Scoliosis

Key points

Early onset scoliosis (EOS) manifests before age 10

Infantile scoliosis < 3 years old

Juvenile scoliosis ages 3 to 10

Pathophysiology

Congenital scoliosis - defects in vertebral formation and segmentation

Structural scoliosis - fused ribs, diaprhagmatice hernia or chest wall abnormalities

Neuromuscular scoliosis - cerebral palsy or muscular dystrophy

Syndromic scoliosis - VACTERL and neurofibromatosis

Management

Goals are to stop the progression of spinal deformity, increase thoracic volume to enhance cardiorespiratory function

Spinal bracing is generally ineffective and poorly tolerated

Optimise the patient's functional status before intervention

Surgical Options

Traditional growing rods allow for periodic lengthening surgeries with initial placement of anchors

Magnetic growing rods use external control for rod elongation

Severe curves over 70 degrees are associated with increased mortality

Complications of scoliosis repair presenting to Paediatric Surgeons

Postoperative superior mesenteric artery syndrome

Due to post operative weight loss and decrease of the aorto-mesenteric angle after spinal straightening

Manage with NJ feeds, aiming to increase weight

Injury to abdominal/thoracic structures by fixation screw

Have a high index of suspicion, perform a CT if required

References

LeFever D, Menger RP. Infantile and Juvenile Scoliosis. [Updated 2023 Jul 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519498/