title: Fusionless surgery in early-onset scoliosis.
abstract: BACKGROUND
  Surgical treatment of early-onset scoliosis has greatly developed in recent years. Early-onset scoliosis covers a variety of etiologies (idiopathic, neurologic, dystrophic, malformative, etc.) with onset before the age of 5 years. Progression and severity threaten respiratory development and may result in respiratory failure in adulthood. Many surgical techniques have been developed in recent years, aiming to protect spinal and thoracic development.
  
  
  METHODS
  Present techniques are based on one of two main principles. The first consists in posterior distraction of the spine in its concavity (single growing rod, or vertical expandable prosthetic titanium rib [VEPTR]), or on either side (dual rod); this requires iterative surgery, for lengthening, unless motorized using energy provided by a magnetic system. The second option is to use spinal growth force to lengthen the assembly; these techniques (Luque Trolley, Shilla), using a sliding assembly, are known as growth guidance.
  
  
  RESULTS
  These techniques are effective in controlling early scoliotic deformity, and to some extent restore spinal growth. However, they show a high rate of complications: infection, rod breakage, spinal fixation pull out and, above all, progressive spinal stiffness, reducing long-term efficacy. Respiratory gain is harder to assess, as thoracic expansion does not systematically improve respiratory function, particularly due to impaired compliance of the thoracic cage.
authors.affiliation: Service de chirurgie orthopédique pédiatrique, CHRU de Tours, université François-Rabelais de Tours, PRES Centre-Val de Loire université, 49, boulevard Béranger, 37044 Tours, France. Electronic address: t.odent@chu-tours.fr.
authors.forename: T
authors.initials: T
authors.lastname: Odent
authors.affiliation: Service de chirurgie orthopédique pédiatrique, hôpital universitaire Robert-Debré, université Paris-Diderot, Assistance publique-Hôpitaux de Paris, 75019 Paris, France.
authors.forename: B
authors.initials: B
authors.lastname: Ilharreborde
authors.affiliation: Service de chirurgie orthopédique pédiatrique, hôpital universitaire Necker-Enfants-Malades, université Paris-Descartes, Sorbonne Paris-Cité, Assistance publique-Hôpitaux de Paris, 149, rue de Sèvres, 75743 Paris cedex 15, France.
authors.forename: L
authors.initials: L
authors.lastname: Miladi
authors.affiliation: Service de chirurgie orthopédique pédiatrique, hôpital universitaire Necker-Enfants-Malades, université Paris-Descartes, Sorbonne Paris-Cité, Assistance publique-Hôpitaux de Paris, 149, rue de Sèvres, 75743 Paris cedex 15, France.
authors.forename: N
authors.initials: N
authors.lastname: Khouri
authors.affiliation: Service de chirurgie pédiatrique, hôpital Sud, université Rennes 1, boulevard de Bulgarie, 35000 Rennes, France.
authors.forename: P
authors.initials: P
authors.lastname: Violas
authors.affiliation: Shriner's Hospital, McGill University, Montreal, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Ouellet
authors.affiliation: Service d'orthopédie pédiatrique, hôpital Femme-Mère-Enfant, université Lyon 1, hospices civils de Lyon, 59, boulevard Pinel, 69677 Bron cedex, France.
authors.forename: V
authors.initials: V
authors.lastname: Cunin
authors.affiliation: Pediatric clinic, Luxembourg, Luxembourg.
authors.forename: J
authors.initials: J
authors.lastname: Kieffer
authors.affiliation: Hôpital hôtel-Dieu, B.P. 166830, Beirut, Lebanon.
authors.forename: K
authors.initials: K
authors.lastname: Kharrat
authors.affiliation: Service d'orthopédie, hôpital des Enfants, CHU de Toulouse, Toulouse, France.
authors.forename: F
authors.initials: F
authors.lastname: Accadbled
mesh_terms: D017668:Age of Onset; D004867:Equipment Design; D006801:Humans; D012600:Scoliosis / Q000601:surgery*; D013123:Spinal Fusion / Q000295:instrumentation*
keywords: Early-onset scoliosis; Fusionless spinal surgery; Spinal growth; Spinal instrumentation