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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) to advanced surgical techniques in children who require spinal fusions. The spine team takes a fully integrated approach to the treatment of pediatric spine conditions.

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
  • 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 treatment options

Bracing

Nonoperative treatment for idiopathic scoliosis:

  • May be combined with prescribed scoliosis specific exercise
  • Can be effective in stopping the progression of the curve
  • 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

Scoliosis specific exercise (A Schroth-based program)

For adolescent idiopathic scoliosis:

  • A conservative treatment option to:
    • Maintain or minimize curve progression
    • Improve posture and aesthetic appearance
    • Improve overall quality of life
    • Provide education specific to your curve type
  • Requires patient to participate in two to three weekly sessions for 60 minutes, for a total of 15–20 sessions, or participate in a two-week intensive program two times a day
  • Must comply with a home exercise program designed by your physical therapist, up to 30 minutes per day
  • Adjunct to brace wear as prescribed by your orthopaedic physician

Serial casting

For infantile scoliosis when the curve is progressive:

  • Requires cast changes under anesthesia every two to three months
  • Casting straightens the spine through the continuous application of external force
  • Casting is an option versus bracing for improved compliance

Surgical treatment options

Fusionless surgery

Innovative newest treatment options for children with scoliosis:

  • Anterior vertebral body tethering (AVBT) 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. This device is currently not FDA approved for this indication and long-term data are lacking. Our results to date appear promising.

Growing systems

Expandable devices used in growing children with scoliosis:

  • 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, helping to correct spinal deformity and allow for the development of the chest and lungs.
  • Growing rods – Growing rods allow for continued and controlled spine growth. This is performed as a surgical procedure through the back where the rods are attached to the spine both above and below the curves with screws. The growing rods will need to be lengthened under anesthesia every four to six months, depending on the advancement of the curvature of the spine.

  • MAGnetic expansion control (MAGEC) spinal bracing and distraction system – MAGEC rods are for younger children with curves less than 50 degrees. With MAGEC rods, a surgical procedure for implantation is required, 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

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.

   
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