A NEW SURGICAL STRATEGY FOR THE TREATMENT OF EARLYONSET IDIOPATHIC SCOLIOSIS

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A NEW SURGICAL STRATEGY FOR THE TREATMENT OF
EARLY-ONSET IDIOPATHIC SCOLIOSIS
Cagatay OZTURK, MD Meric ENERCAN, MD Mehmet
TEZER, MD Mehmet AYDOGAN, MD Mirza BISCEVIC,
MD Azmi HAMZAOGLU, MD

• Florence Nightingale Hospital, Istanbul, TURKEY

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Disclosure

• I have no financial relationships to disclose.

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INTRODUCTION

• Scolisosis in very young children is an extremely
  difficult surgical management problem.
• The main goal of treatment is to obtain and
  maintain curve correction while simultaneously
  preserving spinal, trunk and lung growth.
• The continuation of anterior growth in the apical
  and adjacent segments of the deformity and not
  controlling the rotation in the apical segments
  are two major problems that the dual growing rod
  techniques with only proximal and distal fixation
  points have. To overcome these problems we have
  presented a new surgical strategy allowing spinal
  growth and lung development and controlling the
  apical rotation for the surgical treatment of
  early-onset idiopathic scoliosis.

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MATERIALS METHODS

• Between the years of 2007 and 2008
• 6 children (2 males, 4 females with a mean age
  of 5 years, ranging from 2 to 8 years) with
  progressive scoliosis (average 61 degrees) were
  included in the study.
• In the initial surgery polyaxial pedicle screws
  were placed to the strategic vertebra (apical,
  end, intermediate showing no flexibility under
  bending x-rays and transitional zone vertebrae)
  under flouroscopic guidance after skin and
  subcutaneous tissue dissection without
  subperiosteal muscle dissection on midline. After
  placing pedicle screws, rods were placed in situ
  after achieving correction with the help of
  intraoperative halofemoral traction. The most
  proximal and most distal screws were fixed and
  the rest of the screws were left with nonlocked
  tap-screws.

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RESULTS

• Initial curve correction went from 61 degrees
  (38-88) to and average of 22 degrees (4-40) and
  maintained at 24 degrees (4-36) at minimum one
  year follow-up.
• Two lengthening operations were done in 3
  patients and one in 3 patients.
• The average coronal plane correction was 60 and
  average truncal heigth increase was 12. In the
  sagittal plane decrease of thoracic kyphosis was
  not seen.
• There were no infection, no increase in coronal
  curve magnitude and no implant related
  complications in the patients. There was no
  metallosis seen around nonlocked screws during
  the lengthening surgeries.

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EMO, 2y1m, M
locked
330
300
360
860
880
360
380
locked
400
360
320
660
400
400
After 1st sx
After 2nd sx
Before 1st sx
Before 2nd sx
Before 3rd sx
After 3rd sx
Correction under intraoperative halofemoral
traction Coronal plane correction 59
51 Truncal heigth increase 13
Difference of heigth of implanted spine between
one after 1st surgery and the last control one
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CONCLUSION

• Our new treatment strategy provides that the
  screws in apical and intermediate vertebra
  controlled the curve, prevent progression,
  maintain rotational stability and allows
  continuation of trunk growth.
• Since the intermediate screws are not fixed, it
  prevents decrease of kyphosis in thoracic spine
  (no posterior tethering effect) so the technique
  controls the progression in apical segment
  without fusion.
• This strategy can also provide that there is no
  need to develop special instrument designs and
  production and one can safely perform the
  treatment with classical instrumentation systems
  present in the market.