Diverse treatment options in pediatric scoliosis features EFORT 2020 Congress main theme
For the upcoming Congress in Vienna, the main theme of harmonization and diversity allows EFORT to actively promote its mission of improving patient care. Indeed, with 41 National Member Societies, EFORT is a truly diverse organization.
However, although diversity is the genuine reflection of different practices worldwide and of an increasing heterogeneity of orthopaedic patient populations, harmonization becomes increasingly necessary for the standards of knowledge to be spread throughout Europe and worldwide. In this context of diverse available treatments, EFORT has scheduled programs for several sessions linked to major controversial topics related to current musculoskeletal surgical practice. The Vienna 2020 main theme symposium, to be led by Prof. Alpaslan Senköylü, MD, from Gazi University in Ankara, Turkey, will emphasize the complexity of scoliosis management in young children.
The human spine is a unique structure; not only in terms of its anatomy, but also because of the way pressure is loaded on each vertebral segment. An anterior shear force enables the facet joints to provide rotational stability to the spine. However, different than other vertebrates, certain human vertebrae can have a backward inclination and are thus subject to posterior shear loads. If the main stabilizing mechanism is lost, however, these posterior shear loads can decrease the stiffness of the segment and progressively lead to scoliosis, which is a 3D rotational deformity of the entire trunk in which vertebrae are rotated away from the midline.
As the average vertebral inclination of the female spine is significantly greater than the male spine during growth spurts, initiation and progression of adolescent idiopathic scoliosis are more prevalent in female individuals around the time of puberty. Detailed analysis of the scoliotic spine morphology is essential for determining which type of corrective surgery is indicated to restore the sagittal alignment. There are many uncertain points in the handling of this challenging 3D deformity of spine and treatment often depends on a patient’s etiology, curve pattern, maturity and comorbidities, among other factors.
Early-onset scoliosis (EOS) is a potentially life-threatening condition with onset before 5 years of age, requiring rapid medical care to prevent severe deformity and pulmonary compromise. To achieve curve correction, conservative options, such as braces or serial casting that is applied to the trunk and periodically changed should be the initial choice treatment whenever possible to avoid or delay surgery until the patient is older.
Growing rod constructs are usually used for severe curves or for deformities that do not respond to nonoperative treatment. Vertebral body tethering (VBT) is a minimally invasive procedure which corrects scoliosis at the time of surgery by anchoring vertebral body screws to the front of each vertebral body, attaching a flexible cord (tether) to them and tensioning the whole structure to achieve the desired degree of spine straightening. In young children with a growing spine, the biggest advantage of such a technique is the preservation of mobility to some extent and providing a faster return to normal lifestyle and necessitating less restriction on postoperative activities. Noninvasive serial casting and growing rod techniques will be compared and anterior VBT will be discussed for a thorough review, in particular, as unknown long-term results and major discrepancies regarding complication rates and adverse effects are reported in literature.
Diverse Approaches To Scoliosis In Young Children
Thursday 11 June 2020 from 15:00 to 16:30 – Auditorium Nice
Orthopaedics - Spine
Moderation: Alpaslan Senköylü (Turkey)
Early onset scoliosis (EOS): Case presentation
- I would go for cast | Rolf Bjarne Riise (Norway)
- I would go for growing rod | Alpaslan Senköylü (Turkey)
Juvenile idiopathic scoliosis: Case presentation
- I would go for vertebral body tethering (VBT) | Ilkka Helenius (Finland)
- I would not go for vertebral body tethering (VBT) | Emre Acaroglu (Turkey)
Analysis of the advantages and disadvantages of conservative treatment and minimally invasive surgical techniques will involve participants in the discussion and give them a glimpse of the many possibilities for spine deformity treatment in children. Interestingly, orthopaedic innovation keeps expanding and might play a role in the practitioner’s behavior and practice, as new techniques arise to challenge classic approaches. For instance, more often spine deformity surgeons agree that pedicle screws should be inserted under navigation guidance because, statistically speaking, computer-assisted spine surgeries are safer. Unfortunately, complete avoidance of complications is not possible, even with the most sophisticated guidance system. This highlights the limitations of novel techniques and keeping conservative approaches on the table, especially for extremely young patients.
The symposium entitled, “Diverse Approaches to Scoliosis in Young Children” is part of the core scientific program of the 21st EFORT Congress and is open to fully registered attendees. All details to sign-up are available on the registration platform. Visit the 2020 congress website to learn more.