Early Onset Scoliosis: Guidelines for Management in Resource-Limited Settings

Cover
Title Page
Copyright Page
Dedication
Table of Contents
Preface
Acknowledgments
Editors
List of Contributors
List of Abbreviations
Chapter 1 Introduction
	Introduction
	Discussion
		Why Is This Book Necessary Now?
		What Makes This Book Important?
	Conclusion
	References
Chapter 2a Economics and Implementing Early-Onset Scoliosis in Limited-Resources Facilities
	Introduction
	Problems in Management of EOS with Limited Resources
	Costs of EOS Management
	Managed Care Concepts and Implementation of EOS Management
	Possible Solutions
	Conclusion
	References
Chapter 2b Mismatch in Expectations between Industry and Countries with Limited Resources
	Introduction
		Cost of Doing Business
		Poor Competition Due to ‘Make-Believe’ Product Differentiation
		Financial Relationship between Practising Surgeons and Industry
		Changing Landscape
		Need for Patient Advocacy in Countries with Limited Resources
		Sponsorship, Collaborative Effort, and Regional Innovation
		Reducing Regulatory Hurdles
		Comparing Value of Medical Technologies
		Conclusion
	References
Chapter 2c Organisational Deficiencies in Developing Countries and the Role of Global Surgery
	Introduction
	Organisational Challenges in Developing Countries
	Learning and the Local Surgeon
		The Learning Process
		The Surgeon in Developing Countries
	The Role of Global Surgery
		Long-Term Training Programs
		Collaboration over Hierarchy
		Data Collection
	Conclusion
	References
Chapter 3a Blended Learning in Training Paediatric Deformity Surgeons
	Introduction
	What Is Online Learning?
	What Is Blended Learning (BL)?
	How BL Could Be Applied to the Training of Deformity Surgeons
		Online Part
		Face to Face Part
	Future of Education in Paediatric Spinal Deformity Surgery
	Conclusion
	References
Chapter 3b Evidence-Based Medicine in Low- and Middle-Income Countries
	Introduction to Evidence-Based Medicine and Evidence-Based Surgery
	Evidence-Based Medicine in Low- and Middle-Income Countries: A Focus on the Orthopaedic Literature
	Evidence-Based Medicine in Spine Surgery in Low- and Middle-Income Countries
	Evidence-Based Medicine in Paediatric Spine Care in Low- and Middle-Income Countries
	Conclusion
	References
Chapter 4 Normal and Abnormal Development and Growth of Spine and Thoracic Cage
	Growth Holds the Basics
	Weight
	Cervical Spine (C1–C7) Growth
	Medullar Canal
	Thoracic Spine (T1–12) Growth
	Medullar Canal
	Lumbar Spine (L1–L5) Growth
	Medullar Canal
	Spine and Thoracic Cage Growth from Birth to 5 Years of Age
	Spine and Thoracic Cage Growth between 5 and 10 Years of Age
	Rib-Vertebral-Sternal-Complex (RVSC)
	Lung Growth
	Spine and Thoracic Cage Growth during the Pubertal Growth Spurt
	Pubertal Diagram
	Bone Age
	The Crankshaft Phenomenon
	The ‘Scoliotic Risk’
	What Will Be the Final Deficit of the Trunk after Posterior Spine Instrumented Fusion?
	Conclusions
		Perfect Knowledge of Normal Growth Parameters Is Mandatory
		Anticipation Is the Best Strategy
		Essential Key Points to Keep in Mind When Dealing with Paediatric Spinal Deformities
	References
Chapter 5 Pulmonary Evaluation and Management of Early-Onset Scoliosis
	Pulmonary Manifestations of EOS
	Pathophysiology of EOS
	Pulmonary Evaluation of Children with EOS
	Diagnostic Tests
	Other Diagnostic Tests
	Implications of Lung Function Testing in Children with EOS
	Pulmonary Management of EOS
	Conclusion
	References
Chapter 6 Conservative Management of Early-Onset Scoliosis
	Introduction
	Growth of Spine
	Indications for Interventions
	Nonsurgical
	Bracing
	Casting
	Complications
	Results
	Conclusion
	References
Chapter 7 Anaesthetic Management of Early-Onset Scoliosis
	Introduction
	Classification
	Nomenclature and Grading of Severity
		Systemic Effects of Scoliosis
	Preoperative Investigations
	Preoperative Optimisation
	Intraoperative Concerns
	Spinal Cord Monitoring
	Wake-Up Test
	Somatosensory Evoked Potential
	Motor Evoked Potentials
	Prone Positioning
	Hypothermia
	Blood Conservation Strategies
	Spinal Cord Protection
	Analgesia
	Postoperative Concerns
	Conclusion
	References
Chapter 8a Biomechanics of Surgical Intervention Associated with Early-Onset Scoliosis
	Introduction
	Initiation
	Progression
	Correction Strategies
	Standalone Surgical Philosophies
	Biomechanics of Failure Modes
		Rod Fracture and Screw Loosening with Distraction-Based System
		Autofusion and Law of Diminishing Returns with Distraction-Based System
		Failure to Lengthen MAGEC Rods
		Wear and Metallosis in MAGEC and Guided-Growth Techniques
		Crankshafting, Adding-On, and Distal Migration with Guided-Growth Techniques
	Hybrid Surgical Philosophy
	Conclusion
	References
Chapter 8b Principles of Surgical Management
	Introduction
	Current Surgical Strategies
	EOS Surgical Treatment in Low- and Middle-Income Countries
	Convex Epiphysiodesis
	Anterior Vertebral Staples
	SHILLA Technique
	Luque Trolley
	The Challenge of EOS Surgery in LMICs
	Conclusion
	References
Chapter 8c Preoperative Diagnosis and Management
	Introduction
	History-Taking
	Physical Examination
		Cardiological Assessment
			Urogenital
		Trophic Changes in the Skin
			Neurological Examination
			Musculoskeletal Examination
	Preoperative Laboratory Tests to Complete
	Radiological Investigations
		Plain Radiographs
		Magnetic Resonance Imaging
		Computerised Tomography (CT)
		Conclusion
	References
Chapter 8d Principles of Intraoperative Management of Early-Onset Scoliosis
	Introduction: Can Early-Onset Scoliosis (EOS) Be Managed in Resource-Limited Settings?
