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==Overview==
==Overview==
Surgery is usually indicated for curves that have a high likelihood of progression, curves that cause a significant amount of pain with some regularity, curves that would be cosmetically unacceptable as an adult, curves in patients with [[spina bifida]] and [[cerebral palsy]] that interfere with sitting and care, and curves that affect physiological functions such as breathing.
Surgical correction of [[idiopathic scoliosis]] is primarily considered for curves greater than 45° in immature patients and for curves greater than 50° in mature patients. In addition, [[surgery]] is usually indicated for curves that have a high likelihood of progression, curves that cause a significant amount of pain with some regularity, curves that would be cosmetically unacceptable as an adult, curves in patients with [[spina bifida]] and [[cerebral palsy]] that interfere with sitting and care, and curves that affect physiological functions such as [[breathing]]. For various reasons it is usually impossible to completely straighten a scoliotic spine, but in most cases very good corrections are achieved.


Surgery for scoliosis is usually done by an [[Orthopedic surgery|orthopaedic surgeon]] who specializes in spine surgery. For various reasons it is usually impossible to completely straighten a scoliotic spine, but in most cases very good corrections are achieved.
==Surgery==
{| align="right"
|
[[File:Scoliosis post-op.jpg|400px|thumb|Spinal arhtrodesis with instrumentation. Source: Case courtesy by: [[User:Rohan Bhimani|Dr. Rohan A. Bhimani]]]]
|}
*Surgical treatment is recommended for patients with curves greater than 45 degrees who are Risser 2 or less or for curves greater than 50 who are Risser 3 and greater.<ref name="pmid25439021">{{cite journal| author=El-Hawary R, Chukwunyerenwa C| title=Update on evaluation and treatment of scoliosis. | journal=Pediatr Clin North Am | year= 2014 | volume= 61 | issue= 6 | pages= 1223-41 | pmid=25439021 | doi=10.1016/j.pcl.2014.08.007 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25439021  }} </ref>
*The goal of [[surgery]] is to arrest the curve progression while improving spinal balance and alignment.  
*The goal is achieved by inducing fusion of the spine by way of instrumentation and bone grafting.
*Principle of all fixation techniques involves the placement of bony anchors such as hooks, wires, or [[Pedicles|pedicle]] screws to the vertebrae and connecting them to a dual rod construct.
*Fusion can be performed via anterior, posterior, or both approaches depending on the curve type, magnitude, skeletal maturity, and the available skill set of the surgeon.
*The factors to consider in preoperative planning include the curve type and magnitude, spinal balance, curve flexibility, and the level of [[skeletal maturity]].


==Surgery==
===Spinal Arthrodesis with instrumentation===


===Spinal fusion with instrumentation===
*[[Spinal arthrodesis]] is the most widely performed surgery for [[scoliosis]].
[[Image:Wiki post-op.jpg|thumb|150px|left|Coronal X-ray of the above spine after having undergone successful fusion and instrumentation.]]
*Procedure:
**[[Bone]], autograft or allograft is [[Bone grafting|grafted]] to the vertebrae so that when it heals, they will form one solid block and the [[vertebral column]] becomes rigid.
**This prevents worsening of the curve at the expense of spinal movement.  
**The procedure can be performed from the using the anterior  or posterior approach of the spine. A combination of both is used in more severe cases.


