Optimizing Safety and Outcomes in Spinal Deformity Surgery: Early-Onset Scoliosis

Abstract

Several interventions can improve the natural history of progressive Early-Onset Scoliosis (EOS); however, each has its own specific indications and limitations. The treating surgeon should be aware of the risks and benefits of each intervention. The objective of the study was to review the current management of EOS and how to improve the safety and outcomes of different treatment methods. Pulmonary function correlates with the height of the thoracic spine (T1–T12). The growth of the thoracic spine to 18 Cm at the age of 5 and 22 Cm at the age of 10 will minimize the risk of pulmonary complications. Growing Rods (GR) technique has a wide application in EOS with different etiologies. Index GR surgery at an older age and using submuscular, dual growing rod, have reduced the rate of complications. Patients with abnormal thoracic kyphosis, and also with syndromic and neuromuscular EOS are at higher risk for development of complications. Aside from its original indication, thoracic insufficiency syndrome (TIS), Vertical Expandable Prosthetic Titanium Rib (VEPTR) can address different types of spinal deformity. Morbidity of the rib cradles is the main reason for revisions. Meticulous soft tissue coverage and surgical technique are of utmost importance for an effective and safe management. The goal of growth-guided techniques (eg, Shilla), a single time procedure, is to allow continuing growth with fewer returns to surgery. In selected cases, it can serve as an interim procedure before definitive treatment. Treatment of EOS is a long-term commitment for both the patient and treating surgeon. Careful and individualized treatment planning maximizes the safety and efficacy of the treatment for EOS. Knowledge of indications, capabilities, and drawbacks of each technique is the key to optimize the outcomes. Extensive research is underway to introduce less-invasive techniques to enhance the safety and reduce complications.