Treatment of Severe Pediatric Spinal Deformities

The management of severe pediatric spinal deformities continues to evolve as advances in spinal instrumentation, surgical techniques, and neuromonitoring occur. The techniques of spinal osteotomies have been refined to allow surgeons to perform better corrections with less operative time, more safely, and through a posterior approach alone, making multiple patient positioning changes during surgery a less common occurrence. With these techniques comes a learning curve for the entire surgical team, wherein communication and planning can help minimize major complications and morbidity. This overview will review various techniques used in the correction of severe spinal deformities. Topics reviewed include the role of anterior release, traction, posterior releases, and osteotomies. Indications, techniques, and pitfalls will be reviewed. A clear understanding of the patient’s deformity, normal sagittal parameters, spinal anatomy, and the principles of neuromonitoring will help improve surgical planning and patient outcome.

[1]  S. Lewis,et al.  The use of fusion mass screws in revision spinal deformity surgery , 2014, European Spine Journal.

[2]  G. Mundis,et al.  Delayed postoperative neurological complication in a patient with congenital kyphoscoliosis: recovered by revision of the 4-rod instrumentation technique: case report. , 2013, Journal of neurosurgery. Spine.

[3]  L. Holmes,et al.  Ponte Osteotomies With Pedicle Screw Instrumentation in the Treatment of Adolescent Idiopathic Scoliosis , 2013, Spine deformity.

[4]  E. Ebramzadeh,et al.  Quantification of Increase in Three-dimensional Spine Flexibility Following Sequential Ponte Osteotomies in a Cadaveric Model. , 2013, Spine deformity.

[5]  J. Jarvis,et al.  Responding to Neuromonitoring Changes in 3-Column Posterior Spinal Osteotomies for Rigid Pediatric Spinal Deformities , 2013, Spine.

[6]  Y. Rampersaud,et al.  Posterior Column Reconstruction With Autologous Rib Graft After En Bloc Tumor Excision , 2012, Spine.

[7]  S. Lewis,et al.  Neurophysiological Changes in Deformity Correction of Adolescent Idiopathic Scoliosis With Intraoperative Skull-Femoral Traction , 2011, Spine.

[8]  L. Lenke,et al.  Efficacy of perioperative halo-gravity traction for treatment of severe scoliosis (≥100°) , 2010, Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association.

[9]  L. Lenke,et al.  Posterior Vertebral Column Resection for Severe Pediatric Deformity: Minimum Two-Year Follow-up of Thirty-Five Consecutive Patients , 2009, Spine.

[10]  F. Canavese,et al.  Intralaminar Screw Insertion of Thoracic Spine in Children With Severe Spinal Deformities: Two Case Reports , 2009, Spine.

[11]  R. Zeller,et al.  The effect of intra-operative skeletal (skull femoral) traction on apical vertebral rotation , 2009, European Spine Journal.

[12]  L. Lenke,et al.  A Central Hook–Rod Construct for Osteotomy Closure: A Technical Note , 2008, Spine.

[13]  H. Shufflebarger,et al.  The Ponte Procedure: Posterior Only Treatment of Scheuermann's Kyphosis Using Segmental Posterior Shortening and Pedicle Screw Instrumentation , 2007, Journal of spinal disorders & techniques.

[14]  J. Buchowski,et al.  Temporary internal distraction as an aid to correction of severe scoliosis. , 2006, The Journal of bone and joint surgery. American volume.

[15]  W. Choi,et al.  Posterior Vertebral Column Resection for Severe Rigid Scoliosis , 2005, Spine.

[16]  L. Lenke,et al.  Thoracic adolescent idiopathic scoliosis curves between 70 degrees and 100 degrees: is anterior release necessary? , 2005, Spine.

[17]  L. Lenke,et al.  Prospective Pulmonary Function Comparison of Open Versus Endoscopic Anterior Fusion Combined With Posterior Fusion in Adolescent Idiopathic Scoliosis , 2004, Spine.

[18]  L. Lenke,et al.  Pedicle subtraction osteotomy for the treatment of fixed sagittal imbalance. Surgical technique. , 2004, The Journal of bone and joint surgery. American volume.

[19]  L. Lenke,et al.  Pedicle Subtraction Osteotomy for the Treatment of Fixed Sagittal Imbalance , 2003, The Journal of bone and joint surgery. American volume.

[20]  Y. Hu,et al.  Evaluation of Various Evoked Potential Techniques for Spinal Cord Monitoring During Scoliosis Surgery , 2001, Spine.

[21]  R. Betz,et al.  Prospective Pulmonary Function Evaluation Following Open Thoracotomy for Anterior Spinal Fusion in Adolescent Idiopathic Scoliosis , 2000, Spine.

[22]  C. Larson,et al.  Osteotomy of the spine for correction of flexion deformity in rheumatoid arthritis. , 1969, Clinical orthopaedics and related research.