Treatment of early-onset scoliosis: techniques, indications, and complications

The treatments for early-onset scoliosis(EOS)remain great challenges for spine surgeons.This study aimed to comprehensively review the treatments for EOS,especially the advancements made in the last decade.Current studies on EOS were retrieved through a search on PubMed,UpToDate,the Web of Science Core Collection and Scopus were reviewed.The most pertinent information related to the current treatments for EOS was collected.The foci of treatments for EOS have included creating a well-developed thoracic cavity,improving lung volume,and improving pulmonary function.Conservative treatments include bracing,casting,halo-gravity traction,and physiotherapy.Serial casting is the most effective conservative treatment for EOS.Surgical treatments mainly include growth-friendly techniques,which are generally classified into three types according to the amount of correction force applied:distraction-based,compression-based,and growth-guided.The distraction-based systems include traditional or conventional growing rods,magnetically controlled growing rods,and vertical expandable prosthesis titanium ribs.The compression-based systems include vertebral body stapling and tethering.The growth-guided systems include the Shilla system and modern Luque trolley.In addition,some newer techniques have emerged in recent years,such as posterior dynamic deformity correction(ApiFix).For EOS patients presenting with sharp deformities in a long,congenital spinal deformity,a hybrid technique,one-stage posterior osteotomy with short segmental fusion and dual growing rods,may be a good choice.Hemivertebra resection is the gold standard for congenital scoliosis caused by single hemivertebra.Although the patient’s growth potential is preserved in growth-friendly surgeries,a high complication rate should be expected,as well as a prolonged treatment duration and additional costs.Knowledge about EOS and its treatment options is rapidly expanding.Conservative treatments have specific limitations.For curves requiring a surgical intervention,surgical techniques may vary depending on the patients’characteristics,the surgeon’s experience,and the actual state of the country.

Short fixation with a 3‐rod technique for posterior hemivertebra resection in children younger than 5 years old

Importance Congenital hemivertebra is commonly treated with posterior hemivertebra resection with bilateral transpedicular fixation.However,implant‐related complications are common in children younger than 5 years old who undergo this surgical procedure.Objective To present the preliminary clinical and radiological outcomes of children younger than 5 years old treated by posterior hemivertebra resection and 3‐rod fixation technique.Methods From January 2016 to December 2017,14 consecutive patients of congenital scoliosis with 16 hemivertebrae were retrospectively reviewed,including 5 girls and 9 boys,aged between 25 and 55 months old(average,37.6 months).All patients underwent posterior hemivertebra resection with short fixation with bilateral pedicle screws and a convex lamina hook.Surgical complications and corrective outcomes were assessed based on the clinical charts and spinal radiographs with a minimum 24‐month follow‐up.Results The mean Cobb angle of the main curve was 38.4°before surgery,8.5°after surgery,and 8.7°at final follow‐up.In the compensatory cranial curve,the preoperative Cobb angle of 16.8°was corrected to 8.1°postoperatively and was 10.3°at final follow‐up.In the compensatory caudal curve,the preoperative Cobb angle of 15.9°improved to 5.3°postoperatively and was 7.8°at final follow‐up.The segmental kyphosis was corrected from 13.5°to 0.5°and was 1.1°at final follow‐up.There were no crankshaft phenomena,no proximal kyphosis,and no complications related to the instrumentation.Interpretation Posterior hemivertebra resection with instrumentation with bilateral pedicle screws and a convex lamina hook can achieve rigid fixation and deformity correction.

One-stage posterior hemivertebral resection in the treatment of congenital scoliosis caused by hemimetameric shift

Congenital scoliosis results from defects formed during the embryologic development of the spinal vertebrae. Hemivertebra is a failure of vertebral formation carrying a risk of causing progressive scoliosis if it is fully segmented. When two hemivertebrae are present on the opposite sides of the spine and are separated by at least one normal vertebra, this condition then exemplifies a hemimetameric shift. The hemimetameric shift is often benign for progression, but it may also be problematic depending on the separation and the nature of the two hemivertebrae involved. If the two opposing hemivertebrae are close merely separated by one or two normal vertebrae, they tend to cause two small kinks in the spine and minimal cosmetic deformity. However, if the two hemivertebrae are in different regions of the spine, separate curves are then produced and the spine may become unbalanced, causing spinal decompensation and significant cosmetic deformity. In this article, we report one case for whom a hemimetameric shift was managed via a one-stage posterior hemivertebral resection.