Fusionless instrumentation systems for congenital scoliosis: expandable spinal rods and vertical expandable prosthetic titanium rib in the management of congenital spine deformities in the growing child.
METHODS
Review of relevant literature including personal opinions.


OBJECTIVE
To review the current researches investigating the efficacy of growing rod and thoracic expansion techniques in the treatment of congenital spine deformity of young children, and to highlight the contrasting advantages and limitations in the fusionless treatment of progressive congenital scoliosis.


BACKGROUND
Congenital scoliosis has the potential for severe spinal deformity and thoracic insufficiency syndrome (TIS). Conventional fusion treatments in children tend to shorten the spine further exacerbating trunk shortening and TIS. In the surgical treatment of congenital spinal deformities in young children, while reconstructing the spinal deformity, one should simultaneously pursue preserving the growth potential of the vertebrae, improving the volume, symmetry, and functions of the thorax, and protecting this improvement during the growth. Today, employed in the treatment of spinal deformities of young children, there are 2 deformity reconstruction methods serving these targets: Growing rod technique and vertical expandable prosthetic titanium rib (VEPTR) with or without expansion thoracostomy.


METHODS
Peer-reviewed research articles and major international meeting presentations were reviewed. Methods were compared in terms of advantages and limitations.


RESULTS
The growing rod technique is a safe and reliable method in the treatment of congenital spine deformity of young children who present some flexibility in the anomalous segment, or when the congenital anomaly involves a vertebral segment too long for resection, or with compensating curve with structural pattern concomitant to the congenital deformity. Expansion thoracostomy and VEPTR are the appropriate choice for severe congenital spine deformity when a large amount of growth remains. Although ventilator dependence is significantly decreasing, thoracic volume and space available for the lung are increased after expansion thoracostomy and VEPTR.


CONCLUSIONS
Growing rod technique should be used in patients where the primary problem is at the vertebral column. If the patient has rib fusions and/or TIS has developed, in other words, if the primary problem involves the thoracic cage, expansion thoracostomy and VEPTR should be an appropriate option.
Yazici
Muharrem
M
Department of Orthopaedics, Hacettepe University, Faculty of Medicine, Sihhiye, Ankara, Turkey. yazioglu@hacettepe.edu.tr
Emans
John
J
D002648:Child; D006801:Humans; D016268:Internal Fixators / Q000592:standards* / Q000639:trends; D019635:Neurosurgical Procedures / Q000295:instrumentation / Q000379:methods; D019736:Prostheses and Implants / Q000592:standards / Q000639:trends; D019651:Plastic Surgery Procedures / Q000295:instrumentation* / Q000379:methods; D012272:Ribs / Q000002:abnormalities* / Q000473:pathology / Q000601:surgery*; D012600:Scoliosis / Q000151:congenital / Q000473:pathology / Q000601:surgery*; D013131:Spine / Q000002:abnormalities* / Q000473:pathology / Q000601:surgery*; D013907:Thoracostomy / Q000295:instrumentation / Q000379:methods; D013909:Thorax / Q000002:abnormalities / Q000254:growth & development; D014025:Titanium / Q000627:therapeutic use
D014025:Titanium