Diagnostic and therapeutic strategies in early onset scoliosis: A current concept review

Abstract

Substantial advances in the treatment of early onset scoliosis (EOS) over the past two to three decades have resulted in significant improvements in health-related quality of life of affected children. In addition to classifications that address the marked heterogeneity of this patient population, increasing understanding of the natural history of the disease, and new implants and treatment techniques have resulted in innovations unlike any other area of pediatric orthopedics. The growing understanding of the interaction between spinal and thoracic growth, as well as dependent lung maturation, has had a lasting impact on the treatment strategy of this potentially life-threatening disease. The previous treatment approach with early corrective fusion gave way to a growth-friendly concept. Despite the steady development of new growth-friendly surgical treatment options, whose efficacy still needs to be validated, as well as a revival of conservative growth control with serial casts and/or braces, the psychosocial burden of the long lasting and complication-prone treatments remains high. As a consequence, EOS still represents one of the greatest pediatric orthopedic challenges.

Minimally Invasive Controlled Growing Rods for the Surgical Treatment of Early-Onset Scoliosis—A Surgical Technique Video

“…If there are no effects of the conservative treatment and further progression of the spinal curvature exceeding a Cobb angle of 60–65 degrees, surgical treatment should be considered [ 1 , 3 , 4 ]. We have several options to choose from, such as SGRs, MCGRs, MICGRs, and vertical expandable prosthetic titanium ribs (VEPTRs); growth guidance systems, like Shilla; the Luque trolley technique; or newer concepts, like spring distraction systems for the dynamic growth guidance of early-onset scoliosis or vertebral body tethering [ 1 , 9 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 ]. The most appropriate technique should be selected for the curve and the patient.…”

“…In patients treated with the MCGR system, in medium- and long-term follow-ups, the total number of complications was from approximately 35% to 73%, but this was also related to the results of the treatment of scoliosis of various etiologies because, as we know, scoliosis with an etiology other than idiopathic is associated with an increased risk of overall complications [ 7 , 8 , 13 , 14 , 15 , 16 , 17 , 24 , 39 , 40 , 41 , 42 ]. Compared with other surgical techniques used to treat EOS, MCGRs can be introduced as a less-invasive surgical technique using a mini-open approach [ 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 ]. The implantation of the new MICGR system is also similar [ 21 ].…”