Use of Instrumentation in the Correction of Congenital Spinal Deformities

Abstract

Growth imbalance of the vertebrae leads to three dimensional deformities of the spinal column in congenital spinal deformities. Deformities are often rigid and create serious challenge for reconstructive surgery. In-situ fusions were popular before use of instrumentation in congenital spinal deformities. Combined anterior-posterior fusions of the vertebral column were performed to stop the progression of the curves. Unique problems in congenital spinal deformity like shorter spinal/trunk length and thoracic insufficiency syndrome are worsened due to shortening of the spine in time after conventional fusion treatments. Spine is stiff in congenital spinal deformities and all surgical interventions increase rigidity by reducing the amount of mobile segments. Spinal canal compromises observed in congenital deformities and associated spinal cord anomalies may increase the risk of neurologic injury following surgical manipulation. Aim of the treatment should be to obtain optimal and safe corrections with lesser segment solid fusions, preventing the adding on and crankshaft phenomena with a minimum number of surgical procedures. Modern surgical techniques enabled us to straighten the spines as achieve solid fusions. Now, it is possible to obtain significant level of reconstruction via instrumented fusion on congenital spinal deformities. Modern anesthesiology methods, developments in imaging procedures and neuromonitorization techniques as well as newer implant technologies enable spine surgeons to deal with complicated congenital spinal deformities. We aimed to review the current instrumented treatment modalities for congenital spinal deformities and the difficulties faced during instrumentation of the congenitally deformed spine.