* [[Spinal fusion]] is the most widely performed surgery for scoliosis. In this procedure, bone (either harvested from elsewhere in the body (autograft), or donor bone (allograft) is [[Bone grafting|grafted]] to the vertebrae so that when it heals, they will form one solid bone mass and the [[vertebral column]] becomes rigid. This prevents worsening of the curve at the expense of spinal movement. This can be performed from the anterior (front) aspect of the spine by entering the [[Thoracic cavity|thoracic]] or [[abdominal cavity]], or performed from the back (posterior). A combination of both is used in more severe cases.
===Posterior Instrumentation===
* Initially, [[Spinal fusion|spinal fusions]] were done without metal implants and a cast was applied after the surgery, usually under [[Traction (orthopedics)|traction]] to pull the curve as straight as possible and then hold it there while fusion took place.<ref name="pmid25269032">{{cite journal| author=Yaman O, Dalbayrak S| title=Idiopathic scoliosis. | journal=Turk Neurosurg | year= 2014 | volume= 24 | issue= 5 | pages= 646-57 | pmid=25269032 | doi=10.5137/1019-5149.JTN.8838-13.0 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25269032  }} </ref> 
*However, there was a relatively high risk of [[pseudarthrosis]] at multiple levels and significant correction could not always be achieved.
*In 1962, Paul Harrington introduced a metal spinal system of instrumentation which assisted with straightening the spine, as well as holding it rigid while fusion took place.<ref name="pmid23216320">{{cite journal| author=Desai SK, Brayton A, Chua VB, Luerssen TG, Jea A| title=The lasting legacy of Paul Randall Harrington to pediatric spine surgery: historical vignette. | journal=J Neurosurg Spine | year= 2013 | volume= 18 | issue= 2 | pages= 170-7 | pmid=23216320 | doi=10.3171/2012.11.SPINE12979 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23216320  }} </ref> 
*A major shortcoming of the Harrington method was that it failed to produce a posture where the skull would be in proper alignment with the pelvis and it didn't address rotational deformity.
*As a result, unfused parts of the spine would try to compensate for this in the effort to stand upright.
*The second generation instrumentation system developed by Cotrel and Dobousett, tried to achieve correction using rod rotation manoeuvres.<ref name="pmid9089934">{{cite journal| author=Hopf CG, Eysel P, Dubousset J| title=Operative treatment of scoliosis with Cotrel-Dubousset-Hopf instrumentation. New anterior spinal device. | journal=Spine (Phila Pa 1976) | year= 1997 | volume= 22 | issue= 6 | pages= 618-27; discussion 627-8 | pmid=9089934 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9089934  }} </ref>
*Modern spinal instrumentation  are able to address [[sagittal]] imbalance and rotational defects which was unresolved by the Harrington rod system.
*They involve a combination of rods, screws, hooks and wires fixing the spine and can apply stronger, safer forces to the spine than the Harrington rod.
*Modern spinal instrumentation generally have good outcomes with high degrees of correction and low rates of failure.
*When [[scoliosis]] with severe curves have led to significant deformity resulting in a [[rib]] hump, it is necessary to perform a surgery called a costoplasty also known as thorocoplasty in order to achieve a more pleasing [[Cosmetic Surgery|cosmetic]] result.
*This procedure is usually  performed at the same time with [[arthrodesis]].


