Pediatric Scoliosis Correction: Comparing Costs in Developing Nations

Scoliosis Surgery in Children: Correcting Spinal Curvature

Scoliosis is a sideways curvature of the spine that most often occurs during the growth spurt just before puberty. While some children have mild curves that they outgrow, others have curves that worsen over time. Severe scoliosis can be disabling as the curvature becomes more pronounced.   

Scoliosis surgery aims to correct the spinal curvature and prevent it from worsening. It typically involves a procedure called spinal fusion.

Spinal Fusion Surgery

During spinal fusion surgery:

• The surgeon makes an incision in the back (posterior approach), chest (thoracotomy), or both. Minimally invasive techniques using smaller incisions are also available in some cases.
• The surgeon straightens the spine as much as possible.
• Bone grafts (taken from the patient's body or a bone bank, or synthetic substitutes) are placed to help the vertebrae fuse together over time.
• Metal implants such as rods, screws, hooks, and wires are used to hold the spine in the corrected position until the bone grafts heal and the fusion is solid. These implants usually remain in the body permanently.
• In younger children who are still growing, surgeons may use growing rods that can be lengthened periodically to accommodate growth until the child reaches skeletal maturity, at which point a final fusion surgery may be performed. Magnetic growing rods can be lengthened non-invasively using a remote control.
• Another non-fusion technique for younger children is vertebral body tethering (VBT), a minimally invasive procedure where a flexible cord is attached to the outside of the spinal curve. Tightening the cord helps to straighten the spine while allowing for continued growth.

Why is Surgery Performed?

Surgery is typically recommended for children with:

• Severe scoliosis (curves of 45-50 degrees or more).
• Scoliosis that is progressing despite bracing or other non-surgical treatments.
• Curves that could potentially affect breathing or other bodily functions.

The goal is to correct the curve, prevent further progression, and improve the child's posture and potentially relieve pain.

The Challenges of Scoliosis Surgery in Resource-Limited Settings

In many countries, access to scoliosis surgery is limited due to a lack of resources and trained specialists. This can lead to long waiting lists and significant challenges for families.

• Limited Resources: In some countries, only one scoliosis surgery can be performed per week, resulting in a waiting list of several years. This can be devastating for families, as the condition can worsen during this time.
• High Cost of Implants: Spinal fusion surgery requires specialized implants, which can be very expensive. These implants are often provided by the government but obtaining them can be a difficult and bureaucratic process.
• Additional Expenses: Even with free government surgeries, there are many other expenses associated with the procedure, including:
  • Pre-operative investigations
  • Post-operative ICU care
  • Special sutures (stitching threads), bandages, and plasters, which may be in short supply and require patients to purchase themselves.
• Donations and Support: To help offset these costs, organizations often rely on donations to provide essential supplies and support to patients in need.

The Private Sector Alternative

While government-funded surgeries offer a lifeline for many, the long wait times and associated costs can be overwhelming. For families who can afford it, private hospitals offer an alternative with shorter wait times and potentially better facilities. However, the cost of scoliosis surgery in the private sector can be prohibitively expensive for most families.

Cost of Scoliosis Surgery in Third World Countries

The cost of scoliosis surgery varies significantly depending on several factors, including:

• The complexity of the surgery and the extent of the spinal curve.
• The type of implants and techniques used.
• The hospital and surgeon's fees.
• The length of the hospital stay and post-operative care required.
• The country and specific medical facility where the surgery is performed.

Generally, the cost of scoliosis surgery in third-world countries is considerably lower than in developed nations like the United States or Europe. Based on available information, some countries known for more affordable scoliosis surgery include:

• India: Costs can range from approximately USD 8,000 to USD 12,000.
• Turkey: Costs can range from approximately USD 8,500 to USD 20,000+, depending on the hospital and specific procedures.
• Thailand: Costs can range from approximately USD 5,000 to USD 15,000.
• Iran: Reportedly one of the cheapest options, with costs potentially ranging from USD 4,000 to USD 6,000.
• Philippines: Costs may range from USD 9,000 to USD 15,500.

It's important to note that these are estimated ranges and the actual cost can vary. These figures may or may not include pre-operative tests, medications, and rehabilitation. It is crucial to obtain detailed cost estimates from specific hospitals in these countries.

Scoliosis surgery is a major decision for any family. However, it can be a successful treatment option for children with severe scoliosis. In resource-limited settings, access to this critical surgery can be challenging due to long wait times, high costs, and limited resources. Families often rely on government support and charitable organizations to navigate these obstacles and ensure their children receive the care they need.