What Happens During Spine Lengthening Surgery?

Spine lengthening surgery is a specialized medical intervention to manage complex spinal problems in growing children. Its purpose is to correct deformities and support the spine’s development during crucial years of growth. For patients with specific spinal conditions, these procedures offer a path toward improved posture and function.

Defining Spine Lengthening Surgery

Spine lengthening surgery encompasses procedures designed to gradually extend the length of the spinal column. The primary objective is to correct severe spinal curvatures while simultaneously permitting the child’s torso and chest to grow. This controlled growth is important for allowing adequate space for internal organs to develop properly.

These procedures are different from a standard spinal fusion, where vertebrae are permanently joined to stop growth in that spinal segment. Spine lengthening techniques, often called “growth-friendly” surgeries, use implantable devices that can be periodically adjusted. This allows the spine to lengthen over several years, guiding its growth and correcting the curve progressively.

The core concept is to provide internal support that controls the spinal deformity without permanently locking the spine’s growth potential. This approach balances the immediate need for curve correction with the long-term requirement for spinal development. The goal is to guide the spine’s growth until the child is mature enough for a more permanent solution.

Indications for Spine Lengthening

This surgery is for specific conditions, most notably early-onset scoliosis (EOS), a sideways spinal curve diagnosed before age ten. When a curve is severe and progressive, and nonsurgical treatments like bracing are insufficient, a growth-friendly surgical approach may be required to prevent the deformity from worsening.

Another primary indication is thoracic insufficiency syndrome (TIS), a condition where severe spinal deformities restrict the growth of the rib cage and lungs. This can lead to respiratory problems because the lungs lack space to develop. Spine lengthening helps expand the thoracic cavity, creating more room for the lungs to function properly.

The patient is a young child with significant growth remaining. Other conditions like congenital or neuromuscular scoliosis may also require this intervention. The decision for surgery is often made when a curve is at high risk of progressing beyond 50 degrees, a point at which it can cause major health issues.

Common Surgical Approaches

Surgeons use several techniques and devices, with the choice depending on the patient’s specific condition. The process involves an initial surgery to implant a device, followed by a period of active management. Common approaches include:

• Traditional growing rods, where one or two rods are surgically attached to the spine above and below the curve. These rods act as an internal brace and must be lengthened through a small surgical procedure, typically every six to nine months, to accommodate the child’s growth.
• Magnetically controlled growing rods (MAGEC), which are also implanted surgically but contain an internal magnetic actuator. This feature allows them to be lengthened non-invasively in a clinic setting using an external remote controller. This method significantly reduces the overall number of operations a child needs.
• The Vertical Expandable Prosthetic Titanium Rib (VEPTR) device, which is often used for patients with thoracic insufficiency syndrome. This device is anchored to the ribs, spine, or pelvis to help expand the chest wall and directly create more space for the lungs to grow and function.
• Growth guidance systems, like the Shilla technique, which use special screws that allow a rod to slide as the spine grows naturally. This approach guides the correction without the need for the regular lengthening procedures required by other systems.

Navigating Recovery and Rehabilitation

The recovery period begins immediately after the initial implantation surgery, which requires a hospital stay of several days. Pain management is a primary focus during this time, with medical staff providing medication to ensure the child is comfortable. Once the initial healing phase is over, a structured rehabilitation program is initiated to help the patient regain strength and mobility.

During the active lengthening phase, which can last for several years, specific care is required. Wound care at the incision sites is important to prevent infection, and families are educated on monitoring for implant-related complications. Activity levels are often restricted, particularly high-impact sports or activities where falls are likely, to protect the hardware from damage.

For patients with traditional growing rods, scheduled lengthenings require a return to the operating room for a minor procedure. Children with MAGEC rods undergo their lengthenings in an outpatient clinic, a process that is quick and does not require anesthesia. Throughout this period, regular follow-up appointments with the surgical team are scheduled to monitor the spine’s growth and the device’s function.

Life Following Spine Lengthening

Once a child has reached skeletal maturity or the desired correction has been achieved, the active lengthening phase concludes. For many patients, this culminates in a final spinal fusion surgery. This procedure makes the correction permanent by fusing the previously instrumented portion of the spine, and the growth-friendly implants are removed during this operation. After the final fusion, long-term follow-up care continues with less frequency to ensure the fusion is solid.

With a stabilized spine, many individuals can return to a more active lifestyle. While some high-contact or extreme sports may still be discouraged, participation in a wide range of physical activities is often possible. The successful completion of treatment allows these individuals to move past the phase of repeated surgeries and engage more fully in school, social activities, and daily life.