* Originally, spinal fusions were done without metal implants. A cast was applied after the surgery, usually under [[Traction (orthopedics)|traction]] to pull the curve as straight as possible and then hold it there while fusion took place. Unfortunately, there was a relatively high risk of [[pseudarthrosis]] (fusion failure) at one or more levels and significant correction could not always be achieved. In 1962, Paul Harrington introduced a metal spinal system of instrumentation which assisted with straightening the spine, as well as holding it rigid while fusion took place.  The original, now obsolete Harrington rod operated on a ratchet system, attached by hooks to the spine at the top and bottom of the curvature that when cranked would distract, or straighten, the curve.  A major shortcoming of the Harrington method was that it failed to produce a posture where the skull would be in proper alignment with the pelvis and it didn't address rotational deformity. As a result, unfused parts of the spine would try to compensate for this in the effort to "stand up straight". As the person aged, there would be increased "wear and tear", early onset arthritis, disc degeneration, muscular stiffness and pain with eventual reliance on painkillers, further surgery, inability to work full-time and disability. "Flatback" became the medical name for a related complication, especially for those who had lumbar scoliosis. Modern spinal systems are attempting to address [[sagittal]] imbalance and rotational defects unresolved by the Harrington rod system. They involve a combination of rods, screws, hooks and wires fixing the spine and can apply stronger, safer forces to the spine than the Harrington rod. Spinal fusion is rarely performed without this instrumentation.
===Anterior Instrumentation===
*Anterior approach allows correction with shorter fusion levels in the scoliotic thoracolumbar and [[lumbar]] regions.<ref name="pmid8469999">{{cite journal| author=Turi M, Johnston CE, Richards BS| title=Anterior correction of idiopathic scoliosis using TSRH instrumentation. | journal=Spine (Phila Pa 1976) | year= 1993 | volume= 18 | issue= 4 | pages= 417-22 | pmid=8469999 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8469999  }} </ref><ref name="pmid15948480">{{cite journal| author=Newton PO| title=The use of video-assisted thoracoscopic surgery in the treatment of adolescent idiopathic scoliosis. | journal=Instr Course Lect | year= 2005 | volume= 54 | issue=  | pages= 551-8 | pmid=15948480 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15948480 }} </ref><ref name="pmid15706335">{{cite journal| author=Newton PO, White KK, Faro F, Gaynor T| title=The success of thoracoscopic anterior fusion in a consecutive series of 112 pediatric spinal deformity cases. | journal=Spine (Phila Pa 1976) | year= 2005 | volume= 30 | issue= 4 | pages= 392-8 | pmid=15706335 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15706335  }} </ref><ref name="pmid18665023">{{cite journal| author=Reddi V, Clarke DV, Arlet V| title=Anterior thoracoscopic instrumentation in adolescent idiopathic scoliosis: a systematic review. | journal=Spine (Phila Pa 1976) | year= 2008 | volume= 33 | issue= 18 | pages= 1986-94 | pmid=18665023 | doi=10.1097/BRS.0b013e31817d1d67 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18665023 }} </ref>
*Postoperative [[pain]] and [[scar]] formation decrease in patients with the advent of the video assisted thoracoscopic surgery.
*However, this approach has a higher incidence of implant failure and [[pseudarthrosis]], and has been associated with a risk of [[Lung|pulmonary]] complications secondary to the need for single lung [[anesthesia]] during the procedure.<ref name="pmid14520036">{{cite journal| author=Lowe TG, Alongi PR, Smith DA, O'Brien MF, Mitchell SL, Pinteric RJ| title=Anterior single rod instrumentation for thoracolumbar adolescent idiopathic scoliosis with and without the use of structural interbody support. | journal=Spine (Phila Pa 1976) | year= 2003 | volume= 28 | issue= 19 | pages= 2232-41; discussion 2241-2 | pmid=14520036 | doi=10.1097/01.BRS.0000085028.70985.39 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14520036  }} </ref><ref name="pmid10025017">{{cite journal| author=Betz RR, Harms J, Clements DH, Lenke LG, Lowe TG, Shufflebarger HL et al.| title=Comparison of anterior and posterior instrumentation for correction of adolescent thoracic idiopathic scoliosis. | journal=Spine (Phila Pa 1976) | year= 1999 | volume= 24 | issue= 3 | pages= 225-39 | pmid=10025017 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10025017  }} </ref>


