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Return to Latest Treatment Options for Early Onset Scoliosis Overview

More on Latest Treatment Options for Early Onset Scoliosis

Latest Treatment Options for Early Onset Scoliosis

Spinal Stapling, VEPTR, and Growing Rods Among the Latest Treatment Options for Early Onset Scoliosis

New York (Apr 15, 2009)

Patients with early onset scoliosis can develop severe, complex spinal deformity that distorts and reduces the volume of the thorax. The resulting condition can compromise respiratory function and be life-threatening. The Center for Early Onset Scoliosis at Morgan Stanley Children's Hospital is one of only a few hospitals in the country to offer a new minimally invasive treatment alternative involving spinal stapling, as well as other treatment options, including VEPTR and growing rods, which promise improved outcomes.

Tens of thousands of children in the U.S. are diagnosed with scoliosis each year. When the curvature is moderate, spinal braces can be used to slow or decrease the chance of progression. Until now, however, there was no way to reverse progression and straighten the spine.

Spinal Stapling for Early Onset Scoliosis

Spinal stapling is a two-hour surgery that involves implanting inch-long metallic staples across the growth plates of the spine. Made of a temperature-sensitive metal alloy, the staples are implanted using a thoracoscope, a camera that is inserted into the chest, resulting in a very limited incision and minimal scar. The procedure is available to children with progressive moderate scoliosis (less than 30 degrees) who are still growing (girls up to age 14 and boys up to age 16).

"Through anterior growth modulation, we feel that it will be possible to stop the curve from developing and in fact allow the curve to reverse itself," said Michael G. Vitale, MD, MPH. "While most children do well with spinal fusion, we are on the cusp of a new era in the treatment of scoliosis. For the first time, we have a way to potentially reverse the scoliosis."

According to Dr. Vitale, early fusion is not the preferred choice for treatment. He recently presented findings at the International Conference on Early Onset Scoliosis that spinal fusion in young children can lead to significant issues in quality of life and pulmonary function over the long term. The study followed 27 patients who received spinal fusion, and after 10 years, their pulmonary function and reported quality of life were significantly less than that of a healthy child.

VEPTR and Growing Rods for Early Onset Scoliosis

Other new strategies have evolved that allow growth of the spine and growth of the thorax. The Vertical Expandable Prosthetic Titanium Rib (VEPTR) straightens the spine and opens a larger space for the lungs and other internal organs to grow by placing a titanium brace between two ribs to push them apart. VEPTR can be expanded as the patient grows through an outpatient procedure.

"VEPTR is a new device which in the last 10 years has shown very positive results in a select group of patients that not only treats the curvature, but allows us to treat the chest wall deformity and the thoracic insufficiency that is so often present in these children," said Dr. Vitale. Growing rods attached to the spine and affixed to vertebrae at the top and the bottom can be expanded over time using a mechanism that allows the lengthening to be performed in a simple outpatient surgery. The approach minimizes spinal deformity, and most importantly allows lung development to occur to preserve a normal life span for the patient.

"Results of growing rods have been generally positive," said Dr. Vitale. "A number of authors have, in fact, shown that the use of growing rods allows us to control large curves to expand the thorax, to allow the thoracic spine to grow with some but relatively acceptable complications." From their experience, Dr. Vitale and his colleagues maintain that there are a number of general principles that promise optimum outcomes and success in the use of growing rods. The use of dual rods is particularly important. "Stable foundations based on pedicle screw constructs allow us a more solid area for support," noted Dr. Vitale. "Long constructs allow us to share the load and share the stress of these constructs over time."

"Frequent lengthening is also an extremely important part of this concept," said David P. Roye, Jr., MD. "We lengthen every four months in children less than 3, and then as they get older, we can cut back to every six months. The concept for waiting for the curve to progress prior to lengthening is probably not the right one. We should be looking to have regularly scheduled lengthening to allow maximal growth of the spine."

"Having the full gamut of options – from growing rods to limited fusion to VEPTR – allows us to cater the specific treatment and implant approach, implant choices that were not available even five or 10 years ago, to the needs of our patients," said Dr. Vitale. "The menu of treatment options is much greater than ever before, and we have the ability to promise significantly different and hopefully better results for children with early onset scoliosis."

Faculty Contributing to this Article:

Michael G. Vitale, MD, MPH is Chief of Pediatric Spine and Scoliosis Surgery at the Morgan Stanley Children's Hospital, and the Ana Lucia Associate Professor of Clinical Pediatrics and Orthopaedic Surgery at Columbia University College of Physicians and Surgeons.

David P. Roye, Jr., MD is Chief of Pediatric Orthopaedic Surgery at the Morgan Stanley Children's Hospital, and the St. Giles Professor of Pediatric Orthopedic Surgery at Columbia University College of Physicians and Surgeons

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