Management of infantile thoracic scoliosis

The general principle of treatment and management is to halt the progression of the spinal deformity. The goal is to increase thoracic volume to improve pulmonary and cardiac function.

Spinal bracing - once viewed as a common treatment option - is largely ineffective in this population and is poorly tolerated. Prior to any intervention-based treatment, the patient’s health and functional status should be optimized. (1)

Surgical Options (2)

Traditional growing rods can be inserted to allow for initial placement of proximal and distal anchors (hooks or pedicle screws). The rod can be lengthened with a smaller surgery at planned intervals. This is an effective modality, but risks include anchor pull out, the need for repetitive surgery, and infection.

Magnetic growing rods are an innovative technology that undergoes a similar placement of proximal and distal anchors (hooks or pedicle) screws. However, the rod is elongated via magnetic control. Patients generally need to be at least 2 years old and 25 pounds. Consideration must also be entertained for the need of possible MRI study in the future.

Vertical, expandable, prosthetic, titanium, rib-expansion thoracoplasty can be used in patients with thoracic insufficiency syndrome. This places instrumentation on the ribs as well as spinal constructs to expand the thorax and reduce the spinal deformity.

Growth-guided techniques (Shilla procedure) involves the placement of a pedicle screw into the rigid apical vertebrae (the worst portion of the deformity) while other more proximal and distal pedicle screws have a locking cap mechanism that allows the longitudinal movement of the rod during growth into a fixed pedicle screw to guide alignment. Due to the biomechanical forces, rod-breakage is an expected outcome with 4.5 mm rods generally lasting about 4 to 6 years.

Reference:

1. Akgül T, Dikici F, Şar C, Talu U, Domaniç Ü. Growing rod instrumentation in the treatment of early onset scoliosis. Acta Orthop Belg. 2014 Dec;80(4):457-63
2. Fujimori T et al. Safety of pedicle screws and spinal instrumentation for pediatric patients: comparative analysis between 0- and 5-year-old, 5- and 10-year-old, and 10- and 15-year-old patients. Spine (Phila Pa 1976). 2014 Apr 01;39(7):541-9.