* Modern spinal fusions generally have good outcomes with high degrees of correction and low rates of failure and infection. Patients with fused spines and permanent implants tend to have normal lives with unrestricted activities when they are younger, it remains to be seen whether those that have been treated with the newer surgical techniques will develop problems as they age. They are able to participate in recreational athletics, have natural childbirth and are generally satisfied with their treatment. The most notable limitation of spinal fusions is that patients who have undergone surgery for scoliosis are ineligible for military service in the United States.
=== Non-Fusion Surgery===
*Non-fusion surgery is another option in order to control growth in the treatment of [[idiopathic scoliosis]].<ref name="pmid18712419">{{cite journal| author=Schmid EC, Aubin CE, Moreau A, Sarwark J, Parent S| title=A novel fusionless vertebral physeal device inducing spinal growth modulation for the correction of spinal deformities. | journal=Eur Spine J | year= 2008 | volume= 17 | issue= 10 | pages= 1329-35 | pmid=18712419 | doi=10.1007/s00586-008-0723-9 | pmc=2556471 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18712419  }} </ref><ref name="pmid30478824">{{cite journal| author=Schleicher P, Onal MB, Hemberger F, Scholz M, Kandziora F| title=The C2-Pars Interarticularis Screw as an Alternative in Atlanto-Axial Stabilization. A Biomechanical Comparison of Established Techniques. | journal=Turk Neurosurg | year= 2018 | volume= 28 | issue= 6 | pages= 995-1004 | pmid=30478824 | doi=10.5137/1019-5149.JTN.23791-18.2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30478824  }} </ref><ref name="pmid18423027">{{cite journal| author=Maruyama T, Takeshita K| title=Surgical treatment of scoliosis: a review of techniques currently applied. | journal=Scoliosis | year= 2008 | volume= 3 | issue=  | pages= 6 | pmid=18423027 | doi=10.1186/1748-7161-3-6 | pmc=2346456 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18423027  }} </ref>
*Progression of the curve might be avoided by means of instrumented or non-instrumented epiphysiodesis on the convex side of the curve.
*Recently, new implants have been developed that allow more spinal growth in young children.
*These include rods that are extendable and allow growth while still applying corrective forces and vertebral stapling which is a method of retarding normal growth on the convex side of a curve, allowing the concave side to catch up.
*After the [[Arhrodesis|fusion surgery]] at younger ages, the body remains shorter than the limbs. Shorter body prevent the development of [[Lung|lungs]].
*The upper and lower parts of the curve can be fixed by Isula double rod system developed by Akbarnia, attached to the rods and the rods are attached to one another with an additional rod.  
*The rods are extended in 6-month follow-up. After reaching the full growth, fusion is completed with instrumentation.
*For the youngest patients, [[ribcage]] implants that push the [[Rib|ribs]] apart on the concave side of the curve may be beneficial.
*Vertical expandable prosthetic titanium ribs (VEPTR) weredeveloped to treat the thoracic insufficiency syndrome that is caused by combination of [[Rib|ribs]] and curves.<ref name="pmid15292413">{{cite journal| author=Campbell RM, Smith MD, Mayes TC, Mangos JA, Willey-Courand DB, Kose N et al.| title=The effect of opening wedge thoracostomy on thoracic insufficiency syndrome associated with fused ribs and congenital scoliosis. | journal=J Bone Joint Surg Am | year= 2004 | volume= 86-A | issue= 8 | pages= 1659-74 | pmid=15292413 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15292413  }} </ref>
*The deformity can be corrected acutely by means of VEPTR following the wedge thoracostomy.
*VEPTR device is expanded in 4-6 months time.


* In cases where scoliosis has caused a significant deformity resulting in a rib hump, it is often possible to perform a surgery called a "costoplasty" (also called "thorocoplasty") in order to achieve a more pleasing cosmetic result. This procedure may be performed at any time after a fusion surgery, whether as part of the same operation or several years afterwards. As stated before, it is usually impossible to completely straighten and untwist a scoliotic spine, and it should be noted that the level of cosmetic success will depend on the extent to which the fused spine still rotates out into the ribcage. A rib hump is evidence that there is still some rotational deformity to the spine. Specific weight training techniques can be used to influence this rotational deformity in the unfused parts of the spine. This leads to a marked decrease in pain and to some improvement in organ function depending on the person's particular case and is to be recommended over any cosmetic surgical procedure.
===Complications of Surgery===
{| align="right"
|
[[File:Scoliosis complications.jpg|300px|thumb|Subdural hematoma post scoliosis correction surgery. Source: Case courtesy by: [[User:Rohan Bhimani|Dr. Rohan A. Bhimani]]]]
|}
*[[Pain]]
*[[Pseudoarthrosis]]
*Cosmetic deformity
*[[Infection]]
*[[Lung]] [[hypoplasia]]
*[[Stunted growth]]
*[[Spinal cord]] or [[nerve]] damage
*[[Intracranial hemorrhage]]<ref name="pmid29808094">{{cite journal| author=Bhimani R, Bhimani F, Singh P| title=Subdural Hemorrhage after Scoliosis and Detethering of Cord Surgery. | journal=Case Rep Med | year= 2018 | volume= 2018 | issue=  | pages= 5061898 | pmid=29808094 | doi=10.1155/2018/5061898 | pmc=5902091 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29808094  }} </ref>
*Low [[Spine arthritis|back arthritis]] and [[Degenerative disc disease|disc]] degeneration as an adult
<br><br>


