The following article was featured in Children's Hospitals Today:
For a complicated scoliosis surgery, an unusual approach improves efficiency
When Caleb Wanless arrived at Shriners Hospitals for Children in Chicago, he had one of the most severe cases of scoliosis the doctors there had seen. He was diagnosed with a 120-degree curvature of his spine. Typically, surgery is needed when scoliosis curves reach 50 degrees or greater, as recommended by the Scoliosis Research Society. In addition to the severe sideways spinal curvature of scoliosis, Caleb had kyphosis – an abnormal forward curvature of the spine – which was causing significant pressure on his spinal cord, due to the sharpness of curvature.
"It's among the more complicated procedures we've done," says Purnendu Gupta, M.D., chief of staff and pediatric spine surgeon at Shriners Hospitals for Children — Chicago. "In this instance, there was some compromise to the spinal canal…it was high-risk from a neurological standpoint."
It was clear that Caleb needed aggressive treatment, but first, Gupta and his team needed to determine if a safe and successful surgery was feasible. With an extensive spinal deformity program and many years of collective experience, the Shriners Hospitals team determined surgery for Caleb was indeed viable. From there, through a series of weekly meetings, the team devised a strategy for the procedure. It included an unusual approach for scoliosis surgery, two surgeons, Gupta and Kim Hammerberg, M.D., chief of spine surgery at the Chicago Shriners Hospital.
"Having two spine surgeons decreases the risk because we have two highly trained specialists to do the procedure together," Gupta says. "Having two surgeons who do this routinely also increases the efficiency and improves the outcome for the patient."
Leveraging 3-D technologyAs both surgeons and the rest of the Shriners Hospitals surgical team continued their preparations, they determined a 3-D model would help. They were able to build the model using CT scans of Caleb's spine.
While preparations for more routine scoliosis surgeries would depend solely upon two-dimensional images of a patient's spine, Gupta found the use of a 3-D model to have added benefit in this case. "It's tremendous to be able to see the problem in three dimensions – to hold the model, turn it around, look at it from different angles, to get your approach to the malformation," he says.
Success through teamworkThe 10-hour surgery took place in the spring and was very successful. The curvature of Caleb's spine was significantly reduced, and he has grown several inches as a result. Following a post-operation rehab stay at Shriners Hospitals, Caleb was able to return home.
Now 11 years old, Caleb is thriving. He still sees the team at Shriners Hospitals to continue with his rehabilitation, as well as treat other issues, including bilateral clubfoot, bilateral hip dysplasia and a femur deformation.
"The amazing opportunity we have as physicians at Shriners Hospitals is to be able to provide comprehensive care for children with complex deformities," Gupta says. "We work with a wonderful team of nurses, physical therapists, occupational therapists and recreational therapists to nurture the children and help them recover. I give the credit for our success to the team."
This article was published by Children's Hospitals Today on September 27, 2017