Surgical Correction of Early Onset Scoliosis
Ms. A, a bubbly 10-year-old girl, is one of twins born prematurely. When she was about 3 years old, her mother noticed that her back was bent to the left. The family visited various hospitals sporadically, and when the deformity became quite evident, she presented to us at the age of 7 years. She was diagnosed with Early Onset Scoliosis.
It was a left thoracic curve from T5 to T12 measuring 55 degrees. MRI showed no spinal cord anomaly. Surgical correction was required — however, instrumentation and fusion at the age of 7 would stunt the growth of her lungs. She was therefore treated with growth rods, with anchors at T4 & T5 and T12 & L1 (Synthes USS II system). The rods were distracted once every 6 months, maintaining correction while allowing the lungs to develop. She underwent 3 more such distractions after the index surgery, at 6-monthly intervals.
Now close to 10 years old, she has attained a precocious menarche, and her scoliotic curve is extending into the upper lumbar spine. With lung growth nearly complete, it was time for a final instrumented correction and fusion. The Cobb angle of her thoracolumbar curve measured 60 degrees. Instrumentation with pedicle screws from T4 to L3 was planned based on her standing AP, standing lateral and supine bending views.
At surgery, the thoracic segment from T4 to T11 was found to be completely fused. Pedicle screws were placed in the thoracic and lumbar spine as seen in the pre-op images. Correction was achieved by rod rotation on the convex side at the thoracolumbar junction, and 6 mm contoured rods were placed on either side sequentially (DePuy Synthes USS II & UDS systems were used). Costoplasty was performed to reduce the rib hump, and the excised ribs were used for the fusion.
She has good sagittal and coronal balance post-op and no neurological deficit. She is walking independently and was discharged on the 5th post-operative day in stable condition. The girl as well as her parents are happy with the cosmetic correction achieved.