13 Jan 2010

The University of Hong Kong has, for the first time in the world, applied a revolutionary new technology to treat scoliosis in children. The technology was developed in the United States, in which an implanted rod can help straighten a deformed spine, and the rod can be lengthened as necessary by remote control while the child grows. Two cases were successfully operated by Professor Kenneth Cheung Man-chee, Principal Investigator of the project, and Professor Keith Luk Dip-kei, Tam Sai-Kit Professor in Spine Surgery and Head of Department of The Department of Orthopaedics and Traumatology, The University of Hong Kong, Li Ka Shing Faculty of Medicine in November and December of 2009.

Scoliosis and its treatment

Scoliosis is a condition in which the spine is curved from side to side, and cannot be corrected simply by learning to stand up straight. On an x-ray, a scoliotic spine looks more like an "S" or a "C" than a straight line. Some of the bones may also rotate slightly, making the person's waist or shoulders appear uneven. In more than 80% of the cases, no specific cause is found. Conditions known to cause spinal deformity include congenital spinal column abnormalities, neurological disorders, genetic conditions etc. The overall incidence is approximately 3 to 5 per 1000 children.

Previous treatments for scoliosis in children under 10 years of age

For curves developing progressively in growing children, bracing can help to slow the progression and allow the child to grow before surgery is done. However, the brace needs to be worn the whole day and can result in significant discomfort and changes in body shape. As the child grows, new braces will need to be fabricated every 12 to 18 months.

For children not suitable for bracing, such as those with soft bones, skin intolerance, mental retardation, or with large (45-50 degree) and stiff curves, surgery is often needed.

The aim of surgery is to stop or control the progression of the curve without adversely affecting growth of the child. One of the procedures being used is a “growing rod” operation. In this procedure, the curve is spanned by one or two rods under the skin to avoid damaging the growth tissues of the spine. The rods are then attached to the spine at the top and bottom ends of the curve with hooks or screws. The curve can usually be corrected by fifty percent at the time of the first operation. The child then returns every six months and has a surgical procedure under general anaesthesia to lengthen / distract the rod by approximately one to two centimeters to further correct the curvature and to keep up with the child's growth.

Revolutionary treatment – implanting an expandable device lengthened by remote control

The new Spinal Bracing and Distraction System comprised of an implantable spinal instrumentation including a rod with a distraction element (actuator), which allows the rod to be lengthened non-invasively by remote control. The actuator is remotely operated and lengthened by use of an external motorized magnet. The rotation of the cylindrical rare earth magnet causes the rod to lengthen thereby further correcting the spinal curvature and allowing the spine to grow. Distraction can be performed at any time over the growth period in order to lengthen the implant to follow natural spinal growth. The distraction can also be decreased as needed with the remote control. The whole distraction process was completed in our patients in less than 30 seconds, with the child fully awake. This device is only suitable for selected patients with early onset of scoliosis.

The Department aims to operate on more patients using this new device, thus reducing the need for multiple surgeries at a young age.

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