===Alternatives===
Recently, new implants have been developed that aim to delay spinal fusion and to allow more spinal growth in young children. These include rods that are extendible and allow growth while still applying corrective forces and vertebral stapling which is a method of retarding normal growth on the convex side of a curve, allowing the concave side to 'catch up.' For the youngest patients, whose thoracic insufficiency compromises their ability to breathe and applies significant cardiac pressure, ribcage implants that push the ribs apart on the concave side of the curve may be especially useful. These Vertical Expandable Prosthetic Titanium Ribs (VEPTR) provide the benefit of expanding the thoracic cavity and straightening the spine in all three dimensions while allowing the spine to grow. Although these methods are novel and promising, these treatments are only suitable for growing patients. Spinal fusion remains the 'gold-standard' of surgical treatment for scoliosis. There are now non-surgical ways to help treat scoliosis, as mentioned above in the management section.


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
[[Category:Orthopedics]]
[[Category:Skeletal disorders]]
[[Category:Rheumatology]]
[[Category:Disease]]


{{WH}}
{{WH}}
{{WS}}
{{WS}}

Latest revision as of 16:43, 10 December 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; {AE}} Rohan A. Bhimani, M.B.B.S., D.N.B., M.Ch.[2]

Overview

Surgical correction of idiopathic scoliosis is primarily considered for curves greater than 45° in immature patients and for curves greater than 50° in mature patients. In addition, surgery is usually indicated for curves that have a high likelihood of progression, curves that cause a significant amount of pain with some regularity, curves that would be cosmetically unacceptable as an adult, curves in patients with spina bifida and cerebral palsy that interfere with sitting and care, and curves that affect physiological functions such as breathing. For various reasons it is usually impossible to completely straighten a scoliotic spine, but in most cases very good corrections are achieved.

Surgery

Spinal arhtrodesis with instrumentation. Source: Case courtesy by: Dr. Rohan A. Bhimani
  • Surgical treatment is recommended for patients with curves greater than 45 degrees who are Risser 2 or less or for curves greater than 50 who are Risser 3 and greater.[1]
  • The goal of surgery is to arrest the curve progression while improving spinal balance and alignment.
  • The goal is achieved by inducing fusion of the spine by way of instrumentation and bone grafting.
  • Principle of all fixation techniques involves the placement of bony anchors such as hooks, wires, or pedicle screws to the vertebrae and connecting them to a dual rod construct.
  • Fusion can be performed via anterior, posterior, or both approaches depending on the curve type, magnitude, skeletal maturity, and the available skill set of the surgeon.
  • The factors to consider in preoperative planning include the curve type and magnitude, spinal balance, curve flexibility, and the level of skeletal maturity.

Spinal Arthrodesis with instrumentation

  • Spinal arthrodesis is the most widely performed surgery for scoliosis.
  • Procedure:
    • Bone, autograft or allograft is grafted to the vertebrae so that when it heals, they will form one solid block and the vertebral column becomes rigid.
    • This prevents worsening of the curve at the expense of spinal movement.
    • The procedure can be performed from the using the anterior or posterior approach of the spine. A combination of both is used in more severe cases.

