Treatment of Early Onset Scoliosis
Causes of EOS
What to Expect
- There are many varieties of early onset scoliosis. In many cases, especially in infants, your child will initially be treated with observation. Your doctor will recommend follow-up appointments and xrays to monitor your child. In many cases this is to determine whether the scoliosis is one that will resolve on its own or if it will get worse over time. If it gets worse with observation, your doctor may recommend treatment.
- Casting is increasingly being utilized for the treatment of early onset scoliosis. In many cases casting can offer a way of straightening your child’s spine over time. A cast is used to guide growth of the crooked spine into a straight spine, similar to how a crooked plant can be made to grow straight by tying it to a stake.
For some children, however, casting is used as a means to prevent or delay progression of scoliosis. This may be recommended to allow children to get bigger prior to surgery and also to increase lung development prior to surgery.
Application of a spine cast is done in a procedure center or operating room with your child under anesthesia. No incision is made. The cast is applied by your doctor. It typically needs to be changed every 2-4 months. Some doctors place casts that go over the shoulder; some do not go over the shoulder. You can discuss this with your doctor.
- Bracing is also used for management of early onset scoliosis. There is less data on the effectiveness of bracing for early onset scoliosis compared to casting. Often bracing is used in conjunction with casting either during summer “breaks” or after your child’s spine has straightened with casting.
- VEPTR™ stands for vertical expandable prosthetic titanium rib. It is a device that was developed to treat children with severe malformations of their chest and spine. It is an FDA approved device. VEPTR™ is now used for various spinal and chest deformities in young children.
VEPTR™ attaches to your child’s ribs and either the spine or hip bone. It helps correct spinal and chest deformity without fusing the spine. Your child will usually need to have their device lengthened every 6-12 months by your doctore in the operating room. VEPTR™ has demonstrated effectiveness in management of early onset scoliosis, however, there are complications that can occur. These include infection, broken ribs, movement of implants, nerve injury, and prominence causing pain. Ask your doctor about the specific risks and benefits for your child.
- Growing Rods
- Growing rods are surgical devices placed along your child’s spine and attached to the spine with either hooks or screws above and below the curve. The area around the hooks and/or screws is fused to provide strong support. The curved part of the spine remains unfused. Similar to the VEPTR™, growing rods help correct spine and chest deformity and need to be lengthened every 6-12 months in the operating room.
Growing rods are FDA approved. They have similar risks to VEPTR™ including infection, movement of implants, nerve injury, inadvertent spinal fusion, and prominence causing pain.
- MAGEC™ rods are a specific type of growing rods. They are implanted in a similar manner to VEPTRs and growing rods. Surgeons can decide to pair this rod with other implant systems that attach to the spine including pedicle screws, hooks, wires, and anchors from the VEPTR™ system. An innovative and unique feature of MAGEC™ rods are that they may be lengthened with the use of an external magnetic controller without the patient having to undergo an invasive procedure or even be placed under anesthesia. The surgeon or his or her staff perform the lengthening in the doctor’s office. Due to the relative ease of the lengthening experience, many surgeons adopt a schedule of implant lengthening that is more frequent than the every five to six months used in VEPTRs™ and growing rods. Risks of MAGEC™ rods include the risks associated with VEPTRs™ and growing rods in addition to the risk of failure of the mechanical aspects of the lengthening mechanism. The implant is made by Ellipse Technologies, Inc. of California.
- Stapling of the spine is a new technique that has demonstrated effectiveness in specific patterns of early onset scoliosis. Stapling acts like an “internal brace” for the spine and can help correct scoliosis through altering the growth pattern of the spine. A metal stapled is inserted on one side of the curved spine to limit its growth. It can often be done through small incisions in the chest utilizing a video camera. The best patients for stapling are those with modest sized scoliosis who do not have rib and spine malformations. Stapling is not approved by the FDA and is only offered at a limited number of hospitals. Ask your doctor if they utilize this technique.
- Tethering is similar to stapling and can alter growth of the spine in an attempt to straighten it. It is not as well studied as stapling. Tethering can often be done using small incisions in the chest utilizing a video camera. Very few centers have used tethers on humans. Many centers are studying tethering in animals to evaluate effectiveness and safety. Tethering is not approved by the FDA.
- The Shilla technique involves doing a short spinal fusion at the most curved portion of the spine using screws and rods. The rods are attached then at the top and bottom of the spine to screws that allow for continued growth of the spine. The Shilla technique remains experimental, with limited data about its effectiveness. The benefit of the Shilla technique is that if successful it does not require repeat trips to the operating room for expansion. Complications of the Shilla technique are similar to growing rods and VEPTR. Availability of the special screws and rods needed for Shilla technique are limited in the United States. The procedure remains experimental. You can ask your doctor if they do the Shilla technique and if your child is an appropriate candidate for it.
- Alternative Techniques
- There are many other proposed treatment methods for early onset scoliosis. These include chiropractic care, acupuncture, stretching, and massage. You may find various braces, medications, and exercise programs that propose to treat early onset scoliosis. These various methods have not been scientifically studied and have not been demonstrated to show effectiveness in treating scoliosis. They often require significant out of pocket financial investment. Please ask your doctor about alternative techniques you are considering to help you make an informed decision about your child’s care.
- Definitive Fusion
- In some cases, spinal fusion may be indicated for a child with early onset scoliosis. Most doctors have moved away from extensive spinal fusion for young children with scoliosis because it restricts chest and lung development.
There are certain cases, however, where a short fusion may be appropriate to try and prevent more serious progression of scoliosis. Short fusion is also done as part of the Shilla technique and the growing rod technique.
Usually a short fusion of the spine is done when a child has a hemivertebra. This is a malformed spinal segment. It can be removed and a short fusion done to stabilize the spine. In many cases this can completely straighten the spine and prevent need for future surgeries. Your surgeon may do this all from one incision in the back, or may do an incision through the chest and the back. You should discuss this with your doctor.
In most cases when a short fusion is done, your doctor will use screws, hooks, or wires to anchor to the spine. In some cases, however, they may choose to not use any anchors. In that situation usually your child will wear a cast after surgery for several months to help hold the spine in place while it fuses. If anchors are used, however, your child will usually not require a cast.
- Future Directions
- There is a large amount of innovation occurring in the treatment of early onset scoliosis. Doctors are especially excited about the development of growing spine systems (like VEPTR™ and growing rods) that can expand without surgery. Experimental devices have been implanted in children in Europe and Asia. They are not available in the United States. The safety and effectiveness of these devices are not yet known.
Additionally, there are many scientists studying the genetic causes of scoliosis and there is hope that in the future we will be able to correct scoliosis without needing surgery. In the meanwhile, doctors continue to work on improving the care for children with early onset scoliosis and improving the safety and effectiveness of the techniques available today.
Causes of EOS
What to Expect