Thoracolumbar Spinal Disorders in Pediatric Patients
Disorders of the pediatric thoracolumbar spine may be classified by etiology and include congenital, neuromuscular, syndromic, and idiopathic conditions. Effective care requires an understanding of the conditions encountered, how the patients are clinically evaluated, and the nonoperative and operative strategies by which they are managed. The most common type of pediatric spinal deformity is idiopathic scoliosis, which has been further subdivided by curve pattern according to the Lenke classification. This chapter reviews the Lenke classification and its goal of arthrodesis for only major and structural curves. Neuromuscular scoliosis often involves long, sweeping curves and pelvic obliquity, which typically warrants pelvic fixation. Evidence suggests that sacral-alar-iliac screw pelvic fixation may provide improved correction with fewer complications than prior techniques. In general, pediatric spinal deformity treatment plans should attempt to maximize growth potential of the spine. This may mean attempting nonfusion operative treatment (e.g., growing rods, vertebral body tethering, or stapling) when indicated. Surgical correction for pediatric spinal deformity is associated with high complication rates, especially the subset of patients with neuromuscular scoliosis who have significant comorbidities. However, more recent studies have reported improved complication rates over the past decade, which may partly be attributed to advancements in spinopelvic instrumentation. Other strategies to further reduce complication rates include consistent use of intrawound antibiotics, intraoperative image guidance, intraoperative neuromonitoring, and antifibrinolytic usage. Despite high complication rates, surgical correction of pediatric spinal deformity is associated with improvement in clinical outcome measures. These clinical benefits likely outweigh complication risks if pediatric patients are carefully selected and appropriately treated.
