What is the treatment of early onset scoliosis?
Treatment options can be discussed in 3 groups: observation, brace treatment, and surgical treatment.
Although the choice of treatment varies depending on the causes of scoliosis, the general approach is observation when the curve is less than 20 degrees as first detected. If the curves progress beyond 20 degrees, brace treatment in older children is recommended. However, since brace application is harder in very small children (ages 0-5) , correction torso casts applied under general anesthesia may be preferable. In older children, braces are not applicable for curves above 40 degrees. In younger children, surgical alternatives may be problematic and cumbersome; therefore we can continue with braces in an attempt to slow the curve’s progression until the curve reaches 60 degrees.
Surgical methods are preferred in curves above 60 degrees. The ultimate surgical treatment of scoliosis is fusion, which terminates spine growth. Fusion, which is a fixation of the spine to prevent permanent shortness, elimination of movement and termination of growth, should be avoided in growing children. Therefore, if brace treatment cannot stop the curve, we try to correct the curve without the fusion procedure by insteadusing screw and rods systems placed into the spine. This method is “growing rod system”. It works similar to a brace placed underneath the skin. However, because the spine will continue to grow, the curve will continue to progress in spite of the rods placed inside. This requires periodic surgical operations (every six months) where the implanted rods are lengthened and the curve is corrected. Ideally, this treatment method should continue until the end of puberty, and spine fusion should occur once growth has declined or ceased.
What Prevents Repeated Operations in children?
The magnetic rods system uses an externally created magnetic field, in which special rods placed into the spine are lenghtened under control without the need for re-opening the operative site, or spine. This enables implantation of the rods with a single vs. multiple operations, and control of the curve’s progression by periodic lengthenings that do not require re-opening the spine. Lengthening procedures can be made in clinical settings without anesthesia. This method has arrived in our country, and can be applied by me.
What are Advantages of Magnetic Rod Systems?
Ideally surgery without fusion should continue until the end of puberty. Then fusion of the spine should be made once the growth rate declines or stops. This is a very cumbersome and risky treatment method when performed with classical growing rods. When such a treatment is started at age 3 and continues until age 12, around 22 total operations are needed. Previous clinical studies have shown that repeated operations create a great stress (posttraumatic stress disorder) on the child and families, and may result in psychological problems. Therefore, externally growing rods will prevent repeated operations and consequent problems.
Who are Candidates for this treatment?
It is advantageous in treating curves in growing children. It can also serve as an alternative treatment method to replace braces in adolescent scoliosis. Applications in children so far have yielded successful results. It will be used next in children between ages 10 to 12 and curves between 30-40 degrees.
This process does not guarantee a surgery-free treatment of scoliosis, but does decrease the frequency of repeated operations in small children.
What are Conditions in Early Onset Scoliosis where Fusion is Applicable?
Fusion will be inevitable when treatment methods without fusion fail. Delaying fusion by allowing the curve to progress will create catastrophic consequences. In these conditions, we prefer a “short and straight” spine over a “short and curved” spine.
In addition, in some conditions (e.g. congenital scoliosis) where total correction can be made with fusion of a very short spine segment, we may prefer fusion over applying the long and cumbersive growing rods. Because fusion will be carried out in only a limited area, it may not significantly affect spine and rib cage growth. In exceptional conditions, we may apply the “hybrid” method, where both short-segment fusion and growing rods are simultaneously applied.
In summary, early diagnosis is important in scoliosis occurring in early childhood. Treatment is difficult, however it is not impossible.