by Behrooz A. Akbarnia, MD
Max was a small, very pleasant 3.5 year-old boy when he was first seen as a second opinion for treatment of his progressive Early-Onset Scoliosis (EOS). His parents had heard about dual growing rod surgery and would like to know more about it.
Max had been diagnosed with arthrogryposis at birth and had several moderate to severe joint contractures in both upper and lower extremities in addition to his obvious spinal deformity. He was the second child of the family and his mother had an uneventful pregnancy and delivery. Max had had several surgical procedures to release multiple joint contractures before coming to visit us for his scoliosis. He had a normal mental development and appeared very smart and cooperative.
He had undergone non-operative treatment with brace with little success. He had a good sitting balance and head control when I first visited him in early 2005.
Because of the progression of his curve and pending pulmonary issues surgical intervention was recommended. However, Max was very young and had a fairly high chance of experiencing unwanted consequences during the course of anticipated long treatment.
After discussing the risks and benefits of surgery with growing rods, the family decided to proceed with surgical treatment. My goals of his treatment were to delay the rate of scoliosis progression as much as possible, maintain and assist him to achieve his longitudinal spinal growth and sitting height, helping him to maintain his current sitting balance and finally providing his lungs with more room to grow by correcting his spinal column (mainly thoracic spine) alignment and growth.
Max underwent the index growing rod surgery in August 2005 at the age of 4. From August 2005 to June 2012, Max went through eight lengthenings before his definitive spinal fusion at the age of 11. His latest assessment showed that his scoliosis corrected by more than 40% and his spine grew for about 7.2 Cm throughout the course of treatment. However, this achievement was not easy for the patient, his family and his treating surgeon. Arthrogryposis is one of the most challenging conditions in orthopaedic disorders. Spinal deformity usually presents very early in life and is progressive. Non-operative treatment is almost always futile and operative treatment is prone to repeated failures and complications. Beside his successful GR lengthenings and final fusion, Max had to go through 5 major revisions and 4 surgeries for wound issues. He suffered from deep surgical site infection twice during his treatment course but we were able to save his previous scoliosis correction and height gain without terminating his growing rod treatment.
Max is now fully recovered following his final fusion. He and his family are very happy of the treatment they chose to continue with. Max has an excellent sitting balance, very acceptable clinical and radiographic deformity correction and most importantly near normal spinal height and effortless and independent respiration.