February 08, 2019 7:55 AM

Searching for the Best Treatment for Early-Onset Scoliosis

Serial casting and surgically implanted growing rods are both effective treatments but new research aims to show if one supports a higher quality of life for patients and families.

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Early-onset scoliosis , a condition marked by abnormal spinal curvature diagnosed before age 10, is rare, occurring in about one in 10,000 children. The condition can resolve on its own when it develops in children under age two, but severe cases can lead to heart and lung problems in childhood that worsen into adulthood. 

“We’ve typically reached for one of two options when treatment is required,” notes G. Ying Li, MD, a pediatric orthopedic surgeon at C.S. Mott Children’s Hospital. “The most widely used techniques today involve using repeated rounds of body casting to progressively straighten the spine, or surgically implanting expandable growing rods to straighten the spine.”

Casting for spinal deformity has been around in some form since the 1800s, while the use of rods to correct scoliosis is a newer approach, having been introduced in the 1960s. In the 1980s, “growing” rods were introduced. .

“Surgeons have been moving away from traditional approaches like casting toward newer technologies like rods,” says Li. “But the alternative isn’t without trade-offs.”

Growing rods vs. casting

Li explains that expanding traditional growing rods requires multiple procedures performed through the same incision, increasing the risk of infection and diminished wound healing. And even normal body motion can loosen or disconnect the rods from the spine.

“We knew the growing rods had higher complication rates, but we were also interested in how quality of life was affected by one treatment option over the other,” says Li.

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X-rays: Traditional growth rod treatment for early-onset scoliosis, pre-treatment (L) and after one lengthening procedure (R).

New research conducted by the Growing Spine Study Group (GSSG) provides the first insights into how the two treatment options impact the health-related quality of life of both early-onset scoliosis patients and their parents.

The results, presented by Li at the November 2018 meeting of the International Congress on Early Onset Scoliosis (EOS), may help guide doctors and families in making treatment decisions.

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The toll of multiple procedures on patients and families

Li and her colleagues looked at a number of parent-reported factors to evaluate health-related quality of life for the patients and their families, including pain, fatigue and emotional distress.

A factor that quickly emerged as an important consideration was the number and type of interventions required.

With casting, the cast is removed at regular intervals, the spine is manipulated, and a new cast is applied. Traditional growing rods are implanted via a surgical procedure, with regular procedures to reopen the incision and manually lengthen the rods.

“With both casting and traditional growing rods, patients have to undergo multiple procedures requiring anesthesia,” says Li.  “Those repeat trips to the hospital alone can have an effect on quality of life.”

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Within the study sample, casting patients averaged four procedures and growing rod patients averaged six.

The team also measured the physical, emotional and financial burden of care experienced by parents.

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X-rays: Casting for early-onset scoliosis, pre-treatment (L), final cast (M), and 3 years post treatment (R).

Li and colleagues found that, prior to treatment, quality of life indicators were similar for casting and growing rod patients.  When re-surveyed post-treatment, however, patients and parents who underwent casting reported more positive quality of life factors than those who underwent traditional growing rods.

“Growing rod patients reported worse pain, more difficulty transferring, greater fatigue, and more emotional concerns,” said Li.  “And – importantly – parents of casting patients reported higher satisfaction and less burden of care. That’s important too, for parents starting down a long treatment journey with their child.”

New options on the horizon

Although casting can present a lower risk of complications  and can either cure certain types of scoliosis or delay surgery to correct the scoliosis, Li points out that it, too, has drawbacks, such as not being suitable for kids with pulmonary issues.

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Fortunately, doctors are learning more about newer options every day.

“The next generation of growing rods are magnetically controlled and can be adjusted externally using a magnet, without the need for repeat incisions,” shares Li. “Magnetically-controlled growing rods are a promising development, but more refinement and study are needed to determine which children with EOS are best suited for magnetic growing rods.”

With limited retrospective data available on magnetic growing rods, they were not evaluated in the GSSG study.

In the meantime, more quality of life data will be available for families and providers soon. Li and her colleagues are wrapping up an ongoing GSSG and Children’s Spine Study Group study comparing casting with bracing in EOS.