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Scoliosis and spine care

Scoliosis and spine care

Scoliosis and spine care

From common idiopathic adolescent scoliosis to the most complex young spine deformities, we believe each child deserves an individualized treatment plan utilizing the most advanced and innovative techniques. Our focus is early detection and fusionless treatments for the growing spine, as well as minimally invasive (nonfusion) treatments to advanced surgical techniques in those children who require spinal fusions. The spine team takes a fully integrated approach to the treatment of spine conditions.

Overview of the conditions treated:

  • Idiopathic scoliosis, including infantile, juvenile and adolescent
  • Congenital scoliosis
  • Scoliosis with syndromes including:
    • VACTERL
    • Marfan
    • Neurofibromatosis
    • Klippel-Feil syndrome
    • Thoracic insufficiency syndrome and other rib cage impairments
  • Mesenchymal scoliosis, including osteogenesis imperfecta
  • Torticollis
  • Cervical instability
  • Neuromuscular scoliosis associated with:
    • Spinal cord injury
    • Cerebral palsy
    • Spina bifida
    • Tethered spinal cord
    • Kyphosis, including Scheuermann's
    • Spondylosis and spondylolisthesis
    • Curve progression after spine surgery
    • Abnormal posture
    • Hemivertebrae with fused or absent ribs
    • Scoliosis after thoracotomy

Nonsurgical options

Bracing

Bracing is a nonoperative treatment for idiopathic scoliosis that:

  • May be combined with prescribed scoliosis-specific exercise
  • Can be effective in stopping the progression of the curve
  • Has a schedule and type of brace that is dependent on the location and degree of the curve

Bracing is the best nonsurgical treatment for most kinds of scoliosis. Braces are customized to meet the needs of the patient. Compliance with wearing the brace is vital to the success of bracing treatment.

Serial casting

Serial casting is for infantile scoliosis when the curve is progressive.

Serial casting:

  • Requires cast changes under anesthesia every two to three months
  • Straightens the spine through the continuous application of external force

Casting is an option versus bracing, for improved compliance.

Surgical options

Fusionless surgery

The newest innovative treatment options for children with scoliosis:

Anterior vertebral body tethering (AVBT) is a minimally invasive procedure, which produces stabilization for the anterior thoracic and lumbar spine and avoids spinal fusion. Using bone screws and a flexible cord, the spine curve is gently straightened during surgery. Additional correction occurs as the spine is allowed to grow. The device is not currently FDA approved for this indication, and long-term data is lacking. Our results to date appear promising.

Growing systems

Growing systems are expandable devices used in growing children with scoliosis.

Vertical expandable prosthetic titanium rib (VEPTR or titanium rib) is a titanium rod curved to fit the back of the chest and spine – designed to primarily be used for growing children with a chest wall deformity and thoracic insufficiency, helping to correct spinal deformity and allow for the development of the chest and lungs.

Growing rods allow for continued and controlled spine growth. This is a surgical procedure through the back for the spine, where the 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.

Self growing rods are growing rods that do not require repetitive lengthening, as the spine drives the gliding mechanism. The surgical technique is known as modern Luque trolley using trolley gliding vehicles.

MAGnetic expansion control (MAGEC) spinal bracing and distraction system is for younger children with curves less than 50 degrees. MAGEC rods require a surgical procedure for implantation, but the noninvasive lengthening procedure eliminates the need for repeated lengthening surgeries. The MAGEC system is composed of two magnetic, telescoping rods that can be gradually lengthened from outside the skin after initial implantation. This procedure uses an external remote controller in the outpatient department.

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 50 degrees. Rods and screws are attached to the curved part of the backbone and the spine is straightened. Small pieces of bone graft are then put over the spine; this will grow together with the spinal bone, fusing it into the proper position. In addition to improved internal fixation, posterior spinal fusion allows earlier mobilization of the patient. A spinal fusion also helps prevent severe deformity and can avoid years of bracing.

Inclusive approach to care

The Canada Shriners Hospital's pediatric orthopaedic staff work collaboratively with primary care physicians, parents and the patient to develop comprehensive treatment plans that meet the individual needs of each patient. Through innovative pediatric care, we instill confidence and teach patients that there are no limits to what they can do. Regardless of your child's medical condition or needs, you can expect to benefit from the expertise of a multidisciplinary team dedicated to the needs of your child. Our hospital helps ensure patients receive an optimal outcome by providing all aspects of inpatient and outpatient pediatric orthopaedic care, including surgery, on-site rehabilitation, treatment and psychological support.

   
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