Thread: growing rods
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Old 08-06-2012, 04:19 PM
Dr Scoliosis Dr Scoliosis is offline
 
Join Date: Apr 2009
Posts: 187
Default Re: growing rods

Early onset (previously called infantile or juvenile) scoliosis is a rare condition. Like the more common adolescent scoliosis, bracing and surgery may be required if the curve is worsening. Scoliosis occurring in children under the age of 10 years can present particular problems if surgery is being considered. This is because the spine still has significant growth remaining. Special techniques and implants need to be used so this growth of the spine is allowed to continue as much as possible.

There are many different surgical techniques that can be used in this group of children. All try to address the problem of stabilising or correcting the spinal deformity without interfering too much with the growth of the rest of the spine. The spinal implants are usually just smaller versions of those used in adolescents and adults with scoliosis. However, they are used in a different way. In the older child or adult, the surgery involves putting anchor points (hooks, screws, wires or tapes) along the entire length of the curve, attaching them to rods to straighten the spine and then ensuring that each bone will join to its neighbour (spinal fusion). In early onset scoliosis only small parts of the spine are exposed. These are usually at the top and bottom ends of the curve. There, anchor points and bone graft are placed. The rest of the spine is not exposed. The rods that will correct the scoliosis are then passed along the muscle layers either side of the spine and connected to the anchor points. Once these rods are in place, they are distracted against the anchors to correct the curve. They are then locked together. To allow the spine to continue to grow, the rods need to be unlocked and elongated on a regular basis. It is usual for the child to have a lengthening operation every 6 to 9 months. It is typically a straightforward procedure. Often the child is home within 2 to 3 days.

These growing rods are not without problems. These children are small so the implants can be prominent. Repeated operations are needed and this increases the risk of scarring and infection. As the spine has not been fused there is a lot of movement and the implants can loosen or break over time. To minimise these problems new implants are being developed.

To avoid the need for lengthening reoperations, telescopic rods with internal magnetic motors are being used in small number in some centres. These are implanted in the same way as traditional growing rods. However, once the first operation is done, subsequent lengthenings are performed in a clinic with a computer-controlled magnet. These may be done as often as once a month. Smaller, more frequent elongations probably better approximate the normal growth of the spine compared to the surgical lengthenings every 6 to 9 months. Further operations are only needed when the rods need to be replaced. This may not be for 2 to 3 years. Early results are encouraging but it must be stressed that this technology has not yet reached the stage where it has been proven better than traditional growing rods.

Your child's surgeon will be in the best position to discuss the treatment options with you.

Dr Scoliosis