

What are accepted treatments for congenital scoliosis?

1.      Distraction constructs or Growing Rods, both traditional and magnetically-controlled

               Distraction constructs are used occasionally in congenital scoliosis.  Very young patients, multiple problem areas, unknown progression can be factors in which a distraction construct may be used as a temporary method of treatment.

 

2.      Short fusion

12 year old male                      5 years after hemivertebra resection and fusion

1 hemivertebra

 

               A short fusion can work very well when there is a single area of problem.  In the above case the hemivertebra was resected, the defect was closed down…..and fused, which prevents this area from growing crooked.

 

 

Diagram 1                                Diagram 2

Diagram 3

Diagram 1 demonstrates an isolated, single hemivertebra (triangle).  Resection (diagram 2) creates a triangular defect which is then closed down, straightening the deformity (diagram 3).  For this to be successful treatment the spine above and below has to be fairly straight.

 

3.      Short fusion and growth guidance (Shilla)

We will present this surgical treatment next week……..