INSTRUCTIONAL LECTURE Updates on surgical treatments for pediatric scoliosis

Scoliosis in children poses serious problems including respiratory problems, trunk imbalance, and depression, as well as detracting from the child’s appearance. Scoliosis can also contribute to back pain later in life. Advanced surgical techniques allow for good correction and maintenance of progressive curves, and growth-sparing treatments are now available for patients with early-onset scoliosis (EOS). Posterior corrective surgeries using pedicle screw (PS) constructs, which allow curves to be corrected in three dimensions, has become the most popular surgical treatment for scoliosis. Several navigation systems and probes have been developed to aid in accurate PS placement. For thoracolumbar and lumbar curves, anterior surgery remains the method of choice. Growth-sparing techniques for treating EOS include growing rods, the Shilla method, anterior stapling, and vertical expandable prosthetic titanium rib, which was originally designed to treat thoracic insufficiency syndrome. However, these advanced surgical techniques do not always offer a perfect solution for pediatric scoliosis, and they are associated with complications such as infections and problems with instrumentation. Surgeons have developed several techniques in efforts to address these complications. We here review historic and recent advances in the surgical treatment of scoliosis in children, the problems associated with various techniques, and the challenges that remain to be overcome. Scoliosis can affect a child’s appearance, hamper respiratory function and trunk balance, lead to depression, and cause back pain later in life. Moderate scoliotic curves are usually treated conservatively using a brace, but a curve that continues to progress despite treatment requires corrective surgery, either with or without fusion. Recent advances in surgical techniques have made it possible to obtain good correction and maintenance of progressive curves, and several growth-sparing techniques are now available for treating patients with early-onset scoliosis (EOS). However, these advanced surgical techniques do not provide a perfect solution for pediatric scoliosis, and some are associated with suboptimal clinical outcomes. In this article, we review recent technical advances and problems associated with the surgical treatment of scoliosis in children, both from a historic perspective and with a view to the future. The development of posterior-approach surgery The surgical correction of scoliosis is particularly challenging, and surgeons have applied various methods in efforts to meet that challenge. In 1924, Hibbs [1] reported early results from 59 patients, most with paralytic scoliosis, who had undergone posterior fusion surgery. His fusion technique involved elevating the bone flaps from the laminae and turning the free end of the flaps upward or downward to bring them into contact with the adjacent This review article was presented at the 86th Annual Meeting of the Japanese Orthopaedic Association as Instructional Lecture, Hiroshima, May 24, 2013. M. Matsumoto (&) N. Hosogane Y. Toyama Department of Orthopedic Surgery, Keio University, Shinanomachi 35, Shinjuku, Tokyo 160-8582, Japan e-mail: [email protected] K. Watanabe Department of Advanced Therapy for Spine and Spinal Cord Disorders, Keio University, Tokyo, Japan 123 J Orthop Sci (2014) 19:6–14 DOI 10.1007/s00776-013-0474-2