Posted: Wed Mar 23, 2016 2:04 pm
My child has scoliosis, how should it be managed?
(Asked by a parent)
Posted: Wed Mar 23, 2016 2:05 pm
Children over age 8 who cannot walk and have scoliosis progressing quickly and already over 30 degrees require surgery to fuse the spine. It can be safely done despite total absence of ability to breathe by training the child pre-op in noninvasive ventilatory support and mechanical insufflation-exsufflation (NVS and MIE). This essentially eliminates any risk of extubation failure. The parents MUST, however, be trained in and confident in applying NVS and MIE as necessary and the patient extubated to NVS and MIE as needed in the 1 to 3 days after surgery.
Our surgeons have operated on adolescents with Duchenne muscular dystrophy (DMD) with less than 2% (80 ml) of vital capacity with no respiratory problems. No child needs a tracheostomy tube to permit scoliosis surgery and no one needs to undergo tracheotomy because of post-op extubation failure since these patients can always be transferred to Centers for Noninvasive Respiratory Management that should be able to extubate them to continuous (C)NVS and MIE.
New techniques of surgically placing rods that can grow with the child and extending them by using magnets “buys time” to allow the spine to grow more. Bracing the spine, whether for sleep or during the day, may keep the spine more flexible for a better surgical correction but it should never be used as a definitive alternative to surgical correction.
Posted: Wed Mar 23, 2016 2:09 pm