The new braces are more cosmetically pleasing and more comfortable than earlier models. Some patients, however, have curves that progress faster than others and must be fused early. Killian says each year brings improved instrumentation systems that are designed to overcome limitations of the Harrington rod system, which had few points of fixation to the spine and often failed to provide the degree of stability necessary to correct the curvature. Conklin says today's systems use multiple hooks with at least two cross-linked rods to provide greater stability. This allows better correction of the curve while providing maximum fixation.
Preoperative planning is much more involved today and allows for tailored hook placement.
Experience with these systems has allowed us to decrease operative times to an average 4 hours for correction of adolescent idiopathic Scoliosis, using a routine posterior approach and iliac crest bone grafting. The average patient goes home in 5 days. Conklin says earlier intervention and more powerful instrumentation frequently are required for correcting neuromuscular Scoliosis. Luque rods with sublaminar wires, which allow us to apply greater forces across the curves, work best. Innovative Anterior Approaches Conklin and Killian also are trained in using anterior approaches, which are indicated in a fairly large minority of idiopathic and neuromuscular curves.