Alternatives to spinal fusion surgery in pediatric deformity

Abstract

The standard of care for skeletally immature patients with idiopathic scoliosis is bracing for moderate curves. The standard of care for both skeletally immature and mature patients who have more severe or progressive curves is spinal fusion. We present a summary of four currently used non-fusion surgical techniques as alternatives to bracing and spinal fusion. Vertebral body stapling (VBS) is suggested for patients between the ages of 8 and 13 yr for girls and younger than 15 yr for boys with at least one year of growth remaining (Risser 0-1, Sanders digital stage ≤4). Thoracic curves should measure 25-35 degrees and lumbar curves 25-45 degrees. For best results, the curves should be flexible, bending to < 20 degrees. Correction with a cord/screw construct includes vertebral body tethering (VBT) and anterior scoliosis correction (ASC), which are most commonly being performed for skeletally immature patients (Risser 0-2, Sanders digital stage ≤4) with thoracic and lumbar curves between 30-70 degrees that bend to < 30 degrees. The authors of this article have expanded the indications for treating adolescents with idiopathic scoliosis who are more mature (Risser > 2) with ASC. One commercial product has received CE mark approval in Europe for ASC treatment in both skeletally immature and mature patients. A second product utilizing posterior dynamic concave distraction, also with CE mark approval in Europe, is indicated for patients who are 10-17 yr old with primary single main thoracic or thoracolumbar curves between 30-60 degrees that correct to ≤35 degrees on bending films.