Current Concepts in the Management of Early-onset Idiopathic Scoliosis

Ujjwal K Debnath

Disclosures

Pediatr Health. 2010;4(3):343-354. 

In This Article

Future Perspective

Early-onset scoliosis is a difficult condition to manage and it is also difficult to assess the effects of the current management practices. The treatment for each individual patient varies and runs for a long time. It will take a clinician his whole working life to gather a cohort that can be assessed, by which time he has retired and passed his patients onto a new and younger surgeon with all the enthusiasm and confidence that entails.

The advances in the techniques of surgical treatment of progressive EOS are fraught with complex issues. A high rate of complications (which include metalwork dislodgement or breakage, and wound and alignment problems) have caused anxiety for patients, families and surgeons alike. Furthermore, these children may have comorbidities (especially pulmonary problems) with increased risk of long periods of treatment from initial surgery to final fusion. Even though lengthening may be performed with GRs as an outpatient procedure, general anesthesia is required for multiple procedures.[82] To avoid these problems, other ways of dealing with such complex problems are needed with minimal risk of complications.

Long-term, worldwide research and multicenter studies should be developed to document the effectiveness of the treatment methods in comparison with the natural history of this disease.[83] Assessment of thoracic growth and pulmonary function in children with spinal deformities must be standardized for future research. The measurement tools need to be developed to assess the outcome of VEPTR and other implants, which influence the thoracic growth and function.

There are many unanswered questions, such as the effect of spinal fusion on lung function, minimum length of the thoracic spine required at skeletal maturity for adequate lung function and so on. Future evidence-based models for the study of the disease and the limiting factors, which modulate the growth of the spine and thorax. We look forward to newer technologies that use the principle of fusion-less surgery to stop the progression of spinal curves, for example staples (memory metal), spinal tethering devices[84] or growth plate inhibitors. The Shilla sliding pedicle screw system is a novel growth guidance system that does not require repeated surgical lengthening. The Shilla system guides growth at the ends of dual rods with the apex of the curve corrected, fused and fixed to the rods.[85]

A total of 265 GR patients treated over 4.7 ± 2.1 years in the Growing Spine Study Group database were analyzed to characterize actual practice and compare it with the survey results. All patients had at least 2 years of treatment. The study group concluded that most GRs are used for curves over 60° in patients under 10 years of age.[86]

Further research in genetic engineering may also give insight into the patients who are at risk of progressive spinal deformities. The independent association of several genetic loci and the observed phenotype will foster a knowledge to understand the prognosis of idiopathic scoliosis, counsel patients and guide management plans for physicians who treat this disorder.

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