Scoliosis treatment options

Q: My granddaughter was diagnosed with a severe case of scoliosis. What is scoliosis, and what treatments are available? A: Scoliosis is a side-toside curvature of the spine that can occur in about 1 in

300 children. Curves can progress rapidly, especially during the adolescent growth spurt.

Growth plates, which are compressed, grow more slowly, resulting in progressive wedging of the vertebra and scoliosis progression. Large curves can progress in adulthood, eventually causing problems with quality of life and breathing.

Typically, braces can treat mild or moderate curves by holding the spine in a corrected position while the spine grows. Bracing may prevent the curve from worsening, but it does not typically straighten the alignment of a curved spine.

For some children, the curvature of their spine is significant, thus the diagnosis of severe scoliosis. Severe curves can be treated with spinal fusion. This procedure prevents the curve from returning.

With spinal fusion, an

8- to 12-inch incision is made over the back, and the muscles are moved out of the way to reach the spine. Screws and rods are attached to the curved area of the spine, and the spine is pulled into a corrected position. Then, small joints over the back of the spine are removed, and the bone is roughened. This process creates a solid sheet of bone across the back of the spine. Depending on where the curve is, between six to 13 vertebrae of the 17 vertebrae are fused to treat scoliosis.

After fusion, however, the spine no longer grows over the area where the spine is fused, and the spine does not move over the area that is fused. In most cases, the unfused area of the spine can compensate, and children have normal function and acceptable spine motion. After a fusion surgery, children stay in the hospital for three to four days and may miss about three weeks of school. Most children can return to normal physical activity and play most sports within 12 weeks after surgery.

Once a fusion surgery is performed, there is no reason to perform a nonfusion procedure. However, newer surgeries that do not involve fusion are available to treat scoliosis.

The goal of these nonfusion surgeries is to correct the scoliosis but still allow for spinal growth and motion.

To date, the risk of needing a second surgery is higher after a nonfusion surgery — up to 10% to 20% chance within two years of the procedure. Two devices approved by the Food and Drug Administration are used for nonfusion spine procedures to treat scoliosis.

One device is used for vertebral body tethering. The spine is accessed through incisions in the side. Metal screws are placed in the vertebrae where the spine is curved, and a plastic cord connects these screws. The cord is tensioned to shorten the long side of the scoliosis curve, acting as a brace.

As children grow, the curve continues to correct over time. The cord is flexible so the spine can move.

The other approved device is used to perform posterior dynamic distraction. A 6- to 8-inch incision is made over the back. The muscles on one side of the spine are moved out of the way. Screws are placed and connected with a single rod that has two ball bearing joints for motion.

For young children, similar rods can be used that contain a special magnetic device. These are called magnetic growing rods. The rods are fixed to the spine above and below the scoliosis curve.

While advancements have been made to treat childhood scoliosis, early detection and treatment with bracing are always the first choice. For now, fusion is the most reliable option, but some families may prefer a nonfusion approach to preserve motion and spinal growth.

— Noelle Larson, M.D., Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota

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