The use of growth-sparing instrumentation in pediatric spinal deformity

The management of severe spinal deformity in the growing child remains a challenging problem. Nonoperative methods range from orthotics to casting to traction; however, in certain circumstances, these techniques cannot effectively prevent deformity progression or are not tolerated by the child and surgical methods are required. Current options for surgical management of spinal deformity in the growing child include definitive spinal fusion with or without instrumentation, selective fusion, growth modulation, spinal instrumentation without fusion, or more recently, the use of the vertical expandable prosthetic titanium rib. Historically, all of these methods have a significant complication rate and despite advances in technology and instrumentation, remain problematic. This article provides an overview of current methods and outcomes for spinal instrumentation in the growing spine.