Casting is increasingly being utilized for the treatment of early onset scoliosis. In many cases casting can offer a way of straightening your child’s spine over time. A cast is used to guide growth of the crooked spine into a straight spine, similar to how a crooked plant can be made to grow straight by tying it to a stake.
For some children, however, casting is used as a means to prevent or delay progression of scoliosis. This may be recommended to allow children to get bigger prior to surgery and also to increase lung development prior to surgery.
Application of a spine cast is done in a procedure center or operating room with your child under anesthesia. No incision is made. The cast is applied by your doctor. It typically needs to be changed every 2-4 months. Some doctors place casts that go over the shoulder; some do not go over the shoulder.
Here is a video that discusses mehta casting and shows you what it all entails
Bracing is also used for management of early onset scoliosis. There is less data on the effectiveness of bracing for early onset scoliosis compared to casting. Often bracing is used in conjunction with casting either during summer “breaks” or after your child’s spine has straightened with casting. Bracing typically does not work to hold a congenital early onset curve over a longer period of time. Bracing in congenital cases should typically only be done for brief time frame, such as a 6 weeks summer break.
VEPTR (vertical expandable prosthetic titanium rib)
VEPTR stands for vertical expandable prosthetic titanium rib. It is a device that was developed to treat children with severe malformations of their chest and spine. It is an FDA approved device. VEPTR is now used for various spinal and chest deformities in young children. Current use of the VEPTR is limited to sites that have appropriate research certification and oversight.
VEPTR is a curved metal rod that is surgically attached to a child’s ribs, spine or pelvis using hooks on both ends of the device. The VEPTR helps straighten the child’s spine and separate ribs so their lungs can grow and expand as the child grows. The length of the VEPTR device can be expanded or contracted as the patient grows. In most cases, children receive their initial implant surgery before age five. During surgery, doctors attach and adjust the VEPTR device to fit your child. The device is generally attached vertically on your child’s ribs near the spine. In some cases, more than one VEPTR device is used to create space in the chest for the lungs to develop more fully. VEPTRs can also be attached to the spine or pelvis, depending on your child’s specific anatomy.
As your child grows, she will need to return every 4-6 months for check-ups and to schedule VEPTR adjustment surgery, which typically occur every 6-8 months until your child reaches skeletal maturity (between 10 and 16 years old).
These adjustments allow your child to continue to grow taller, as well as further correct spine and chest wall deformities. Adjustments to the length of the VEPTR device are made during surgery through a small incision in your child’s back.
Here’s is a video talking more about the device and provides some visuals of what it is:
Growing rods are surgical devices placed along your child’s spine and attached to the spine with either hooks or screws above and below the curve. The area around the hooks and/or screws is fused to provide strong support. The curved part of the spine remains unfused. Similar to the VEPTR, growing rods help correct spine and chest deformity and need to be lengthened every 6-12 months in the operating room.
Growing rods are not FDA approved, but have demonstrated effectiveness. They have similar risks to VEPTR including infection, movement of implants, nerve injury, inadvertent spinal fusion, and prominence causing pain.
Stapling of the spine is a new technique that has demonstrated effectiveness in specific patterns of early onset scoliosis. Stapling acts like an “internal brace” for the spine and can help correct scoliosis through altering the growth pattern of the spine. A metal stapled is inserted on one side of the curved spine to limit its growth. It can often be done through small incisions in the chest utilizing a video camera. The best patients for stapling are those with modest sized scoliosis who do not have rib and spine malformations. Stapling is not approved by the FDA and is only offered at a limited number of hospitals. Ask your doctor if they utilize this technique.
MAGEC Growing Rods
The MAGEC™ (MAGnetic Expansion Control) Spinal Growing Rod is a non-invasive treatment for children with early onset scoliosis.
After the initial procedure to implant the growing rod, doctors use an external remote control outside of the body to lengthen the magnetically controlled rod as a child grows. Follow-up care typically takes place in the office. It’s non-invasive, making the adjustments easier for patients during their course of treatment, because they need fewer surgeries. Here’s is a video about the device and shows an actual lengthening!
This is Nora’s surgeon in the video below! I’m thrilled to see him and Children’s Hospital Colorado bringing this amazing technology to young growing kids with severe scoliosis. While Nora was not a candidate for MAGEC rods, these rods are a game changer for many.
Here’s another video on MAGEC Rods
The Shilla technique involves doing a short spinal fusion at the most curved portion of the spine using screws and rods. The rods are attached then at the top and bottom of the spine to screws that allow for continued growth of the spine. The Shilla technique remains experimental, with limited data about its effectiveness. The benefit of the Shilla technique is that if successful it does not require repeat trips to the operating room for expansion. Complications of the Shilla technique are similar to growing rods and VEPTR. Availability of the special screws and rods needed for Shilla technique are limited in the United States. The procedure remains experimental. You can ask your doctor if they do the Shilla technique and if your child is an appropriate candidate for it.
In some cases, spinal fusion may be indicated for a child with early onset scoliosis. Most doctors have moved away from extensive spinal fusion for young children with scoliosis because it restricts chest and lung development.
There are certain cases, however, where a short fusion may be appropriate to try and prevent more serious progression of scoliosis. Short fusion is also done as part of the Shilla technique and the growing rod technique.
Usually a short fusion of the spine is done when a child has a hemivertebra. This is a malformed spinal segment. It can be removed and a short fusion done to stabilize the spine. In many cases this can completely straighten the spine and prevent need for future surgeries. Your surgeon may do this all from one incision in the back, or may do an incision through the chest and the back. You should discuss this with your doctor.
Hemivertrebra Excision for Congenital Scoliosis
A hemivertebra excision surgery is a surgical procedure used to remove the hemivertebra, the cause of the congenital scoliosis, in order to correct spinal deformity. Because a hemivertebra is, by definition, a form of congenital scoliosis, a hemivertebra excision surgery is only used to treat individuals with this form of congenital scoliosis. The major goal of a hemivertebra excision surgery is to remove the hemivertebra in order to prevent further curve progression, and a secondary goal is to make the spine as straight as possible.
Halo Traction Therapy
Halo gravity traction is a procedure used to reduce the degree of curvature in the spines of children with severe idiopathic or congenital scoliosis. Spinal traction is the gentle pulling of the soft tissue (joints and muscles) to help straighten the spine. The idea of halo traction therapy can be very concerning and scary for parents or patients who aren’t familiar with it but halo is generally not painful. The child may have a headache for a couple of days after the device is put in place but most kids do very well and may actually feel better in traction as their spines are stretching out and the chest cavity is expanded. Please see this incredible video to learn more about and see and hear from kids actually going through halo.