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There is an additional treatment option available that is a relative newcomer to treating scoliosis as an option to bracing or surgery. Minimally invasive spinal fusion surgery also known as internal bracing, or “fusionless procedure” is now a fourth option in the treatment of scoliosis, whether it is (AIS) Adolescent idiopathic scoliosis, congenital scoliosis, or neuromuscular scoliosis (both in adult and children).
This minimally invasive operation is essentially a surgical intervention to try to limit the abnormal growth of the developing spine. This procedure uses smaller surgical cuts, and most often carries less risk than full-blown spinal fusion surgery. By using video assistance in the surgery, a scoliosis surgeon does not need to have as large of an opening since his field of vision is not limited by the smaller incision sight.
In a study performed at various hospitals, including the Israeli Spine Center in Tel Aviv, and Mount Sinai Hospital Icahn School of Medicine in New York, nineteen children (ages 13-17) were operated for adolescent idiopathic scoliosis and there was an 82% success rate.
The children all had greater than a 60 degree Cobb angle with Risser grade above 2 . The spineless fusion, an intermediate treatment plan, between bracing and spinal fusion surgery, achieved lessening the scoliotic spine curve by more than half, to below a 30 degree Cobb angle, after surgery.
The main purpose of this type of minimally invasive surgery, is to correct the spinal deformity by limiting verbal growth at the apex or convexity or the abnormal curve of the developing spine in children.
This internal bracing essentially restricts the vertical growth of the developing spine.
While this type of surgery is very promising, there exists limited data, and is currently still under investigation despite the results in such world renowned hospitals like Mount Sinai and The Israeli Spine Center .
The specific hardware used in this type of surgery are either rigid shape memory alloy staples, or bone screw anchors combined with a flexible braid synthetic ligament, or polyaxial joint with self-adjusting rod.
These two options are essentially a less invasive operation as compared to an invasive Spinal fusion surgery. Whether the surgeon uses memory alloy staples or the bone screen anchors with the flexible synthetic ligament , they are placed across the thoracic and lumbar disk space using video assisted thoracic surgical techniques.
This procedure should be used when there is a compliance issue with the prescribed bracing treatment plan. If a child will not wear a brace as prescribed and “cheats” by not wearing the brace when the parents are not around, then this is a great option as opposed to going with the more invasive spinal fusion surgery.
There's promising initial results, but there's just not enough data to determine what are the long term effects on an aging spine, as well as the efficacy of this procedure versus bracing.
Of course, as with any promising and new medical procedure, more studies are needed. But this treatment option appears to be something promising that may find a significant place in the toolbox of the scoliosis surgeon for those children that are at risk for scoliosis curve progression.
Specifically, when they refuse to wear any type of bracing due to peer pressure or social stigmas associated with wearing a brace in public, especially amongst those children that play teen sports.