Progress in surgical treatment of congenital scoliosis_West China Medical Journal

Authors：

ZHOU Jinju , FENG Ganjun , LIU Limin ,  SONG Yueming

Department of Orthopedics / Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

SONG Yueming, Email: hx_sym@163.com

Keywords：

Congenital scoliosis; Hemivertebrae excision; Growing rods; Surgical treatment

DOI：

10.7507/1002-0179.202107240

Video：

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Congenital scoliosis is the presence of a sideways curvature of the spine caused by the failure of normal vertebral development. Congenital scoliosis is usually progressive, and surgical treatment is crucial for the treatment of congenital scoliosis. Surgical treatments of congenital scoliosis mainly include simple fusion surgery, hemivertebrae excision, growing rods technique, and vertical expandable prosthetic titanium rib. However, there is no uniform standard for the selection of surgical techniques and surgical timing. This article reviews the progress of different surgical treatments for congenital scoliosis, introduces the classification of congenital scoliosis, and clarifies the timing, pros and cons of different surgical techniques, aiming to provide a reference for the development of individualized optimal surgical plans for patients with congenital scoliosis.

Citation： ZHOU Jinju, FENG Ganjun, LIU Limin, SONG Yueming. Progress in surgical treatment of congenital scoliosis. West China Medical Journal, 2021, 36(10): 1321-1326. doi: 10.7507/1002-0179.202107240 Copy

