Surgical Treatment of Early Onset Scoliosis Probable causes of undesirable results

Abstract

Aim: Early Onset Scoliosis (EOS) is in many cases a surgical challenge. These deformities are present during the child’s most active physical development and may raise several issues, especially cardio-respiratory problems which will irreversibly affect the quality of life. The aim of EOS treatment is to ensure a proper lung development and to control the kyphoscoliotic deformity without fusion. The purpose of the study represents the analysis  of postoperative evolution in a series of operated EOS patients made us aware of  possible therapeutic related issues. We consider the importance to highlight them, in order to carefully choose the surgical treatment in EOS.

Material and Methods: The study represents a retrospective clinical and imagistic analysis of operated EOS patients.A series of 52 EOS patients, operated by different treatment methods (2003-2014) has been analyzed. The series included congenital, idiopathic infantile and one syndromic scoliosis. Surgical procedures consisted in hemivertebral resection concomitant with instrumentation, the use of VEPTR or Shilla devices or combinations of these. The follow-up period ranged 4-15 years. The patients were investigated by clinical and imagistic exams. 15 patients with poor clinical and radiological results after surgery were identified (worsening of the curve, extended fusion with a short, stiff spine, impaired trunk imbalance and/or pseudarthrosis).

Results: The possible identified therapeutic issues included: the use of surgical techniques which resulted in extended posterior fusion, the choice of an possibly poor surgical technique, improper or faulty applied implants.

Conclusions: Complications and possible postoperative evolutions related to the chosen therapeutic decision should be very thorough taken into account before any procedure. A poor strategy treatment of these deformities decreases quality of life. The prognosis is variable, depending on the cause inducing the deformity. That’s why the treatment should be individualized for each EOS patient. An improper treatment may produce real disasters or cuts short any therapeutic chance, maybe the only one available, in order to ensure the best life quality obtainable.