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Home / Spine Paed / Early-onset scoliosis and growing rods
Spine Paed

Early-onset scoliosis and growing rods

Infantile and early curves at the thoracolumbar junction, treated with growth-friendly rods such as VEPTR.

11 questions 2 source pages 1 fact-check flags

Images appear with the first question taken from each source page — tap a question to open it.

11 questions
Q1What is congenital scoliosis and how is it classified?▸
  • Failure to form normal vertebrae at gestation week 4-6
  • Failure of formation / segmentation / mixed (MacEwen classification)
  • Failure of formation divided by segmentation (segmented, semisegmented, nonsegmented) and extent (partial vs complete)
  • Most are sporadic
Q2What associated anomalies should be screened for in congenital scoliosis?▸
  • Extraspinal: VACTERL, Klippel-Feil, NF
  • Intraspinal: Chiari malformation, tethered cord, syrinx - MRI
  • Internal organs: renal USG and echo
Q3What is the natural history of congenital scoliosis?▸
  • McMaster: 485 patients, 75% need surgical treatment
  • Prognosis depends on type of anomaly and anatomical site
  • Progression by type: mixed > unilateral bar > fully segmented > partially segmented > incarcerated > nonsegmented
  • Position: TLJ worse; also younger age
Q4What are the surgical options for congenital scoliosis?▸
  • Early in situ fusion for minimal deformity (young: A+P fusion; older: P fusion)
  • Hemivertebrectomy for marked truncal imbalance (<5yo, flexible curves <40)
  • Convex hemiepiphysiodesis for unilateral failure of formation (<5yo, progressive curves <40-50)
  • Spinal column shortening resection for rigid, severe late deformities with decompensation
  • Growing rods maximise spinal growth but are controversial
Q5Which types of congenital scoliosis may be observed without surgery?▸
  • Incarcerated hemivertebrae
  • Nonsegmented hemivertebrae
  • Some partially segmented hemivertebrae
  • Selected because of absence of progression
Q6What are the clinical and radiological clues in this case?▸
  • Acute curve at the TLJ convex to the right
  • One pedicle less on the left, seems unsegmented
  • Suspect congenital scoliosis with hemivertebra
Q7What history and examination are needed in suspected congenital scoliosis?▸
  • Hx: birth history, walking age and motor development, associated problems (Klippel-Feil, NF, VACTERL)
  • PE: maturity (Tanner-Whitehouse), shoulder balance, rib or loin hump, truncal shift or listing
  • Neurology, gait, skin stigmata
Q8What is the aim of management in congenital scoliosis?▸
  • Arrest progression
  • Achieve a balanced spine while preserving as much spinal growth as possible
Q9What does VEPTR stand for?▸
  • Vertical Expandable Prosthetic Titanium Rib
  • Not covered in the speaker notes beyond the title
Q10What is the role of VEPTR in early-onset scoliosis?▸
  • Not covered in the speaker notes
  • Review the source image and lecture recording
Q11When is VEPTR used in the lecture?▸
  • Mentioned for infantile scoliosis with Cobb >50 degrees, together with growing rods
  • this section itself has no speaker notes - the title is the only source

Fact check

McMaster's natural history paper studied 485 patients, 75% needing surgery — Incorrect patient number — McMaster & Ohtsuka (JBJS 1982) studied 251 patients; 485 does not match the cited source — source
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