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Scoliosis and spine care

Scoliosis and spine care

Our proficiency in scoliosis and spine care is internationally renowned. 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. We have extensive experience in management strategies for patients of all ages and for all types of scoliosis ranging from casting for infantile scoliosis to definitive fusion in adolescents. We also provide growth-friendly solutions for children who require corrective surgery, but who are too young for spinal fusion procedures.

Graham Fedorak, M.D. trained with Jacques D’Astous, M.D., who brought the early treatment EDF (elongation, derotation, flexion) casting technique (often referred to as Mehta or Risser casting) to Salt Lake City. Dr. Fedorak has specialized in spine care and especially treatment in EDF casting. John Heflin, M.D., one of our orthopaedic spine specialists, also works closely with our scoliosis population and has extensive training in spinal deformity. Steve Santora, M.D., is another on-staff orthopaedic spine specialist with more than 20 years’ clinical practice, focusing on scoliosis surgery and international medicine.

Conditions treated:

  • Abnormal posture
  • Cervical instability
  • Congenital scoliosis
  • Curve progression after spine surgery
  • Early onset scoliosis
  • Hemivertebrae with fused or absent ribs
  • Idiopathic scoliosis, including infantile, juvenile and adolescent
  • Kyphosis, including Scheuermann'sap
  • 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’s
    • Neurofibromatosis
    • Thoracic insufficiency syndrome and other rib cage impairments
    • VACTERL
  • Spondylosis and spondylolisthesis
  • Torticollis

Diagnosing scoliosis

Medical history – When confirming a diagnosis of scoliosis, a doctor will speak with you and your child while also reviewing your child’s available medical records to determine if any medical conditions could contribute to the spinal deformity. Questions regarding muscle weakness, numbness, tingling, pain or any problems controlling the child’s bowel or bladder, will be asked.

Physical examination – An examination of your child’s back, chest, feet, legs, pelvis and skin will be performed. The doctor will check to determine if your child’s shoulders are level, whether their head is centered and if the opposite sides of the body appear even. Your child’s back muscles will be checked while they are bending forward to determine if one side of the rib cage is higher than the other. If there is any significant asymmetry between opposite sides of the body, the doctor may order an X-ray.

X-ray evaluation – If physical examination suggests possible scoliosis, two X-rays will be taken – one from the back and the other from the side. Each X-ray captures the entire spine and occasionally the doctor will need additional images. Often X-rays of the hand are also taken to determine your child’s skeletal age and growth remaining. 

Further imaging – certain patterns of deformity and findings on history and physical examination can sometimes prompt a need for advanced spinal imaging. This is typically an MRI (magnetic resonance image) of the spine and is not needed in most children seen for scoliosis. Learn more about our radiology services.

Curve measurement – If your child requires an X-ray evaluation, the doctor will measure the curve on the X-ray. Doctors classify curves of the spine by location, shape, pattern and cause. Whether or not treatment is required and the possible treatment options will depend not only upon the size of the curvature but also on how much growth your child has remaining.

Watch and wait — “you don’t have scoliosis you have spinal asymmetry” - We classify spinal curvatures of at least 10 degrees as scoliosis. Smaller degrees of deformity are called spinal asymmetry. Curvatures less than 10 degrees never need treatment. They can, however, progress and should be followed.  

Watch a tutorial by Graham Fedorak, M.D., on how you can perform an at-home screening with the Shriners Hospitals for Children SpineScreen app. As this is strictly an initial check, it should be followed up by a doctor’s examination to determine if your child has scoliosis. If your child does have scoliosis, Shriners Hospitals for Children may be able to help.

 

Nonsurgical options

Bracing

Bracing is a nonoperative treatment for idiopathic and nonidiopathic scoliosis.

  • May be combined with prescribed scoliosis-specific exercises
  • 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
  • Most orthotic devices are made in-house by Shriners Hospitals for Children — Salt Lake City

Serial casting (Mehta, EDF casting)

Serial casting is 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 options

Growth friendly systems

Expandable devices used in growing children with scoliosis:

  • 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 or hooks. The growing rods will then be surgically lengthened every six months depending on the advancement of the curvature of the spine and patient growth.
  • MAGEC stands for MAGnetic Expansion Control is a device implanted into the patient as a temporary internal bracing system for use in skeletally immature patients 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. 
  • Vertical expandable prosthetic titanium rib (VEPTR or titanium rib) is a titanium rod curved to fit the back of the chest and spine and is designed to be used for the growing child 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.

Definitive management

  • 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 to 50 degrees, or in skeletally mature patients with progressive curves or curves greater than 50 to 55 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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