For children with spinal deformities, surgical intervention can lead to life-changing improvements in pain relief, daily functioning, and cosmetic appearance. With proper screening, the majority of children do well after undergoing surgery to correct spinal deformity. However, for a small percentage of children, additional surgery may be required in order to address painful symptoms, a deformity that continues to progress or to maintain the child’s growth potential.
There are a number of factors may contribute to the need for primary surgery, including:
- Pseudarthrosis, or a non-union of the bone, following a spinal fusion;
- Crankshaft phenomenon: in which the posterior column of the spine is fused, and the anterior column continues to grow and “rotate” around the fused area;
- Junctional degeneration: damage to the spine (discs and vertebrae) that develops above or below the area that has been fused;
- Deformity progression (also known as “adding on”) in the sagittal and/or coronal planes of the spine;
- Infection in the bone or around instrumentation;
- Fixed sagittal imbalance (also called flatback): a condition in which too much of the natural sway in the lumbar spine has been eliminated;
- Pain associated with instrumentation, either due to prominence of the implanted instrumentation and tenderness, or related to infection;
- Broken implants requiring replacement.
The nature of revision surgeries can vary, depending on the underlying problem. In order to help to guide the orthopedist’s treatment recommendations, there must be a thorough understanding of the patient’s condition prior to surgery. For this, there is no better way to do it than with an intuitive 3D pre-operative planning software, though for orthopedic surgeons and developed with surgeons, such as PeekMed®.
Surgeries for pediatric spinal deformities present a complex set of challenges, but with diligent preoperative assessment and diagnosis and proper perioperative technique, as well as the participation of a multidisciplinary team including pediatricians, nutritionists, intensive care, and pulmonary specialists, patients can do very well.