1.	Giampietro PF, Raggio CL, Blank RD, et al. Clinical, genetic and environmental factors associated with congenital vertebral malformations. Mol Syndromol, 2013, 4(1/2): 94-105.
2.	Wynne-Davies R. Congenital vertebral anomalies: aetiology and relationship to spina bifida cystica. J Med Genet, 1975, 12(3): 280-288.
3.	Cho W, Shepard N, Arlet V. The etiology of congenital scoliosis: genetic vs. environmental-a report of three monozygotic twin cases. Eur Spine J, 2018, 27(Suppl 3): 533-537.
4.	McMaster MJ, Ohtsuka K. The natural history of congenital scoliosis. A study of two hundred and fifty-one patients. J Bone Joint Surg Am, 1982, 64(8): 1128-1147.
5.	Hedequist D, Emans J. Congenital scoliosis. J Am Acad Orthop Surg, 2004, 12(4): 266-275.
6.	Kawakami N, Tsuji T, Imagama S, et al. Classification of congenital scoliosis and kyphosis: a new approach to the three-dimensional classification for progressive vertebral anomalies requiring operative treatment. Spine (Phila Pa 1976), 2009, 34(17): 1756-1765.
7.	Kesling KL, Lonstein JE, Denis F, et al. The crankshaft phenomenon after posterior spinal arthrodesis for congenital scoliosis: a review of 54 patients. Spine (Phila Pa 1976), 2003, 28(3): 267-271.
8.	Murphy RF, Mooney JF 3rd. The crankshaft phenomenon. J Am Acad Orthop Surg, 2017, 25(9): e185-e193.
9.	Terek RM, Wehner J, Lubicky JP. Crankshaft phenomenon in congenital scoliosis: a preliminary report. J Pediatr Orthop, 1991, 11(4): 527-532.
10.	Goldberg CJ, Moore DP, Fogarty EE, et al. Long-term results from in situ fusion for congenital vertebral deformity. Spine (Phila Pa 1976), 2002, 27(6): 619-628.
11.	Roaf R. The treatment of progressive scoliosis by unilateral growth-arrest. J Bone Joint Surg Br, 1963, 45(4): 637-651.
12.	Winter RB. Convex anterior and posterior hemiarthrodesis and hemiepiphyseodesis in young children with progressive congenital scoliosis. J Pediatr Orthop, 1981, 1(4): 361-366.
13.	Tikoo A, Kothari MK, Shah K, et al. Current concepts - congenital scoliosis. Open Orthop J, 2017, 11: 337-345.
14.	Burnei G, Gavriliu S, Vlad C, et al. Congenital scoliosis: an up-to-date. J Med Life, 2015, 8(3): 388-397.
15.	李叶天, 徐磊磊, 夏超, 等. 凸侧骨骺阻滞术对阻止半椎体所致脊柱侧凸的进展疗效分析. 中国骨伤, 2020, 33(2): 116-120.
16.	Rizkallah M, Sebaaly A, Kharrat K, et al. Is there still a place for convex hemiepiphysiodesis in congenital scoliosis in young children? A long-term follow-up. Global Spine J, 2020, 10(4): 406-411.
17.	Yaszay B, O’Brien M, Shufflebarger HL, et al. Efficacy of hemivertebra resection for congenital scoliosis: a multicenter retrospective comparison of three surgical techniques. Spine (Phila Pa 1976), 2011, 36(24): 2052-2060.
18.	Leatherman KD, Dickson RA. Two-stage corrective surgery for congenital deformities of the spine. J Bone Joint Surg Br, 1979, 61(3): 324-328.
19.	Bradford DS, Boachie-Adjei O. One-stage anterior and posterior hemivertebral resection and arthrodesis for congenital scoliosis. J Bone Joint Surg Am, 1990, 72(4): 536-540.
20.	Mladenov K, Kunkel P, Stuecker R. Hemivertebra resection in children, results after single posterior approach and after combined anterior and posterior approach: a comparative study. Eur Spine J, 2012, 21(3): 506-513.
21.	Chang DG, Kim JH, Ha KY, et al. Posterior hemivertebra resection and short segment fusion with pedicle screw fixation for congenital scoliosis in children younger than 10 years: greater than 7-year follow-up. Spine (Phila Pa 1976), 2015, 40(8): E484-E491.
22.	Wang Y, Liu Z, Du C, et al. The radiological outcomes of one-stage posterior-only hemivertebra resection and short segmental fusion for lumbosacral hemivertebra: a minimum of 5 years of follow-up. J Orthop Surg Res, 2019, 14(1): 426.
23.	Li Y, Wang G, Jiang Z, et al. One-stage posterior excision of lumbosacral hemivertebrae: retrospective study of case series and literature review. Medicine (Baltimore), 2017, 96(43): e8393.
24.	Xue X, Zhao S, Miao F, et al. Posterior-only lumbosacral hemivertebrae resection and fusion in paediatric scoliosis with minimum two year follow-up. Int Orthop, 2020, 44(5): 979-986.
25.	Yang JH, Chang DG, Suh SW, et al. Clinical and radiological outcomes of hemivertebra resection for congenital scoliosis in children under age 10 years: more than 5-year follow-up. Medicine (Baltimore), 2020, 99(32): e21720.
