How to treat congenital scoliosis, choose the method according to the situation

There are two types of treatments for congenital scoliosis: surgical and non-surgical. Common non-surgical methods include physical therapy, exercise, plaster correction and other treatments. If the scoliosis is severe, surgical treatment is required as soon as possible. The earlier the surgery, the better the recovery.

1. Non-surgical treatment

Extensive experience has shown that congenital scoliosis is different from idiopathic scoliosis and is not effective for gymnastics therapy, physical therapy, exercise therapy, electrical stimulation therapy, etc. Risser plaster orthopedic treatment is often accompanied by problems such as pressure sores, chest deformation, and poor lung function due to the weight of the plaster. Currently, this treatment has been mostly abandoned or used less frequently. Therefore, brace therapy is the main non-surgical treatment for congenital scoliosis. Here we briefly describe the indications and efficacy of brace therapy. Although brace therapy is the main or only non-surgical treatment for congenital scoliosis, not all congenital scoliosis is suitable for brace treatment.

Its indications are limited. Brace treatment is suitable for patients who have not yet matured, whose deformity is gradually worsening, and whose scoliosis segments are long and soft. There is no need to use a brace for cases without progression, and it is even less suitable for cases where the deformity has improved spontaneously. In cases where the segment is short and stiff, brace treatment is almost ineffective. Flexibility plays an important role in treatment selection. Therefore, before treatment, the degree of flexibility should be carefully understood through examinations in the upright, supine, traction, or lateral flexion positions. Winter believes that: if the scoliosis is less than 50° and the flexibility is greater than 50%, the brace treatment is generally effective. If the scoliosis is between 50° and 75° and the flexibility is between 25% and 50%, brace treatment may be beneficial. However, for those with a scoliosis greater than 75° and a flexibility less than 25%, brace treatment is almost ineffective.

2. Surgical treatment

1. Simple spinal fusion surgery

The main purpose is not to correct scoliosis, but to stabilize the spine and prevent further aggravation of scoliosis. Especially for those with rigid type, who are not responsive to brace correction and whose scoliosis is aggravated, simple posterior fusion should be performed. For unilateral non-segmented scoliosis, do not fuse too many non-segmented upper and lower movable units, and the amount of bone graft should be sufficient. It is best to use autologous bone transplantation. If the patient is young and it is difficult to obtain the iliac bone, allogeneic bone can also be used.

2. Posterior fusion under plaster correction

It is suitable for those who are young (under 9 years old) and have scoliosis that is difficult to correct with implanted devices, but has high flexibility and progressive type.

3. Traction correction followed by instrument fixation and fusion for congenital scoliosis. Slow, long-term traction before surgery can avoid sudden correction and traction during one surgery. This is of great significance in preventing spinal nerve complications and increasing the surgical correction rate. Before surgery, gradually increase the amount of traction to understand whether the patient has changes in numbness, pain, muscle tone, muscle strength, and reflexes. After achieving a satisfactory degree of correction, instrumented fixation and bone graft fusion were performed. Myelography is required before surgery to rule out coexisting abnormalities in the spinal canal. During the operation, spinal cord electrophysiological monitoring and wake-up test should be performed at the same time. Commonly used orthopedic fixators include the Harrington instrument and the Luque instrument. However, due to the lack of intervertebral space in congenital scoliosis, it is difficult to pass the wire under the Luque intervertebral lamina, and the distraction performance of the Luque instrument is not as good as that of the Harrington instrument. Therefore, the Luque instrument alone is rarely used and is often used in combination with the Harrington instrument.