Posterior Instrumentation

  • Initially, spinal fusions were done without metal implants and a cast was applied after the surgery, usually under traction to pull the curve as straight as possible and then hold it there while fusion took place.[2]
  • However, there was a relatively high risk of pseudarthrosis at multiple levels and significant correction could not always be achieved.
  • In 1962, Paul Harrington introduced a metal spinal system of instrumentation which assisted with straightening the spine, as well as holding it rigid while fusion took place.[3]
  • A major shortcoming of the Harrington method was that it failed to produce a posture where the skull would be in proper alignment with the pelvis and it didn't address rotational deformity.
  • As a result, unfused parts of the spine would try to compensate for this in the effort to stand upright.
  • The second generation instrumentation system developed by Cotrel and Dobousett, tried to achieve correction using rod rotation manoeuvres.[4]
  • Modern spinal instrumentation are able to address sagittal imbalance and rotational defects which was unresolved by the Harrington rod system.
  • They involve a combination of rods, screws, hooks and wires fixing the spine and can apply stronger, safer forces to the spine than the Harrington rod.
  • Modern spinal instrumentation generally have good outcomes with high degrees of correction and low rates of failure.
  • When scoliosis with severe curves have led to significant deformity resulting in a rib hump, it is necessary to perform a surgery called a costoplasty also known as thorocoplasty in order to achieve a more pleasing cosmetic result.
  • This procedure is usually performed at the same time with arthrodesis.

Anterior Instrumentation

  • Anterior approach allows correction with shorter fusion levels in the scoliotic thoracolumbar and lumbar regions.[5][6][7][8]
  • Postoperative pain and scar formation decrease in patients with the advent of the video assisted thoracoscopic surgery.
  • However, this approach has a higher incidence of implant failure and pseudarthrosis, and has been associated with a risk of pulmonary complications secondary to the need for single lung anesthesia during the procedure.[9][10]

Non-Fusion Surgery

  • Non-fusion surgery is another option in order to control growth in the treatment of idiopathic scoliosis.[11][12][13]
  • Progression of the curve might be avoided by means of instrumented or non-instrumented epiphysiodesis on the convex side of the curve.
  • Recently, new implants have been developed that allow more spinal growth in young children.
  • These include rods that are extendable and allow growth while still applying corrective forces and vertebral stapling which is a method of retarding normal growth on the convex side of a curve, allowing the concave side to catch up.
  • After the fusion surgery at younger ages, the body remains shorter than the limbs. Shorter body prevent the development of lungs.
  • The upper and lower parts of the curve can be fixed by Isula double rod system developed by Akbarnia, attached to the rods and the rods are attached to one another with an additional rod.
  • The rods are extended in 6-month follow-up. After reaching the full growth, fusion is completed with instrumentation.
  • For the youngest patients, ribcage implants that push the ribs apart on the concave side of the curve may be beneficial.
  • Vertical expandable prosthetic titanium ribs (VEPTR) weredeveloped to treat the thoracic insufficiency syndrome that is caused by combination of ribs and curves.[14]
  • The deformity can be corrected acutely by means of VEPTR following the wedge thoracostomy.
  • VEPTR device is expanded in 4-6 months time.

Complications of Surgery

Subdural hematoma post scoliosis correction surgery. Source: Case courtesy by: Dr. Rohan A. Bhimani




