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 3
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……..