Congentile Scoliosis surgery on 3 yr old

[smedina1]

Morning everyone,
It has been a very long time since I've posted. My daughter Hannah just saw her surgeon (Dr. Frances Farley in Ann Arbor, Michigan) and she has told us that she will need surgery in April. She has 2 hemivertabraes. She had seen Dr. Robert Hensinger but has opted to retire. He had put her in a TSLO brace for about 2 years. It was not to correct it but as he said to prevent it from getting worse. But our new ortho said that with congentile bracing doesn't help. Her curve is about a 65 degree which hasn't changed for the 2 years of bracing. She has told us that she wants to remove her 2 hemivertabraes and then put in hardware and fuse the vertabraes. I've read before that you should try and wait to fuse any vertabraes until she stops growing. But she said that this is the best procedure for her. Has anyone had fusion at this early of an age? As you can see I'm up at this hour because this is all I've been thinking about and I'm trying to get all the information I need to get through this. She is highly recommended. Has anyone ever heard of her? Hannah has also had unthethered surgery a year ago in October and that went wonderfully. Other than her hemi's she wonderful.
I'm just so scared and want to be prepared. Has anyone any questions that I should be asking our surgeon. That would help me very much.
I feel bad that I haven't kept up with this website, she was doing so wonderful and she is now too, I've put it off and doing everyday stuff.
Like I said I worry about the fusion and her growth potential.
But from what I've heard about her she's one of the best here in Michigan.
Please help.
Thank you so much in advance for any advice and help that you may give.
Bless you all.

[Celia]

Hi,

Dr. Francis Farley is a member with the SRS so I would assume her qualifications are good. I hear excision surgeries are quite complex but results can be quite dramatic in experienced hands. I don't know too much about this procedure but one question I would have is why hardware is being put in if the vertebrae are being removed and why she wouldn't opt for in situ fusion, is it because of the severity of the curve or is the child's age the determining factor ???? The nice thing about this surgery is that it's a one time thing (hopefully) and your child won't require further surgeries.

I'm sure you have heard of the Veptr ? There are many parents who are very grateful for this procedure.

It wouldn't hurt to get a second opinion, since two of your doctors have very different views as to the *right* treatment.

[smedina1]

Hi Celia,
Thank you so much for your reply. Great question about why is hardware being put in. I will ask her that. I know a lot had to do with her curve severity. It's a 65 degree curve. I don't know what a situ fusion is. I've never heard of that. She did say that if she had this done she shouldn't have to have another one. Praying. You had a lot of good questions that I will ask her. This is why this website is great. Thank you so much. Not sure of the VEPTR procedure is. Hannah's doctors only have the difference on whether to brace or not. Her other doctor just thought it may prevent further progression. He was going to do the same type of procedure.
Thank you so much again, if you can think of anything else I may ask. Please don't hesistate. I'm just trying to gather as much info as possible to be prepared.

[Celia]

Hi,

What I meant by in situ fusion is once the hemivertebrae is removed, the space is packed with bone graft and then the child is placed in a cast for 3 months or so ? I wasn't aware that instrumentation is also used to secure the site.... keep in mind I don't know very much about this I don't know if they get better correction with the instrumentation but it's something that is not used for everyone - I was wondering what the criteria was. I thought I read somewhere that young children have very small vertebrae and instrumentation can lead to complications. This is something you could ask Dr. Farley and once you find out let me know, I'm curious now Here is an abstract that discusses this and there is no mention of instrumentation:


1: J Pediatr Orthop. 2001 Nov-Dec;21(6):761-4. Links

Comment in:
J Pediatr Orthop. 2003 Mar-Apr;23(2):273-4.

Hemivertebral excision for congenital scoliosis in very young children.Klemme WR, Polly DW Jr, Orchowski JR.

Department of Orthopaedic Surgery and Rehabilitation, Walter Reed Army Medical Center, Washington, DC 20307-5001, USA. William.Klemme@na.amedd

The present study reports the results of a consecutive series of six very young children who underwent single-anesthetic sequential anterior and posterior hemivertebral excision. The children, all less than 34 months old (mean age 19 months), presented with high magnitude or progressive congenital scoliosis related to an unbalanced hemivertebra. Curve correction required hemivertebral excision, which was accomplished during a single operative event using sequential anterior and posterior procedures. The intraoperative curve correction was maintained with plaster immobilization for 3 months. All patients were followed for at least 24 months. Pre-and postoperative spinal radiographs were analyzed for initial and final curve correction. Excellent correction of preoperative deformity was obtained and maintained throughout the follow-up period. The mean postoperative curve correction (67%; range 52%-84%) compared favorably with the average correction at final follow-up (70%; range 50%-85%). Radiographs revealed a consistently solid arthrodesis with no evidence of curve progression. There were no neurologic or other significant complications. In conclusion, single-anesthetic sequential anterior and posterior hemivertebral excision appears to be a safe and efficacious procedure for the management of congenital scoliosis in very young children.

PMID: 11675550 [PubMed - indexed for MEDLINE]

The Veptr is the Titanium Rib and there is a website with many parents whose children are going through the procedure:

www.veptr.com