Pediatric Scoliosis Surgery Guide

Surgical approaches to treat abnormal spinal curvature

Learning your child has scoliosis can be hard to wrap your mind around. Discovering that spine surgery is part of the treatment plan can make the outlook seem even more daunting. But there is good news: The surgical approaches available today correct the curve or, at a minimum, stop its progression or worsening.

In many childhood scoliosis cases, nonsurgical options—such as observation, spinal bracing or even specialized physical therapy—are the first course of treatment. But, if the curve measures 45-degrees or more or is progressing despite bracing, spine surgery may likely be the next step.

Your spine surgeon has several scoliosis surgery options from which to choose. Your surgeon crafts their recommendation based on your child's specific scoliosis case, including the type of scoliosis, your child’s age, and medical history.

This article provides an overview the following pediatric scoliosis surgical approaches:

Spinal Fusion for Pediatric Scoliosis
When surgery enters the scoliosis treatment conversation, spinal fusion is often part of the discussion, whether it is the primary surgery or included to support a separate scoliosis procedure. In simple terms, spinal fusion utilizes bone graft to stimulate new bone growth that "fuses" or biologically welds together two spinal bones into one solid bone over a period of time. Fusion adds stability to a spine that has been straightened surgically.

The goals of spinal fusion for childhood scoliosis may be to stop the progression of the abnormal curve or to correct the curve altogether. Whether the fusion will stop your child's curve from worsening or permanently fix it is based on your child's specific case.

In-situ Fusion: Halting Curve Progression
If your child has a mild or moderate curve that will likely worsen, your spine surgeon may recommend an in-situ spinal fusion. In-situ means, "in its original place." This approach manages the curve before it becomes a problem. The curve won't necessarily be corrected by this type of fusion, but it should not progress. Most children will have some amount of spinal correction performed during this procedure.

  • Like other types of fusions, in-situ fusion may be performed from your child's back (this is known as posterior), through the front of the body (anterior), or a combination of both.
  • To help straighten and secure the fusion, your doctor may use instrumentation (such as rods and screws). Also, additional bone called bone graft will stimulate the fusion of two bones into one.

If your doctor thinks your child is too young for spinal instrumentation, your child will wear a brace or cast after surgery to support a healthy recovery.

Spinal Fusion with Corrective Instrumentation: Curve Correction
Corrective spinal fusion is a surgical procedure that permanently corrects the deformity. Not all children are candidates for this procedure.

  • Your surgeon may use an anterior approach (from the front), posterior approach (from the back), or a combination anterior-posterior approach.
  • Today, most surgery is done from a posterior or combined anterior-posterior approach.
  • If your child has a thoracic-lumbar and/or thoracic curve, your spine surgeon may opt to perform spinal fusion using an anterior approach. Supporting spinal instrumentation is implanted from the side of the spine.

The anterior-posterior approach is preferred by some surgeons to correct severe, rigid curves. It's also effective at preventing "crankshaft phenomenon,” which occurs when the abnormal curve moves around the posterior fusion. In this procedure, one curve is approached from the front and back. If there is a second curve, it is approached only from the back.

Sometimes, if there are two severe curves, a double anterior-posterior procedure is performed. Many surgeons perform the entire surgery—even for severe and stiff curves—from a posterior approach alone, but this may require advanced and riskier osteotomies (cutting into spinal column bone).

Minimally invasive surgical techniques are performed by some surgeons. This type of surgery involves smaller incisions and specialized instruments (eg, scope, video camera). Discs between two vertebral bodies may be removed to increase spinal column flexibility for correction purposes.

All corrective fusion approaches typically include spinal instrumentation and fusion (bone graft). The instrumentation provides support to the spine as the bone graft stimulates new bone growth that heals and fuses the spine over a period of 3-6 months. The ultimate goal is a solid section of spinal bone that will not move or curve, thus permanently correcting the scoliosis.

pediatric scoliosis preoperative standing x-ray, postoperative posteroanterior x-ray, postoperative lateral x-ray

Hemivertebra Removal for Pediatric Scoliosis
A hemivertebra is a misshaped spinal bone (vertebral body). A healthy vertebra is rectangular, whereas a hemivertebra is shaped like a wedge or triangle. A hemivertebra forms while the fetus is in the womb, and it may result in congenital scoliosis.

If your surgeon suspects your child's scoliosis will worsen, or the scoliosis is causing your child to lean and/or be off balance, the hemivertebra can be removed. Based on your child's specific situation, your doctor may use a posterior approach or a combination anterior-posterior approach to remove the misshaped bone. Most commonly, a posterior approach is used to excise (remove) the hemivertebra and to straighten the spine. Rods and screws along with spinal fusion join the bones above and below the removed hemivertebra—the instrumentation stabilizes the spine and holds the correction until the fusion heals the spine into a solid.

After surgery, your child may need to wear a custom brace or cast to promote healing and proper fusion of the bones.

hemivertebra in pediatric scoliosis; mishappened vertebral body

To continue reading the Pediatric Scoliosis Surgery Guide, and learn about traditional growing rods, magnetically controlled growing rods, growth-guided devices, and vertebral body tethering fusionless scoliosis correction, click here.

Updated on: 04/06/17
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Pediatric Scoliosis Surgical Technologies: Growing Rods, Growth-Guided Devices, Vertebral Body Tethering
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Pediatric Scoliosis Surgical Technologies: Growing Rods, Growth-Guided Devices, Vertebral Body Tethering

Traditional and magnetically controlled growing rods, growth-guided devices, and vertebral body tethering (fusionless correction) are explained and shown in many pre- and postoperative x-rays.
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