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Infantile Idiopathic Scoliosis

Infantile Idiopathic Scoliosis. Chris Dowding CHEO 10 Minute presentation. Infantile Idiopathic Scoliosis. Spine deformity in the very young Decreased lung volume Decreased lung compliance Reduced alveolar growth Reduced tidal volume, increased work of breathing, restrictive lung disease

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Infantile Idiopathic Scoliosis

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  1. Infantile Idiopathic Scoliosis Chris Dowding CHEO 10 Minute presentation

  2. Infantile Idiopathic Scoliosis • Spine deformity in the very young • Decreased lung volume • Decreased lung compliance • Reduced alveolar growth • Reduced tidal volume, increased work of breathing, restrictive lung disease • QOL similar to severe asthma or cardiac disease • Potentially fatal if untreated • However fusion before age 10 can also lead to respiratory compromise

  3. Infantile Idiopathic Scoliosis • History and physical must take into account possible pulmonary compromise • Respiratory excursion • Serial pulse oximetry or blood gases to monitor oxygenation • Pre-op • 20% will have underlying intraspinal anomoly

  4. Infantile Idiopathic Scoliosis • Rib Vertebral Angle Difference • Likely to resolve in 90% of children with a RVAD less than 20° • Less likely to resolve when the RVAD is greater than 20°. • .: Progressive

  5. Infantile Idiopathic Scoliosis • Treatment • Spinal fusion can lead to restrictive lung disease • Bracing less likely than casting to result in permanent correction • Bracing indicated for older children with large curves not expected to correct • Also: • Intolerance to casting • Intolerance to surgery

  6. Infantile Idiopathic Scoliosis • Serial casting • Elongation De-rotation Flexion • Can be curative in < 17 m and smaller curves • Can delay need for surgery 3 years • Moderate to severe scoliosis, > 2.5 years, > 50 degrees

  7. Infantile Idiopathic Scoliosis • Serial casting • Superior and inferior traction • Rotational mould around trunk/ribs • Ex protocol: • cast changes under anesthesia every 8 to 16 weeks until the curve is nearly resolved • followed by an underarm brace that may be weaned if the patient’s curve correction continues.

  8. Infantile Idiopathic Scoliosis • Growing rods • Short segments of fusion at proximal and distal curve • Linked with extraperiosteal, submuscular rods • Lengthening procedure q6 months until fusion • Curve correction with more space available for lung • Single vs dual

  9. Infantile Idiopathic Scoliosis • Growing rods • Disadvantages • Implants are proportionally large for very small child • Multiple procedures • Skin complications • Diminishing results after repeated lengthenings • Rods can break or pull out

  10. Infantile Idiopathic Scoliosis • VEPTR • Expansion thoracoplasty using the Vertical Expandable Prosthetic Titanium Rib • Straightening of spine through chest wall expansion • Can improve space available for lung • However may lead to decreased chest wall compliance secondary to thoracic stiffening • Potential for brachial plexus injury

  11. Infantile Idiopathic Scoliosis • VEPTR • Skeletally immature patients with thoracic insufficiency syndrome • Lengthening of the constricted hemithorax • Lengthened q4-6 months

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