Monday, 18 July 2011

Surgical Options

I have been doing research into various options available for surgery.  I want to be prepared so that when D-day comes we have explored all our options and feel confident with the technique and surgeon we decide on.

I have discovered that there are doctors performing different styles of scoliosis surgeries for children around the world, and also within Australia.  From what I have discovered so far these are the main options for the growing child. 
NB. This is just info I have collected from websites, forums and other contacts. I approached this with a blank slate, as a mum, not a medical professional.

Growing Rods - Single or Dual
The theory of  growing rods is to allow for continued, controlled growth of the spine. This is done along the back of the spine. One or two rods span the curve under the skin along the length of the spine. The rods attach to the spine at the top and bottom of the curve with hooks or screws. The curve is not fully corrected, but 'controlled' whilst the child is still growing. They then return every six months to have the rods lengthened via keyhole surgery. 

There are a number of possible complications. For example, hook or screw dislodgement, rod breakage, infection, high sensitivity and poor healing of wound site for recurrent lengthenings.  A family I have contact with in the US have an 8-year-old who has gone through 8 surgeries in 2 years due to rods breaking and screws loosening etc.

Vertical Expandable Prosthetic Titanium Rib - VEPTR
VEPTR rods were developed for children with scoliosis with chest wall abnormalities or lung involvement. They attach to the ribs and also involve regular lengthenings as the child grows.  
This technique is unfortunately thought to be less effective in curves that do not involve thoracic spine or chest cavity abnormalities.  There are similar complications to growth rods in regards to infection and wound site, however from what information I have read, I believe less hardware problems. 

Vertebral Body Stapling
A technique to 'staple' the vertebrae together in an attempt to strengthen the spine, an alternative to bracing.  It is not suitable for curves over 45 degrees. However some surgeons combine growth rods with vertebral stapling as an additional support to the growing rods. This is dependent on the type of curve, the position and the correction achieved with the rod placement.  The same complications as growth rods exist.

Luque Trolley or Luque Rod system
A rod system which consists of 4 rods-2 each side of the spine. On each side of the spine, one rod is anchored at the top, the other anchored at the bottom.  Then on each pair of rods on each side, there are intermittent loops of wire attached to the spine holding the pairs together. So as the child grows, the rods can slide apart a bit more. This system may mean less surgeries as the 6 monthly lengthenings are not required.  However, since the wires pass through the spinal canal, this system poses a greater risk of neurological damage than other systems. 

Futuremedicine - Current concepts early-onset scoliosis
Growing Rods
Scoliosis Research Society - growing rods
Scoliosis Research Society - idiopathic - growing rods
The growing Spine e-book (pages 449-467)
Scoliosis Research Society - VEPTR
Medcastle Scoliosis VEPTR
Veptr support site
Vertebral Body Stapling Procedure for the Treatment of Scoliosis in the Growing Child
Scoliosis texas - VBS
Spine Universe VBS
Luque rod system
Review of Luque system
Review of Luque System 2
Review 3

Sunday, 10 July 2011

New Brace

We got final adjustments made to the new brace last week.  Here is the final product!
It is essentially the same design, but higher at the front of the chest to force her shoulders and upper back into a better position.