References

  1. ↑ El-Hawary R, Chukwunyerenwa C (2014). "Update on evaluation and treatment of scoliosis". Pediatr Clin North Am. 61 (6): 1223–41. doi:10.1016/j.pcl.2014.08.007. PMID 25439021.
  2. ↑ Yaman O, Dalbayrak S (2014). "Idiopathic scoliosis". Turk Neurosurg. 24 (5): 646–57. doi:10.5137/1019-5149.JTN.8838-13.0. PMID 25269032.
  3. ↑ Desai SK, Brayton A, Chua VB, Luerssen TG, Jea A (2013). "The lasting legacy of Paul Randall Harrington to pediatric spine surgery: historical vignette". J Neurosurg Spine. 18 (2): 170–7. doi:10.3171/2012.11.SPINE12979. PMID 23216320.
  4. ↑ Hopf CG, Eysel P, Dubousset J (1997). "Operative treatment of scoliosis with Cotrel-Dubousset-Hopf instrumentation. New anterior spinal device". Spine (Phila Pa 1976). 22 (6): 618–27, discussion 627-8. PMID 9089934.
  5. ↑ Turi M, Johnston CE, Richards BS (1993). "Anterior correction of idiopathic scoliosis using TSRH instrumentation". Spine (Phila Pa 1976). 18 (4): 417–22. PMID 8469999.
  6. ↑ Newton PO (2005). "The use of video-assisted thoracoscopic surgery in the treatment of adolescent idiopathic scoliosis". Instr Course Lect. 54: 551–8. PMID 15948480.
  7. ↑ Newton PO, White KK, Faro F, Gaynor T (2005). "The success of thoracoscopic anterior fusion in a consecutive series of 112 pediatric spinal deformity cases". Spine (Phila Pa 1976). 30 (4): 392–8. PMID 15706335.
  8. ↑ Reddi V, Clarke DV, Arlet V (2008). "Anterior thoracoscopic instrumentation in adolescent idiopathic scoliosis: a systematic review". Spine (Phila Pa 1976). 33 (18): 1986–94. doi:10.1097/BRS.0b013e31817d1d67. PMID 18665023.
  9. ↑ Lowe TG, Alongi PR, Smith DA, O'Brien MF, Mitchell SL, Pinteric RJ (2003). "Anterior single rod instrumentation for thoracolumbar adolescent idiopathic scoliosis with and without the use of structural interbody support". Spine (Phila Pa 1976). 28 (19): 2232–41, discussion 2241-2. doi:10.1097/01.BRS.0000085028.70985.39. PMID 14520036.
  10. ↑ Betz RR, Harms J, Clements DH, Lenke LG, Lowe TG, Shufflebarger HL; et al. (1999). "Comparison of anterior and posterior instrumentation for correction of adolescent thoracic idiopathic scoliosis". Spine (Phila Pa 1976). 24 (3): 225–39. PMID 10025017.
  11. ↑ Schmid EC, Aubin CE, Moreau A, Sarwark J, Parent S (2008). "A novel fusionless vertebral physeal device inducing spinal growth modulation for the correction of spinal deformities". Eur Spine J. 17 (10): 1329–35. doi:10.1007/s00586-008-0723-9. PMC 2556471. PMID 18712419.
  12. ↑ Schleicher P, Onal MB, Hemberger F, Scholz M, Kandziora F (2018). "The C2-Pars Interarticularis Screw as an Alternative in Atlanto-Axial Stabilization. A Biomechanical Comparison of Established Techniques". Turk Neurosurg. 28 (6): 995–1004. doi:10.5137/1019-5149.JTN.23791-18.2. PMID 30478824.
  13. ↑ Maruyama T, Takeshita K (2008). "Surgical treatment of scoliosis: a review of techniques currently applied". Scoliosis. 3: 6. doi:10.1186/1748-7161-3-6. PMC 2346456. PMID 18423027.
  14. ↑ Campbell RM, Smith MD, Mayes TC, Mangos JA, Willey-Courand DB, Kose N; et al. (2004). "The effect of opening wedge thoracostomy on thoracic insufficiency syndrome associated with fused ribs and congenital scoliosis". J Bone Joint Surg Am. 86-A (8): 1659–74. PMID 15292413.
  15. ↑ Bhimani R, Bhimani F, Singh P (2018). "Subdural Hemorrhage after Scoliosis and Detethering of Cord Surgery". Case Rep Med. 2018: 5061898. doi:10.1155/2018/5061898. PMC 5902091. PMID 29808094.

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