Evolution of Technology

Growth Friendly Scoliosis Surgery

Traditional scoliosis surgery involved drilling screws into the strong pedicle parts of each vertebral bone and attaching them to long, straight metal rods along each side of the spinal column. The bones of the spine would then be fused together in a corrected position; no further spine growth was possible with this early scoliosis surgery technique. Lung function was often compromised in these patients because the chest cavity was restricted in growth after spine fusion at an early age. The next generation of scoliosis surgery for children involved placing rods along the spine without fusion of the vertebral bones. The idea was to focus on and be ‘friendly’ to growth, while still treating the scoliosis. As children or teenagers grew taller, the rods would be changed out for longer ones, through multiple surgeries, roughly every six months, throughout childhood and adolescence. When adult height was reached, the spine could be fused in the corrected position. Concerns about repeated procedures under anesthesia led surgeons to search for other techniques of surgical scoliosis management.

Evolution of Procedure

Early Onset and Adolescent Idiopathic Scoliosis Surgery

Treatment of scoliosis is aimed at decreasing the spine curvature to an amount that allows normal growth, posture, and activity. Additionally, the shape of the spine, rib cage, and pelvis should allow for adequate protection of the spinal cord and organs contained inside. Other concerns in children or teenagers involve preserving their potential for future growth. Specialized orthopaedic surgeons, usually working in a pediatric orthopaedic department, are trained in the correction of scoliosis. They work with families to decide if and when intervention is needed, and then to determine the best surgical approach to safely straighten the spine.

Evolution of Diagnosis

Early Onset and Adolescent Idiopathic Scoliosis

Adolescent Idiopathic Scoliosis is the term for excess curvature of the spine that occurs in children over age 10 years, while Early Onset Scoliosis affects children less than 10 years of age. Often diagnosed by a school nurse, pediatrician, or parent, this curvature begins in childhood and can worsen during the accelerated growth that occurs during adolescence. Patients are evaluated by an orthopaedic surgeon who reviews xrays of the entire spine and measures all the curves and angles between the bones. Depending on the amount and type of curvature, children may be observed or treated in a specially-fitted brace to start. If the spine curvature worsens over time, some patients may be recommended to undergo surgery to correct their scoliosis.

Evolution of Technology

Traditional Growth Rods

Dr. Harrington was the surgeon whose growth rod technique and implants became eponymous in scoliosis surgery. Harrington rods are placed through an initial surgery where they are anchored to the spine at the top and bottom of the construct. These bony segments may be fused, but the remaining bones in the spine are not fused and can grow over time with the child. The Harrington rods are changed out over time, with surgery up to every six months during childhood and adolescence.

Evolution of Technology

Early Spinal Fusion Surgery

The earliest form of surgery for scoliosis in children and adolescents involved surgical correction of the deformity with fusion at that time. The idea was that a shorter, straight spine was better than a longer, curved spine. However, studies of the lung function in these patients showed that pulmonary function tests were very often abnormal when the spine was fused at an early age. The reduction in lung function is due to the smaller size of the rib cage and the resulting compression of the lungs. Children with severe spine curves, often in the company of other medical conditions, may still be treated with this technique, but, when feasible, surgeons try to allow as much growth as possible.