Monday, September 10, 2007

Hey Clinic: Arthrogryposis and Scoliosis in a Six-Year Old Boy.

Last week I saw a 6 yo boy with arthrogryposis who was adopted from India by a wonderful couple in Durham, NC.

He has a severe R thoracic scoliosis and also severe clubfoot deformity, which has been operated on once in India.

The issue for this little boy is this:  when should he have his big scoliosis fixed?

One of the questions the father of the boy asked was very important:  what happens if you do a spinal fusion on a young boy – does the spine keep growing and cause a problem?

The answer is this:  Yes, the spine could continue to grow anteriorly, since the growth plates are along the disc endplates at each level.  In children under age 8 or so, we try to avoid doing a posterior instrumentation and fusion only, since this continued anterior growth could lead to “crankshaft phenomenon”, where the scoliosis actually recurs as the spine twists around the posterior rod.

For this reason, we avoid doing posterior fusions alone in children under age 8 in most cases.  Instead, we postpone surgery til they are older, or do a “growing rod”, where the spinal rod actually can expand along with growth, or do an anterior fusion combined with posterior fusion (least desirable) to eliminate the anterior growth plates in area of the fusion.


For this child, we will continue to observe the curve, and let him get bigger, with better nutrition, and also have his clubfoot get fixed so he can walk more erect on a proper foot.



Lloyd A Hey, MD MS

The Hey Clinic for Scoliosis and Spine Surgery

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