Congenital Scoliosis

Surgical Options

Spinal Instrumentation and Fusion

Definitive spinal fusion is performed to stop growth of the spine and thus achieve permanent correction. This treatment becomes appropriate when the patient has demonstrated significant evidence of progression of the congenital scoliosis.

Posterior fusion provides permanent stabilization in the corrected position and is achieved by removing the joints between the vertebrae to be fused, usually all the vertebrae which are involved in the curve. Bone graft - either from the pelvis, ribs, or from the bone bank (allograft) - is placed over the spine. Over time (4-6 months), the graft incorporates to the vertebral bone, and the operated portion of the spine heals into a solid block of bone. The bony fusion cannot bend, thus eliminating further progression of the curve. Typically in a child who has reached an appropriate age for definitive fusion, instrumentation will also be placed when the fusion is performed. The instrumentation rigidly fixes the spine internally, so that the corrected position is carefully preserved while the fusion takes place over the 4-6 month period. This rigid fixation is achieved by screws, hooks, and wires ("anchors") attached to the spine, usually at multiple sites along the curve, and then rods are attached to the anchors to stiffen the entire area (see Figure 1). Often the patient does not need any further external immobilization (cast or brace) if the internal fixation device is felt to be adequate at the time of surgery.