	Preoperative Considerations That Will Have a Bearing on Intraoperative Management
	Respiratory System
	Curve Type and Cord Status
	Associated Conditions
	Nutritional Status
	Bone Quality
	Intraoperative Management
		Positioning
		Anaesthesia Considerations
		Antibiotic Prophylaxis
		Hypothermia Prevention
		Blood-Loss Management
	Cell Saver System
	Hypotensive Anaesthesia
		Drugs
		Neurophysiologic Monitoring
		Fluid Management
		Neurological Injury
		Traditional Growing Rods
	Technique and Intraoperative Care
	Evidence and Complications
		Magnetic Growing Rods
	Technique and Intraoperative Care
	Rod Placement and Contouring
	Rod Testing and Orientation
	Rod Tunnelling
	Evidence and Complications
		Reversal and Extubation
	Immediate Postoperative Care
		Postoperative Pain Management
		Postoperative Nausea and Vomiting
	Conclusion
	References
Chapter 8e Postoperative Management for EOS Children
	Introduction
		Immediate Postoperative Period
			Haemodynamic Recovery
			Pain Management
			Minimising Complications
			Switching to Oral Diet
			Early Mobilisation
		Early Postoperative Period
		Late Postoperative Period
			Special Considerations
	Conclusion
	References
Chapter 8f Principles of Management of Long-Term Complications in EOS
	Introduction
	Distraction-Based Systems
	Magnetically Controlled Growing Rods
	Growth Guidance System
		Preferred Technıque
	Conclusion
	References
Chapter 8g Management of Spinal Tuberculosis in Young Children
	Introduction
	Clinical Presentation and Diagnosis
	Imaging
	Laboratory Investigations
	Management
		Medical (Multidrug Chemotherapy)
			Drug-Resistant Tuberculosis
	The Natural History of Childhood Spinal Tuberculosis and Deformity
	Surgical Management
	Surgeries in Active Disease
	Surgeries for Healed TB
	Choice of the Osteotomy
	Conclusion
	References
Chapter 9a Guidelines for Management in Limited-Resource Settings: Pakistan Experience
	Pakistan Introduction
		Geopolitical
		Population
		Socioeconomic Status
		Healthcare System of Pakistan
		Health Financing
		Healthcare Facilities and Equipment
	Early-Onset Scoliosis
		Epidemiology
		School Health Services/Scoliosis Screening
		Modes of Presentation
		Beliefs
		Reasons for Delay
		Reasons for Refusal to Receive Treatment
	Health Personnel and Facilities
		Neurosurgeons
		Orthopaedic Surgeons/Spine Surgeons
		Institutions Caring for Scoliosis
		Electrophysiological Monitoring
		Management
		Scoliosis Data
		Ghurki Trust Teaching Hospital
	Treatment Options
		Conservative
		Surgery
		GTTH Protocol For EOS
		Conventional Growing Rods
		Difficulties Faced
		Solutions and Recommendations
		The Example of GTTH Spine Center
	Conclusions
	Acknowledgment
	References
Chapter 9b China Experience
	Introduction
	Main Body
	References
Chapter 9c Egyptian Experience of Surgical Management of Early-Onset Scoliosis
	Introduction
	Technique for the Index Surgery
	Technique for the Lengthening Procedures
	Results
	Discussion
	Conclusion
	Conflict of Interest
	Acknowledgements
	References
Chapter 9d Mozambique Experience
	Introduction
	Background
		Methods and Results
	Conclusion
	References
Chapter 9e Chile Experience
	Introduction
	Health Provision Organisation
		Administrative Organisation
	EOS Treatment
		Epidemiology
		Surgical Management
	Conclusion
	References
Chapter 9f Evolution of Experience and Practise in Two Nations
	Introduction
	Nottingham, 1999
	Cardiff, 2005
	Nottingham, 2007
	Operation Straight Spine (OSS), Kolkata
	Kolkata, 2011
	London, 2015
	SRS Golden Jubilee Meeting, Minneapolis, Minnesota, 2015
	Kolkata 2016–20
	Conclusion
	References
Chapter 9g Experience of EOS Management in Two Worlds-II
	Introduction
	Platforms That Deliver Care in LMICs
	Global Spine Outreach
	Challenges with EOS and STSMs in LMICs
	Success or Failure?
	Overcoming Challenges
	Surgeon Skill and LMIC Facility Mismatch
	Improvising or Staying Creative?
	The Role of Outreach in Training
	Conclusion
	References
Chapter 9h Cross-Border Spine Surgical Treatment: Issues to Consider
	Introduction
	Historical Perspective
	Basic Considerations
	Ethical Considerations of Patients Receiving Cross-Border Health Care
	Specific Risks in Medical Tourism
	Specific Risks in Outreach/Teaching Programmes
	A Suggested Example of a Patients’ Charter in Cross-Border Health Care
	Protection of the Surgeon
	Issues to Consider when Consenting to Cross-Border Surgical Treatments
	Conclusion
	References
Chapter 10 Future Considerations
	Introduction
	Change in Health Globalisation Policies
	Training Programmes
	Availability of Highly Experienced Surgeons in LMICs
	Conclusion
	References
Index