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Idiopathic Scoliosis
Infantile
Figure 1. Front and side X-rays of a young girl with growing rods. The center portion of
the spine is never exposed to avoid disturbing growth. The rods are intentionally left
long to make “extensions” (pushing the bottom screws down to straighten the spine)
easier in the future.
Surgical Management
Growing Rods
Most operations address spinal deformity in the young child work by stopping growth. This may have unfavorable effects on the growth of the thorax, lungs, and the 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, one or two rods span the curve under the skin to avoid damaging the growth tissues of the spine. The rods attach to the spine at the top and bottom of the curve with hooks or screws. The curve can usually be corrected 50% at the time of the first operation. The child then returns every six months to have the spine “lengthened” approximately one centimeter to keep up with the child’s growth. Often, the rods are kept longer than usual so lengthenings are less involved than the initial procedure and only involve opening one incision. The lengthening procedures can usually be performed on an outpatient basis. 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.
