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Scoliosis and spine care

Scoliosis and spine care

The mission of our spine clinic is to provide early diagnosis and treatment of common to complex pediatric spinal deformities and conditions through advanced medical and surgical treatment. We believe each child deserves an individualized treatment plan with a family centered approach.

At Shriners Hospitals for Children — Erie, our primary focus is on the growing pediatric spine.

Conditions treated:

  • Abnormal posture
  • Cervical instability
  • Congenital scoliosis
  • Hemivertebrae with fused or absent ribs
  • Idiopathic scoliosis, including infantile, juvenile and adolescent
  • Kyphosis, including Scheuermann's
  • Neuromuscular scoliosis associated with:
    • Cerebral palsy
    • Spina bifida
    • Spinal cord injury
    • Tethered spinal cord
  • Scoliosis after thoracotomy
  • Scoliosis with syndromes including:
    • Klippel-Feil syndrome
    • Marfan
    • Neurofibromatosis
    • VACTERL
  • Spondylosis and spondylolisthesis
  • Torticollis

Nonsurgical treatment options

Bracing

  • Bracing can be effective in stopping the progression of the curve.
  • The Schedule and type of brace will depend on the location and degree of curve.
  • Compliance with wearing the brace is vital to the success of bracing treatment.

Mehta casting

  • Mehta casting is used for infantile scoliosis when the curve is progressive.
  • This method requires cast changes under anesthesia every two to three months.
  • Casting straightens the spine through the continuous application of external force.
  • Casting, if started at a young age, can make the curve disappear in some children.

Scoliosis specific exercises

  • This method incorporates customized exercises designed to return the patient’s curved spine to a more natural position.
  • The goal is to de-rotate, elongate and stabilize the spine in a three-dimensional plane.
  • Effectiveness is highly dependent on ability and commitment of patients and caregivers.

Surgical treatment options

Each child’s condition is unique. After evaluation, our orthopaedic surgeons will determine the most appropriate treatment option available.

Growth friendly systems

Expandable devices used in growing children with scoliosis:

  • Growing rods – Growing rods are used in younger patients with progressive curves and significant growth remaining. They are used to partly correct the spinal deformity, while also allowing the patient to grow. These patients have typically failed conservative measures, such as casting or bracing. Growing rods require a surgical procedure through the back. Expandable rods are attached to the spine both above and below the curves with screws. The growing rods are lengthened under anesthesia every four to six months, depending on the advancement of the curvature of the spine and patient growth.
  • Vertical expandable prosthetic titanium rib (VEPTR or titanium rib) – This is a titanium rod curved to fit the back of the chest and spine, and is designed to primarily be used for growing children with a chest wall deformity and thoracic insufficiency. VEPTR helps to correct spinal deformity and allow for the development of the chest and lungs. VEPTR, like growing rods, requires periodic expansion to match the spinal growth of the child.
  • MAGnetic expansion control (MAGEC) – MAGEC is a device that is implanted into the patient as a temporary internal bracing system for use in patients whose bones and skeletons are still immature with progressive spinal deformity that is nonresponsive to bracing, casting or other nonsurgical treatments. Unlike traditional growing rods or VEPTR, once implanted the device can be expanded in clinic noninvasively. This allows the child’s spine to grow while avoiding multiple trips to the operating room. The MAGEC System is composed of two magnetic, telescoping rods that are gradually lengthened from outside the skin after initial implantation. This procedure uses an external remote controller in the outpatient department every three months.

Spinal fusion surgery

Spinal fusion surgery is recommended to correct a curve or stop it from progressing when the patient is still growing and has a curve that is greater than 45–50 degrees. Screws or hooks are placed into the vertebrae through the curved portion of the spine. Rods are then attached to the screws and hooks which result in straightening of the deformity. A bone graft is then placed over the spine. The bone graft will grow together with the individual bones of the spine, resulting in a fusion of the corrected spine in the proper position. Spinal fusion is a good option for select patients as it corrects much of the cosmetic deformity, can significantly improve sitting and standing posture, and most importantly prevents continued progression of deformity, which may otherwise become severe.

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