3-12-2024
This is a 10 year old female with idiopathic scoliosis. Radiographs measured out a 64 degree right thoracic curve.
To determine the treatment options some of the additional information is crucial. Specifically, the amount of growth remaining which is best determined by the Sanders classification. This patient is a 3- which means the spine is growing very quickly and is at risk for continuing to progress to a bigger curve.
The above radiographs are called “side-benders” in which the patient maximally bends to the left and to the right. This gives us an idea of the spine flexibility. On the sidebender to the right the curve went from 64 degrees down to 30 degrees.
The above slide collates all the information together. So what are the treatment options?
The above is a treatment matrix I put together to help structure the decision making, with the input of the two most important pieces of information: curve magnitude and the amount of spine growth remaining. The red dot is our patient.
The two main therapeutic options are: Posterior Spinal Fusion and ApiFix. Vertebral Body Tethering, which is a very popular surgery option over the last 5 years, is an option but was not deemed viable based on discussions with parents.
After a lot of discussions about the alternatives, benefits, complications and risks of ApiFix and Posterior Spinal Fusion the decision was made to proceed with the ApiFix device. There was a strong desire to NOT fuse the spine and the need for additional surgeries was deemed acceptable.
An ApiFix device was placed from T5 to L1. There are two levels at the top (T5 and T6), each with 1 pedicle screw. At the bottom there is a single pedicle screw at L1. There is overall very good correction, based on Cobb measurement, but also improvement of the trunk shift in which her body was moved to the right side before surgery.
The patient is now 18 months after surgery and is doing well. Correction is maintained and the patient and parents are happy with her correction, appearance and function.