Setting Young Spines Straight
Pushing the Boundaries of Scoliosis Treatment
For youngsters whose spines are bent with scoliosis, the approaches coming out of Cincinnati Children’s Spine Center are nothing short of life-changing.
Early Detection is Important
Scoliosis often develops unnoticed – and worsens with teenage growth spurts. It is often painless, making detection difficult. That is why many schools provide screenings; if not, your family doctor can check for it. Once detected, a physical and X-rays can determine the extent of the problem. Whether and how to treat it depends on many factors, including a child’s age, the nature of the curve and how much a child may continue to grow. If you suspect your child has curvature in the spine, have it checked out as early as possible.
“We look for early assessment so we can identify the curves that may ultimately require intervention,” says Alvin Crawford, MD, director of Cincinnati Children’s Spine Center.
Improved, Less Invasive Options
When intervention is necessary, new treatments are available that are more effective and less invasive. Some children can be helped with videoassisted thoracoscopic surgery (VATS). Dr. Crawford is an international authority on this minimally invasive technique, which replaces the 15-inch incision of traditional fusion surgery with four one-inch incisions on a patient’s side.
Other patients may be better suited for growing rods, which reduce the need for braces. “When we diagnose children at 8 or 10 years old,” Dr. Crawford says, “they could face seven or eight years of bracing. Instead, I can use growing rods with hooks or screws as anchors. These children have a surgery every six months or so to lengthen the rods as they grow. This avoids fusion, and children can remain fairly active, living without a brace most of that time.”
For other patients, the treatment of choice remains the traditional surgical fusion of vertebrae, stabilizing the spine with a corrective metal rod and hooks or screws. This method helps prevent the progression of scoliosis.
Bracing a Thing of the Past?
Researchers here are re-examining the merits of traditional bracing to realign the spine. Cincinnati Children’s is Ohio’s only center in the multisite Bracing in Adolescent Idiopathic Scoliosis (AIS) Trial of the National Institutes of Health to study the value of bracing. Researchers are comparing the risk of curve progression in teens with AIS who wear a brace to the risk of those who do not.
A minimally invasive technique developed by spine surgeons here could revolutionize treatment of early onset scoliosis. It eliminates extensive spinal fusion to correct an abnormal curvature. “This new technique staples together the growth plates on the actively growing side of the deformity and allows the other side of the spine to catch up,” says Dr. Crawford. The method is currently under review by the Food and Drug Administration and is not yet available to patients.
Other research involves locating the genes responsible for scoliosis and evaluating a less invasive posterior spinal fusion technique.