26.	Odent T, Ilharreborde B, Miladi L, et al. Fusionless surgery in early-onset scoliosis. Orthop Traumatol Surg Res, 2015, 101(Suppl 6): S281-S288.
27.	Thompson GH, Akbarnia BA, Kostial P, et al. Comparison of single and dual growing rod techniques followed through definitive surgery: a preliminary study. Spine (Phila Pa 1976), 2005, 30(18): 2039-2044.
28.	Akbarnia BA, Emans JB. Complications of growth-sparing surgery in early onset scoliosis. Spine (Phila Pa 1976), 2010, 35(25): 2193-2204.
29.	Liang J, Li S, Xu D, et al. Risk factors for predicting complications associated with growing rod surgery for early-onset scoliosis. Clin Neurol Neurosurg, 2015, 136: 15-19.
30.	Wang S, Zhang J, Qiu G, et al. One-stage posterior osteotomy with short segmental fusion and dual growing rod technique for severe rigid congenital scoliosis: the preliminary clinical outcomes of a hybrid technique. Spine (Phila Pa 1976), 2014, 39(4): E294-E299.
31.	Sun X, Xu L, Chen Z, et al. Hybrid growing rod technique of osteotomy with short fusion and spinal distraction: an alternative solution for long-spanned congenital scoliosis. Spine (Phila Pa 1976), 2019, 44(10): 707-714.
32.	McCarthy RE, Luhmann S, Lenke L, et al. The Shilla growth guidance technique for early-onset spinal deformities at 2-year follow-up: a preliminary report. J Pediatr Orthop, 2014, 34(1): 1-7.
33.	Nazareth A, Skaggs DL, Illingworth KD, et al. Growth guidance constructs with apical fusion and sliding pedicle screws (SHILLA) results in approximately 1/3rd of normal T1-S1 growth. Spine Deform, 2020, 8(3): 531-535.
34.	Cheung KM, Cheung JP, Samartzis D, et al. Magnetically controlled growing rods for severe spinal curvature in young children: a prospective case series. Lancet, 2012, 379(9830): 1967-1974.
35.	Akbarnia BA, Cheung K, Noordeen H, et al. Next generation of growth-sparing techniques: preliminary clinical results of a magnetically controlled growing rod in 14 patients with early-onset scoliosis. Spine (Phila Pa 1976), 2013, 38(8): 665-670.
36.	Dannawi Z, Altaf F, Harshavardhana NS, et al. Early results of a remotely-operated magnetic growth rod in early-onset scoliosis. Bone Joint J, 2013, 95(1): 75-80.
37.	Hickey BA, Towriss C, Baxter G, et al. Early experience of MAGEC magnetic growing rods in the treatment of early onset scoliosis. Eur Spine J, 2014, 23(Suppl 1): S61-S65.
38.	Subramanian T, Ahmad A, Mardare DM, et al. A six-year observational study of 31 children with early-onset scoliosis treated using magnetically controlled growing rods with a minimum follow-up of two years. Bone Joint J, 2018, 100(9): 1187-1200.
39.	Akesen B, Ulusaloğlu AC, Atici T, et al. Magnetically controlled growing rod in 13 patients with early-onset scoliosis and spinal improvement. Acta Orthop Traumatol Turc, 2018, 52(6): 438-441.
40.	Stokes OM, O’Donovan EJ, Samartzis D, et al. Reducing radiation exposure in early-onset scoliosis surgery patients: novel use of ultrasonography to measure lengthening in magnetically-controlled growing rods. Spine J, 2014, 14(10): 2397-2404.
41.	Campbell RM Jr, Smith MD, Mayes TC, et al. The effect of opening wedge thoracostomy on thoracic insufficiency syndrome associated with fused ribs and congenital scoliosis. J Bone Joint Surg Am, 2004, 86(8): 1659-1674.
42.	Berger-Groch J, Weiser L, Kunkel POS, et al. Vertical expandable rib-based distraction device for correction of congenital scoliosis in children of 3 years of age or younger: a preliminary report. J Pediatr Orthop, 2020, 40(8): e728-e733.
43.	Murphy RF, Moisan A, Kelly DM, et al. Use of vertical expandable prosthetic titanium rib (VEPTR) in the treatment of congenital scoliosis without fused ribs. J Pediatr Orthop, 2016, 36(4): 329-335.
44.	Waldhausen JH, Redding G, White K, et al. Complications in using the vertical expandable prosthetic titanium rib (VEPTR) in children. J Pediatr Surg, 2016, 51(11): 1747-1750.
45.	Hensinger RN. Congenital scoliosis: etiology and associations. Spine (Phila Pa 1976), 2009, 34(17): 1745-1750.
46.	Mohanty SP, Pai Kanhangad M, Narayana Kurup JK, et al. Vertebral, intraspinal and other organ anomalies in congenital scoliosis. Eur Spine J, 2020, 29(10): 2449-2456.
47.	Marks DS, Qaimkhani SA. The natural history of congenital scoliosis and kyphosis. Spine (Phila Pa 1976), 2009, 34(17): 1751-1755.

