Orthopaedic surgeons are optimistic about recent improvements in operative treatment of very young children suffering from scoliosis severe enough to consider surgery, even for those under the age of five years. For decades, spinal fusion surgery has been the prescription for severe scoliosis. The significant drawback of early fusion is that growth of the spine stops and this, in turn, interferes with the development of the lungs and chest cavity.
"Scoliosis surgeons are exploring opportunities to treat a child's chest and spine to allow continued growth," reports B. Stephens Richards, MD, moderator of a media briefing on scoliosis treatment advances on Friday, February 16 at the Academy's 74th Annual Meeting. "Although the majority of scoliosis surgical patients present in early adolescence when spinal growth is no longer an issue, there are some very young children with severe deformities who need surgery but also need to maintain growth potential of the spine."
Fusion involves inserting a series of rods, hooks and screws to straighten the spine. Side effects, in addition to cessation of growth, may include increased stress on the unfused segments which could lead to the need for more surgery as an adult.
Several surgical options give today's very young patients brighter prospects than earlier generations. One technique includes the use of "growing" rods attached to the spine that are increased in length at least twice per year to guide straighter growth. Another technique expands the chest cavity in children with missing or fused ribs, thus providing an opportunity for better lung development. A third evolving procedure uses staples in the convex side of a spinal curvature which allows growth to potentially straighten the spine.
Scoliosis is a condition of side-to-side spinal curves, and affects about two percent of the population. Bracing is the standard treatment for less severe patients, generally in adolescence, with scoliotic curves between 25 and 40 degrees.
