Blog Topic: Surgical Treatment of Congenital Scoliosis

 

As previously mentioned congenital scoliosis comes in a wide range of types, locations, and complexity. 

This means surgeons caring for this group of patients needs to have multiple surgical treatment options to optimally care for this potentially challenging deformities, from simple hemivertebra resections to complex vertebral column resections and Shilla constructs. The below three cases demonstrate the progression from simple to complex, both in terms of the deformity and the required surgery.

 

Simple: 7 year old male with a single hemivertebra treated with resection and short fusion

Moderate: 13 year old female with previously operated (outside hospital) on lumbosacral hemivertebra with continued worsening of deformity.  Underwent hemivertebra resection and longer fusion.

 

 

Complex: 8 year old male with Prune Belly syndrome.  Treated with vertebral column resection (VCR) at T10, and Shilla construct T4-L4.

 

On the more complicated end of the congenital scoliosis spectrum (i.e. mixed-type), the simple resection and short fusion may not be the best option.  This is due to the possible presence of adjacent areas of involvement which may induce increasing curves above or below the surgical site.  In the past if this was a concern after surgery, the patient may be placed into a brace, which often is less than ideal as these patients may need to wear a brace for many, many years. 

 

Shilla treatment of congenital scoliosis

The “complex” case above was treated with a VCR and a Shilla procedure.  However performing a Shilla procedure in less severe cases can be optimal.  The below case is a 4 year old male with two areas of congenital deformity (one higher and 31.5 degrees, and one lower and 46.8 degrees). 

CASE 1

 

Because of the upper deformity was congenital and more stiff (see below slide), a simple hemivertebra resection will not be able to control the upper curve.

So, at the time of surgery the left T10 hemivertebra (the lower curve) underwent a VCR (complete removal of the vertebra), and then Shilla T4-L4

The arrow on the below slide shows the closure of the gap when the T10 hemivertebra was resected.

Here is the 6 months after surgery follow-up.  His body shift to the left is significantly improved.  The only levels of fusion are within the white box (below).  The remaining vertebra above and below this white boxed area will be able to grow vertically along the Shilla rods.

The next Blog post will demonstrate complex congenital scoliosis cases using Shilla procedures