New Advances in Treating Pediatric Spine Disorders
At one time, surgical treatment of scoliosis was “torturous,” Dr. Brian Shaw says – including surgery done in stages and the patient in a full body cast for up to a year.
I don’t know how they got anybody to agree to that,” says Shaw, a pediatric orthopedic surgeon with Children’s Hospital Colorado. Today, he says, surgery is quicker, safer and more efficient.
Scoliosis causes a sideway curve in the spine. There are different types of scoliosis that affect children and adolescents; the most common is “idiopathic,” meaning the exact cause is unknown.
“It’s clearly a genetic condition,” Shaw says, “but it doesn’t always appear in successive generations and it can vary in individuals from one generation to the next in terms of severity.”
Idiopathic scoliosis is more common in girls and often is minor enough that no treatment is required. A brace is used in more severe cases, Shaw says. Until recently, there was little evidence a brace helped, he says. But a study a few years ago confirmed certain braces are quite effective for certain types of scoliosis. The brace is worn until the child has stopped growing.
Surgery is performed in the most extreme cases. The procedure involves exposing the spine, straightening the curve as much as safely possible and using a bone graft to fuse the area and metal implants to hold the spine in position.
Shaw ticks off several advancements, including improved pain control, spinal-cord monitoring during the surgery and the use of synthetic bone grafts. In the old days, bone was harvested from the patient’s pelvis or elsewhere, meaning more surgery and more pain. Another option is allograft — using bone tissue from cadavers – but that raised the concern of transmitting disease.
Patients now get out of bed on the day of surgery and are in the hospital for days instead of weeks or months, Shaw says. “Most kids return to light-level sports a few weeks after surgery and full sports three months after surgery.”
Despite all of the advances, Shaw says, it remains “a very, very big operation.” A brand-new tool is helping surgeons: Children’s Hospital Colorado is the first pediatric facility to use new 3D-printed FIREFLY technology in the treatment of scoliosis. After scans of the patient are taken, the technology is used to create a 3D-printed exact anatomical replica of the spine. It helps the surgeon know exactly what he or she is facing, Shaw says, and also offers a guide to exact placement of screws or other hardware to attach the metal implants.
The surgical advances also help in treating a different spinal curvature, Scheurmann’s kyphosis. Less common than scoliosis, it involves a forward bend in the spine, Shaw says. “For some reason, the front of the spine stops growing and the back keeps growing, so they just grow more and more pitched forward.” Treatment with physical therapy and bracing can often ward off the need for surgery, he says.
“It’s really just amazing how far we’ve come,” Shaw says.