Interventions for Scoliotic Curves and Associated Spinal Deformities

Scoliosis, curvature of the spine in the coronal plane, is a condition that leads to nearly 30,000 surgeries a year in the United States alone. The surgeries for this condition have seen significant changes and advances over the past two decades. The two surgeries performed around 2000 were non-expandable rod placement with full-fusion or fusion only at the rod anchor points (2-3 vertebrae each, rostral and caudal to affected spine). In 2005, anchor-fusion Growing-Rods that could be expanded were introduced, allowing for continued growth but requiring multiple subsequent surgeries and definitive fusion upon achieving full growth. Growing-Rods have a complication rate from 17% to 40%. Additionally, motion is limited due to the either real or de facto fusion of the spinal apparatus. After 2010, laparoscopic tether-based surgery (VBT) was introduced to allow growth with no fusion. In VBT, screws are placed horizontally through the vertebrae indicated in the curve, and a tether is run through the screws’ heads and tightened to correct the curve. Correction further improves with growth. Later in 2015, surgeons performing tether-based surgeries began using an anterior semi-open approach (ASC) which allowed for secondary techniques to improve correction. Those techniques and the surgical approach made multi-staged and revision surgeries easier to perform while simultaneously reducing their necessity. Additionally, the possible candidate populations for ASC range from 7 years-old to over 50 versus 10 to 15 for VBT. Given the overall benefits of ASC relative to the other surgeries, it should be the first-line surgery for childhood and adolescent scoliosis.