THE ROLE OF ENDOSCOPY IN TREATMENT OF ADOLESCENT IDIOPATHIC SCOLIOSIS

Abstract

Scoliosis is defined as a spinal curvature in the coronal plane greater than 10° as measured by the Cobb method. However, scoliosis is a deformity that generally occurs not only in the coronal, but also in the sagittal and transverse planes. Idiopathic scoliosis constitutes about 80% of all cases of scoliosis and is categorized by the age of onset to infantile (0-3 years old), juvenile (4-10 years old), and adolescent(> 10 years old) Idiopathic scoliotic curves of more than 10 degrees are estimated to occur in 2% to 3% of children younger than 16 years of age. Small degrees of scoliosis are very common but larger curves occur much less frequently. Less than 10% of children with curves of 10 degrees or more have a progressive curve and require treatment. The exact etiology of idiopathic scoliosis, however, remains unknown at this time. The general consensus is that there is a hereditary predisposition and its actual cause is multi factorial. Once scoliosis has been discovered in a child, the curve must be evaluated for the probability of progression. Most authors define progression as an increase of 5 degrees or more measured by the Cobb measurement over two or more visits 6 month apart. What is unknown is, whether this progression will continue and what the final curve will be. The complications of curve progression include (1) Pulmonary function deterioration. (2) Mortality. (3) Psychosocial effects. (4) Back pain. (5) Neurological deficit.

Various methods have been used to treat adolescent idiopathic scoliosis. The two most widely accepted non-operative techniques for idiopathic scoliosis are observation and bracing. During the last century the technological advances in the field of spinal surgery had a dramatic impact on the treatment of spinal deformity in children and adults. In the 1950s and 1960s, owing to the efforts of Harrington and others, the process evolved to create the first generation of modem spinal instrumentation. Segmental fixation involving sub-laminar wires was introduced in the 1970s by Luque. Anterior approaches and instrumentation-related techniques developed by Zielke and his colleagues as well as Dywer and his coworkers in the late 1960s and mid-1970s allowed better correction of deformity with immobilization of fewer motion segments