Scoliosis (curvature of the spine) can be a serious problem in young children. The spine can curve so much that the lungs and heart are compressed causing deadly complications. When scoliosis is present early (between birth and age five), the chances of a fast growing curve are much higher than when the curvature develops in the teen years.
In this report, researchers at the San Diego Center for Spinal Disorders in California take a closer look at complications following growing rod treatment for scoliosis. These expandable rods hold the spine in neutral alignment (as much as possible).
As the child grows, the rod can be lengthened. This type of treatment prevents removing the rods and replacing them as growth occurs. You can see the advantages of such treatment in cases of early-onset scoliosis. When the child stops growing, then spinal fusion can be done.
But there can be complications, too. By studying who is affected and possibly answering the question, Why do these problems develop?, it might be possible to prevent such problems.
The main factors reviewed in this study included 1) age of the child at the time of surgery, 2) where the rods are placed (under the skin above the fascia versus below the fascia), 3) single or dual rods (placed on one side versus both sides of the spine), and 4) the number of surgeries performed. Fascia is another word for the connective tissue that surrounds and supports the soft tissues (e.g., muscles).
The information gathered on children comes from The Growing Spine Study Group. This is a computer database with information downloaded from around the world. Various spine centers treating children with early-onset-scoliosis provide information about results of treatment using these growing rods.
Over the years, this group has been able to show that early spinal fusion (before age seven) is not a good idea. These are the kids who end up with cosmetic deformities and difficulty breathing. This same group was also able to show that growing rods have more complications than previously appreciated.
Different rod designs with growth expansion at the ends versus in the center of the rod have been tried. The single-rod on one side of the spine has been compared with using dual-rods (one on each side of the spine). Data has also been collected and analyzed on the different ways the rods are attached to the spine (e.g., screws, hooks, connecting bars at the top and bottom).
There was a whole host of different complications. Infections, blood loss, rods breaking, painful scars, hook or screw pullout, and rods poking through the skin give you some idea of what was happening. There were also cases of lung, heart, and/or intestinal problems.
In the database, there were 140 patients who had a total of 897 growing-rod procedures. More than half (58 per cent) of those 140 children had at least one complication. The rate of complications was higher in children with the single-rod support or subcutaneous placement. They also found that the more surgeries the child had, the greater the risk of problems developing.
For early-onset scoliosis, the surgeons advise putting off surgery for as long as possible. Bracing or casting may be used to delay surgery. When surgery is finally done, dual rods should be considered over single rods. The deeper the rods are placed, the better the results. And the fewer times the rods are lengthened, the fewer the complications.
Children with curves that are growing too fast to hold with conservative measures must have the growing-rod treatment. Careful monitoring is essential to get the best results with the fewest problems. The goal is to prevent deformities while still allowing for growth and development of the spine and trunk.
Parents of children with early-onset scoliosis that is progressively getting worse must be prepared for changes in treatment. Casting or bracing may be used at first and then replaced with surgery. At the same time, every child with a growing rod must be using a special plastic brace called a thoracolumbar sacral orthosis (TLSO). Complications, problems, and additional (often unplanned) surgeries are to be expected.
In the future, it may be possible to lengthen the rods without doing surgery. The internal rods could have an external remote. The remote could be used to allow for expansion without opening up the spine to adjust the rods by hand. This type of technology could reduce the number of procedures (and complications) until spinal fusion is possible.
Reference: Shay Bess, MD, et al. Complications of Growing-Rod Treatment for Early-Onset Scoliosis. In The Journal of Bone and Joint Surgery. November 3, 2010. Vol. 92.No. 15. Pp. 2533-2543.