Advances in the surgical management of early-onset spinal deformities (EOSD)

Early-onset spinal deformity (EOSD) is characterised by detection of spinal deformity (scoliosis, kyphosis or multi-planar) in children at aged less than five years. The common causes could be classified under congenital, neuromuscular, syndromic and idiopathic etiologies. Early treatment is paramount in preventing rigid, severe and progressive deformities that can cause pulmonary compromise. The inability of lungs and thoracic cage to support normal ventilation at rest constitutes the pathophysiology in manifestation of thoracic insufficiency syndrome (TIS). The treatment options have evolved from observation, serial casting, bracing to surgery. Early definitive spinal fusion is now obsolete and contra-indicated for EOSD. Growing rods (submuscular or subfascial) continues to be the standard of care in treating these challenging deformities. Vertebral expandable prosthetic titanium rib (VEPTR) continues to be an attractive option for TIS but is fraught with high complication rate. I hereby present a theme on EOSD with a set of thirty three peer reviewed indexed publications and one surgical patent in treating such challenging conditions highlighting my original contribution as Consultant spinal surgeon spanning over two decades. My pioneering and ground-breaking research that has shaped the surgical management of EOSD and helped define 'standard of care' is presented. My novel and innovative concept of treating EOSD using magnet driven growing rod (MdGR) along with its preliminary results is discussed. MdGRs are an attractive alternative in eliminating need for repetitive anaesthesia facilitating normal cognitive development in comparison to growing rods (CGRs). They also improve pulmonary function in neuromuscular scoliosis. A brief one page summary of all my indexed publications with comments on originality and how they contributed to spinal surgery is enclosed at the end of each chapter. My current research update on MdGR project at Royal National Orthopaedic Hospital (Stanmore), my surgical patent National institute of clinical excellence (NICE) position statement on MdGRs and clinical guidance documents are attached appendices I - III.This thesis is not currently available in OR