Rochester, Minnesota - Fusion surgery has long been a long-term treatment for people with scoliosis - side-to-side curvature of the spine. But other options have emerged - including the vertebral body strapping of children with scoliosis .
She said eh. Noelle Larson, MD , pediatric orthopedic surgeon at Mayo Clinic in Rochester, Minnesota, and expert in scoliosis surgery: “Spinal ligation is a new tool in the scoliosis toolkit.”
The cause of scoliosis is still unknown, but scoliosis affects an estimated 1 in 300 people worldwide. Any curvature of the spine greater than 10 degrees is considered scoliosis. Severe scoliosis that requires treatment is more common among women.
Mild scoliosis is monitored over time. Small curves in growing children can develop rapidly if left untreated. Mild scoliosis in developing children is treated with a brace. Until recently, severe scoliosis was treatable only with fusion surgery.
In fusion surgery, surgeons connect the bones in the spine (vertebrae) through an incision in the back and place screws into the spine. Rods are attached to screws to pull the spine into the correct position. These vertebrae are then fused into a solid plate of bone.
“Fusing has been a reliable treatment with long-term results and strong correction of spinal curvature,” says Dr. Larson. “But with fusion surgery, the spine stops growing, and there is no flexibility in the spine over the fused vertebrae. Some patients and families appreciate the range of motion and growth of the spine. and prefer another treatment approach for acute scoliosis."
In August 2019, the U.S. Food and Drug Administration granted human device exceptions for two surgical implants without fusion — vertebral body ligation and posterior kinetic traction surgery. It is a limited approval indicating the safety of the procedure, not its efficacy. A flexible wire is placed in the front of the spine through small incisions and secured to the vertebrae with screws that are placed through the 1-inch incisions.
When the cord is stretched during surgery, the spine is straightened. As the child grows, the spine may become more straight. Developing children with mild to severe scoliosis and certain types of curves are eligible for this procedure.
Although the range of motion of the spine continues and grows, there are potential downsides to this procedure. Currently, there are higher risks of a second surgery than fusion surgery, due to over- or under-correction of scoliosis. The long-term sustainability of the procedure is not known, and fusion surgery may eventually be required.
Since approval by the US Food and Drug Administration, more studies are being conducted nationwide on spinal ligation. Larson and colleague Todd Milbrandt, MD , are leading an FDA-approved study evaluating the outcomes of vertebral body ligation two years after surgery. Dr. Larson is also the Mayo Principal Investigator in the International Scoliosis Registries of the Scoliosis Control Foundation and the Pediatric Spine Foundation, for patients treated with vertebral body ligation.
“Patients and their families should be informed of the treatment options available to them,” says Dr. Larson. “Some families may want an alternative to fusion surgery. There is more information about scoliosis surgery without fusion. If patients are interested in vertebral body ligation, I urge them to go to a center with experience, as it is still an emerging technology.”
Related English content:
Mayo Clinic Frequently Asked Questions : Scoliosis Treatment Options
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