Surgical management of early-onset scoliosis: indications and currently available techniques

Abstract

Early-onset scoliosis (EOS) is a heterogeneous group of spinal deformities affecting children under the age of 10 years of which the aetiology, natural history and treatment options vary considerably. In progressive EOS, treatment is based on exhausting conservative measures (casting or bracing) to halt curve progression while allowing for continuous growth of the spine and chest development. Early spinal fusion leads to loss of longitudinal spinal growth and restriction of cardiopulmonary function. In rapidly progressive curves that have failed conservative treatment a range of 'growth-friendly' surgical techniques have been developed to control curve deterioration. The indications and characteristics of distraction-based or compression-based methods, growth guidance and promising new techniques are discussed according to aetiology of EOS. Definitive spinal fusion remains reserved for patients ideally towards the end of their spinal growth and for short-segment treatment in congenital scoliosis.

Minimally Invasive Posterior Spinal Nonfusion Surgery in Patients With Adolescent Idiopathic Scoliosis Using a Bipolar One-Way Self-Expanding Rod System: Protocol for a Single-Center Clinical Cohort Study

“…The concept of PSnF for scoliosis surgery is not new. For patients diagnosed with EOS and NMS, multiple successful PSnF options are available and are currently regarded as the standard surgical treatment [ 16 ]. However, to the best of our knowledge, this concept has not been used in patients diagnosed with AIS.…”

“…They found an overall complication rate of 38% (n=8), consisting of 14% (n=3) mechanical complications and 24% (n=5) infectious complications [ 20 ]. Although these complication rates seem high, compared to the traditional growing techniques, there is an important decrease in complication rates [ 28 ].…”

“…Anterior vertebral body tethering and a concave distraction technique (ApiFix) have been used as nonfusion techniques in patients with AIS, although with mixed results and high complication rates [11][12][13]. In spinal deformity surgery, nonfusion techniques with growing rods have been used for patients diagnosed with progressive early-onset scoliosis (EOS) or neuromuscular scoliosis (NMS) [14][15][16]. The rods function as an "internal brace" of the spine and aim to control or reduce spinal deformity.…”

“…This study aims to evaluate the efficacy and safety of a nonfusion bipolar self-expanding rod system, here referred to as the “nonfusion OWSER system,” in the surgical treatment of patients with progressive AIS. Based on the positive surgical results and relatively low complication rates found when this type of system is used in patients with NMS or EOS [ 14 , 16 , 20 ], we hypothesize that the minimally invasive surgery using the nonfusion one-way self-expanding rod system (nonfusion OWSER) system is safe and efficient for the surgical correction of progressive AIS.…”

Early Onset Scoliosis and Adolescent Idiopathic Scoliosis: A Review of the Literature and Correlations With Pulmonary Dysfunction

“…Although spinal fusion is typically the first-line surgical intervention for severe scoliosis, a variety of other surgical intervention techniques exist for the management of scoliosis. Surgical techniques can be categorized as growth-friendly, definitive spinal fusion, or combinations [ 47 ]. Within the growth-friendly category, there are further subcategories that include distraction-based methods, compression-based methods, growth guidance, and hybrid.…”