[Dynamic instrumentation techniques in early-onset scoliosis]

Similar to the situation in idiopathic scoliosis, the decision for operative or conservative treatment is based on the progression of the curve. Apart from age and Cobb angle, the rib-vertebral angle difference and rotation of the vertebrae are decisive for the prognosis. Surgery is indicated if, despite consistent brace treatment, a progression of >10 degrees or a Cobb angle of more than 45 degrees is found. Two different dorsal dynamic systems are presently used. With the growing rod technique, one or two rods are fixed to the spine cranially and caudally and are repeatedly"lengthened." Surgery is mandatory at least every 6 months. The Orthobiom system follows a new approach in which a rigid fixation is done in the middle of the curve, while the ends of the rods are linked to flexible connectors that can slide while the child grows. No long-time results are presently available for either system, so no general recommendations can be given.