Congenital Scoliosis

Surgical Options

Growing Rods

Most operations that address spinal deformity in the young child work by stopping growth. This may have unfavorable effects on growth of the thorax, lung development, and size of the trunk. The theory of the growing rod operation is to allow for continued controlled growth of the spine. This is done through the back of the spine. In general, the curve is spanned by one or two rods under the skin to avoid damaging the growth tissues of the spine. The rods are then attached to the spine above and below the curve with hooks or screws. The curve can usually be corrected by fifty percent at the time of the first operation. The child then returns every six months to have the rods "lengthened" approximately one centimeter to keep up with the child's growth. This is usually an outpatient procedure performed through a small incision. Some children will have to wear a brace to protect the instrumentation. When the child becomes older and the spine has grown, the doctor will remove the instrumentation and perform a formal spinal fusion operation. In the past, this procedure had a very high complication rate, most of which were related to the instrumentation (hook dislodgement, rod breakage). Modern techniques reduced this complication rate to a reasonable degree.

With congenital scoliosis, this technique is valuable when there is a secondary curve adjacent to the congenital curve. At times, this curve will resolve or remain dormant if the hemivertebra is removed. However, if the adjacent curve progresses, it may be treated like idiopathic scoliosis, and spanned with growing rods.

Growing Rods

Figure 1:
A) A front X-ray of an 18-month old girl with congenital scoliosis. The green arrow notes a bony spur in her spinal canal.
B) A CT 3-D reconstruction of the vertebrae showing multiple malformations.
C) A photo of the young girl with upper thoracic congenital scoliosis. Note the elevation of the right shoulder and the fullness in her neck.
D) An MRI showing a syrinx (fluid sac) in her spinal cord (white arrows highlighted with yellow arrows).
E) A picture of the bony spur (called “diastematomyelia”) after neurosurgical resection.
F) A CT scan (top view) showing the bony spike extending through the spinal cord.
G) A front X-ray showing the hemivertebra resection with instrumentation in the upper right, and a growing rod on the left.
H) A front X-ray several years later after a second growing rod was placed. The rods are left long to simplify later extensions of the spine.

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