1. Giampietro PF, Raggio CL, Blank RD, et al. Clinical, genetic and environmental factors associated with congenital vertebral malformations. Mol Syndromol, 2013, 4(1/2): 94-105.
2. Wynne-Davies R. Congenital vertebral anomalies: aetiology and relationship to spina bifida cystica. J Med Genet, 1975, 12(3): 280-288.
3. Cho W, Shepard N, Arlet V. The etiology of congenital scoliosis: genetic vs. environmental-a report of three monozygotic twin cases. Eur Spine J, 2018, 27(Suppl 3): 533-537.
4. McMaster MJ, Ohtsuka K. The natural history of congenital scoliosis. A study of two hundred and fifty-one patients. J Bone Joint Surg Am, 1982, 64(8): 1128-1147.
5. Hedequist D, Emans J. Congenital scoliosis. J Am Acad Orthop Surg, 2004, 12(4): 266-275.
6. Kawakami N, Tsuji T, Imagama S, et al. Classification of congenital scoliosis and kyphosis: a new approach to the three-dimensional classification for progressive vertebral anomalies requiring operative treatment. Spine (Phila Pa 1976), 2009, 34(17): 1756-1765.
7. Kesling KL, Lonstein JE, Denis F, et al. The crankshaft phenomenon after posterior spinal arthrodesis for congenital scoliosis: a review of 54 patients. Spine (Phila Pa 1976), 2003, 28(3): 267-271.
8. Murphy RF, Mooney JF 3rd. The crankshaft phenomenon. J Am Acad Orthop Surg, 2017, 25(9): e185-e193.
9. Terek RM, Wehner J, Lubicky JP. Crankshaft phenomenon in congenital scoliosis: a preliminary report. J Pediatr Orthop, 1991, 11(4): 527-532.
10. Goldberg CJ, Moore DP, Fogarty EE, et al. Long-term results from in situ fusion for congenital vertebral deformity. Spine (Phila Pa 1976), 2002, 27(6): 619-628.
11. Roaf R. The treatment of progressive scoliosis by unilateral growth-arrest. J Bone Joint Surg Br, 1963, 45(4): 637-651.
12. Winter RB. Convex anterior and posterior hemiarthrodesis and hemiepiphyseodesis in young children with progressive congenital scoliosis. J Pediatr Orthop, 1981, 1(4): 361-366.
13. Tikoo A, Kothari MK, Shah K, et al. Current concepts - congenital scoliosis. Open Orthop J, 2017, 11: 337-345.
14. Burnei G, Gavriliu S, Vlad C, et al. Congenital scoliosis: an up-to-date. J Med Life, 2015, 8(3): 388-397.
15. 李叶天, 徐磊磊, 夏超, 等. 凸侧骨骺阻滞术对阻止半椎体所致脊柱侧凸的进展疗效分析. 中国骨伤, 2020, 33(2): 116-120.
16. Rizkallah M, Sebaaly A, Kharrat K, et al. Is there still a place for convex hemiepiphysiodesis in congenital scoliosis in young children? A long-term follow-up. Global Spine J, 2020, 10(4): 406-411.
17. Yaszay B, O’Brien M, Shufflebarger HL, et al. Efficacy of hemivertebra resection for congenital scoliosis: a multicenter retrospective comparison of three surgical techniques. Spine (Phila Pa 1976), 2011, 36(24): 2052-2060.
18. Leatherman KD, Dickson RA. Two-stage corrective surgery for congenital deformities of the spine. J Bone Joint Surg Br, 1979, 61(3): 324-328.
19. Bradford DS, Boachie-Adjei O. One-stage anterior and posterior hemivertebral resection and arthrodesis for congenital scoliosis. J Bone Joint Surg Am, 1990, 72(4): 536-540.
20. Mladenov K, Kunkel P, Stuecker R. Hemivertebra resection in children, results after single posterior approach and after combined anterior and posterior approach: a comparative study. Eur Spine J, 2012, 21(3): 506-513.
21. Chang DG, Kim JH, Ha KY, et al. Posterior hemivertebra resection and short segment fusion with pedicle screw fixation for congenital scoliosis in children younger than 10 years: greater than 7-year follow-up. Spine (Phila Pa 1976), 2015, 40(8): E484-E491.
22. Wang Y, Liu Z, Du C, et al. The radiological outcomes of one-stage posterior-only hemivertebra resection and short segmental fusion for lumbosacral hemivertebra: a minimum of 5 years of follow-up. J Orthop Surg Res, 2019, 14(1): 426.
23. Li Y, Wang G, Jiang Z, et al. One-stage posterior excision of lumbosacral hemivertebrae: retrospective study of case series and literature review. Medicine (Baltimore), 2017, 96(43): e8393.
24. Xue X, Zhao S, Miao F, et al. Posterior-only lumbosacral hemivertebrae resection and fusion in paediatric scoliosis with minimum two year follow-up. Int Orthop, 2020, 44(5): 979-986.
25. Yang JH, Chang DG, Suh SW, et al. Clinical and radiological outcomes of hemivertebra resection for congenital scoliosis in children under age 10 years: more than 5-year follow-up. Medicine (Baltimore), 2020, 99(32): e21720.
