Clinical Medicine Insights: Pediatrics

This review discusses the basic knowledge and recent innovation of surgical treatment for scoliosis. Surgical treatment for scoliosis is indicated, in general, for a curve exceeding 45 to 50 degrees by the Cobb’s method on the basis that:

1. Curves larger than 50 degrees progress even after skeletal maturity.

2. Curves larger than 60 degrees cause loss of pulmonary function, and much larger curves cause respiratory failure.

3. Greater the curve progression, the more difficult it is to treat with surgery.

Posterior fusion with instrumentation has been the standard form of surgical treatment for scoliosis. In modern instrumentation systems, more anchors are used to connect the rod and the spine, resulting in better correction and less frequent implant failures. Segmental pedicle screw constructs or hybrid constructs using pedicle screws, hooks, and wires are the trend of today. Anterior instrumentation surgery was once the choice of treatment for thoracolumbar and lumbar scoliosis because better correction could be obtained with shorter fusion levels. But in the recent times, superiority of anterior surgery for the thoracolumbar and lumbar scoliosis has been questioned. Initial enthusiasm for anterior instrumentation for the thoracic curve using video assisted thoracoscopy has faded out.