In cases of pediatric scoliosis where spine curvature is advanced, surgical intervention may be necessary. When left untreated, abnormal spine growth in small children can impact the heart and lungs. Children up to seven years old may require special scoliosis treatment.
Managing scoliosis as the spine grows can require surgery for scoliosis and spinal deformity. These procedures are designed to stop scoliosis and other spine conditions from progressing while maintaining continued spine growth, function and motion.
The primary goal of growth preservation procedures is to promote correct spine growth and support healthy heart and lung development. This means that your child may need multiple surgeries during their development. The majority of children who have surgery for scoliosis and other spinal deformities should be able to get back to their normal activities in just a few months.
The pediatric spine specialists at Ascension Seton will determine which growth preservation treatment is the most appropriate for your child’s needs. They may recommend one of the following procedures:
This method involves placing rods along each side of the spine. The rods are attached to anchors both above and below the curve. The anchored parts are fused to the spine to provide strong support. The curved part of the spine remains unfused. The rods allow for continued spine growth while helping to correct spine and chest malformation. Every six to 12 months the rods are lengthened via surgery.
VEPTR™ (Vertical Expandable Titanium Rib)
Some scoliosis cases in young children can cause deformity of the chest in addition to severe spine curvature. A VEPTR™ is a medical device that makes the shape of the chest more normal. By expanding the chest size, the lungs can grow and function normally. A larger, longer chest can also help a child’s spine to stay straight while supporting continued spine growth.
During this growth preserving procedure, one or more of the ribs are spread apart to make the chest larger. Depending upon the location of the abnormality, the VEPTR™ device is attached to a combination of ribs, spine or pelvis. As the child grows, the VEPTR™ is surgically expanded every six to 12 months.
The SHILLA System
The SHILLA system uses screws and rods to straighten the curved portion of the spine. Screws are inserted into specific points along the spine. The rods are partially attached to the spine with these screws, but are not locked into place. This track and trolley system allows the rods to slide through the screws and lengthen as the spine grows. The SHILLA system is a new innovation in the field of growth preservation surgery and scoliosis treatment. Unlike grow rod surgery or use of a VEPTR™ device, repeat surgeries are not part of this treatment protocol. The goal of the SHILLA system is to promote normal spine growth.
Children with idiopathic scoliosis and curves that are less than 35 degrees may benefit from this newer technique. Stapling is a form of internal bracing that helps to correct scoliosis by altering the spine’s abnormal growth pattern. This growth preserving surgery involves inserting metal staples across the spine’s growth plates. The staples are implanted in a minimally invasive surgery that uses a tool with a camera attached. The goal of stapling is to prevent scoliosis from worsening, and it can also correct the curve.
Spinal fusion is sometimes necessary for children with scoliosis or kyphosis. It involves joining together the damaged bones in the spine to create stability and correct curves. If spinal fusion is recommended for your child, the following techniques may be used:
VATS (Video-Assisted Thoracoscopic Surgery)
Video-assisted thoracoscopic surgery allows entry into the chest wall using a minimally invasive approach that minimizes muscle damage. VATS has a range of surgical applications and can be used in vertebral stapling, spinal fusion and reconstruction.
Small incisions are made in the chest wall, through which a camera and surgical instruments are inserted. The camera magnifies the internal structures to make them more visible. During the procedure, live X-ray images are used to help guide the surgeon to the surgical site.
The benefits of VATS include less postoperative pain, shorter hospital stays, faster recovery and less impact on short and long term lung function.
XLIF (eXtreme Lateral Interbody Fusion)
In an XLIF procedure, the surgeon approaches the spine through a lateral position (with the person laying on their side). An X-ray is taken to show the exact portion of the spine to be operated on. Small incisions are made on the side of the body. This approach avoids the major back muscles.
A nerve-monitoring probe helps guide the surgeon and protect nearby nerves. An instrument known as a retractor is used to gently move tissue so the surgeon can see the spine. Through the incisions, the surgeon is able to access the spine and prepare the space for fusion. This includes removing some disk material.
An implant with grafted bone is inserted. Spinal implants stabilize and hold bones in place until new bone tissue fuses with the vertebrae to form one solid bone mass.
Additional X-rays may be taken to confirm correct alignment. Plates, screws or rods are fixed to the implant for further stabilization.
The XLIF procedure is not appropriate for all cases of scoliosis. It cannot treat the lowest level of the spine.
Experience the Ascension Seton Difference
At Ascension Seton, our orthopedic surgeons are trained in cutting-edge surgical techniques. We are dedicated to improving your child’s health and quality of life. As a parent, it’s natural that you may have questions or concerns about your child’s surgery. To find out more about surgical options for scoliosis and spinal deformity, visit one of our locations.