Surgical management of congenital scoliosis

Abstract

Objective The aim of this study was to assess outcomes and complications in patients surgically treated for congenital scoliosis. Background Congenital scoliosis due to hemivertebra and unsegmented bar is most often progressive and requires surgical treatment. The recommended surgical options include 'in-situ' fusion, convex hemiepiphysiodesis, and hemivertebra excision. Patients and methods This study included 20 patients (six boys and 14 girls). The age at operation was between 4 and 18 years. Two techniques were used: the anterior procedure and the posterior procedure. The anterior procedure involves thoracotomy and the thoracoabdominal approach. In this procedure disc excision above and below the level of the anomaly was performed and the segment of the vertebral column (hemivertebra, segment of unsegmented bar) that would be excised was determined. In the posterior procedure, posterior correction, fixation, decortications, and grafting were performed. Fixation was carried out using claw, sublaminar wires, pedicular screws, and rods. Results 'In-situ' fusion does not address the anomaly directly; it allows a moderate correction rate but is associated with long spinal fusion. Hemivertebral resection directly addresses the spinal anomaly; it produces the best correction results and is a safe procedure to perform. The average angle after posterior correction and fusion of congenital scoliosis was 37.5΀ (range from 15 to 60΀). The percentage of correction was 55% (range from 20 to 90%). The early postoperative correction following the staged combined anterior and posterior correction, and fusion was 60%, ranging from 40 to 80΀. Conclusion The treatment of congenital scoliosis focuses on early diagnosis and appropriate surgical management before the development of large curves. All of the procedures described can be effective and safely performed if correctly selected and performed by an experienced team of surgeons.