26. Odent T, Ilharreborde B, Miladi L, et al. Fusionless surgery in early-onset scoliosis. Orthop Traumatol Surg Res, 2015, 101(Suppl 6): S281-S288.
27. Thompson GH, Akbarnia BA, Kostial P, et al. Comparison of single and dual growing rod techniques followed through definitive surgery: a preliminary study. Spine (Phila Pa 1976), 2005, 30(18): 2039-2044.
28. Akbarnia BA, Emans JB. Complications of growth-sparing surgery in early onset scoliosis. Spine (Phila Pa 1976), 2010, 35(25): 2193-2204.
29. Liang J, Li S, Xu D, et al. Risk factors for predicting complications associated with growing rod surgery for early-onset scoliosis. Clin Neurol Neurosurg, 2015, 136: 15-19.
30. Wang S, Zhang J, Qiu G, et al. One-stage posterior osteotomy with short segmental fusion and dual growing rod technique for severe rigid congenital scoliosis: the preliminary clinical outcomes of a hybrid technique. Spine (Phila Pa 1976), 2014, 39(4): E294-E299.
31. Sun X, Xu L, Chen Z, et al. Hybrid growing rod technique of osteotomy with short fusion and spinal distraction: an alternative solution for long-spanned congenital scoliosis. Spine (Phila Pa 1976), 2019, 44(10): 707-714.
32. McCarthy RE, Luhmann S, Lenke L, et al. The Shilla growth guidance technique for early-onset spinal deformities at 2-year follow-up: a preliminary report. J Pediatr Orthop, 2014, 34(1): 1-7.
33. Nazareth A, Skaggs DL, Illingworth KD, et al. Growth guidance constructs with apical fusion and sliding pedicle screws (SHILLA) results in approximately 1/3rd of normal T1-S1 growth. Spine Deform, 2020, 8(3): 531-535.
34. Cheung KM, Cheung JP, Samartzis D, et al. Magnetically controlled growing rods for severe spinal curvature in young children: a prospective case series. Lancet, 2012, 379(9830): 1967-1974.
35. Akbarnia BA, Cheung K, Noordeen H, et al. Next generation of growth-sparing techniques: preliminary clinical results of a magnetically controlled growing rod in 14 patients with early-onset scoliosis. Spine (Phila Pa 1976), 2013, 38(8): 665-670.
36. Dannawi Z, Altaf F, Harshavardhana NS, et al. Early results of a remotely-operated magnetic growth rod in early-onset scoliosis. Bone Joint J, 2013, 95(1): 75-80.
37. Hickey BA, Towriss C, Baxter G, et al. Early experience of MAGEC magnetic growing rods in the treatment of early onset scoliosis. Eur Spine J, 2014, 23(Suppl 1): S61-S65.
38. Subramanian T, Ahmad A, Mardare DM, et al. A six-year observational study of 31 children with early-onset scoliosis treated using magnetically controlled growing rods with a minimum follow-up of two years. Bone Joint J, 2018, 100(9): 1187-1200.
39. Akesen B, Ulusaloğlu AC, Atici T, et al. Magnetically controlled growing rod in 13 patients with early-onset scoliosis and spinal improvement. Acta Orthop Traumatol Turc, 2018, 52(6): 438-441.
40. Stokes OM, O’Donovan EJ, Samartzis D, et al. Reducing radiation exposure in early-onset scoliosis surgery patients: novel use of ultrasonography to measure lengthening in magnetically-controlled growing rods. Spine J, 2014, 14(10): 2397-2404.
41. Campbell RM Jr, Smith MD, Mayes TC, et al. The effect of opening wedge thoracostomy on thoracic insufficiency syndrome associated with fused ribs and congenital scoliosis. J Bone Joint Surg Am, 2004, 86(8): 1659-1674.
42. Berger-Groch J, Weiser L, Kunkel POS, et al. Vertical expandable rib-based distraction device for correction of congenital scoliosis in children of 3 years of age or younger: a preliminary report. J Pediatr Orthop, 2020, 40(8): e728-e733.
43. Murphy RF, Moisan A, Kelly DM, et al. Use of vertical expandable prosthetic titanium rib (VEPTR) in the treatment of congenital scoliosis without fused ribs. J Pediatr Orthop, 2016, 36(4): 329-335.
44. Waldhausen JH, Redding G, White K, et al. Complications in using the vertical expandable prosthetic titanium rib (VEPTR) in children. J Pediatr Surg, 2016, 51(11): 1747-1750.
45. Hensinger RN. Congenital scoliosis: etiology and associations. Spine (Phila Pa 1976), 2009, 34(17): 1745-1750.
46. Mohanty SP, Pai Kanhangad M, Narayana Kurup JK, et al. Vertebral, intraspinal and other organ anomalies in congenital scoliosis. Eur Spine J, 2020, 29(10): 2449-2456.
47. Marks DS, Qaimkhani SA. The natural history of congenital scoliosis and kyphosis. Spine (Phila Pa 1976), 2009, 34(17): 1751-1755.

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