Orthopaedic Surgery
Treatment Options
The pediatric orthopaedic surgeons at NewYork-Presbyterian Morgan Stanley Children's Hospital are dedicated to advancing treatment options for Early Onset Scoliosis through research and clinical innovation. Many children with EOS do not require treatment -- close clinical follow-up is needed, but many do not progress. For those who do demonstrate progressive curves, there are a number of options outlined below. For children who experience progression of scoliosis early intervention is indicated to prevent chest wall deformity and to allow normal lung development.
The pediatric orthopaedic surgeons at Morgan Stanley Children's Hospital are dedicated to advancing treatment options for Early Onset Scoliosis through research and clinical innovation.
Upon meeting, each child will be evaluated and appropriate treatment options will be discussed. Although early results are positive, the new treatments using VEPTR, Growing Rods, and Stapling do not have an extensive history. Results may vary for each patient.
Casting for Infantile and Juvenile Scoliosis
The very young child with scoliosis is often not a candidate for surgery and in fact may not need surgery. The Early Onset Scoliosis Center has state-of-the-art noninvasive treatment techniques available for these children. The patient has a cast applied to the trunk on a specially designed table that allows us to control and correct the curves. The cast is changed regularly until the curve is appropriately reduced.
Spinal Fusion is NOT Recommended Treatment for EOS
Ground breaking research in 2007 by the Pediatric Orthopaedic Research Team at Morgan Stanley Children's Hospital revealed that spinal fusion, once a standard practice when treating early onset scoliosis, prevents growth of the spine and thorax during a critical period of lung development. The patients with early fusion had poor pulmonary function and a significantly decreased quality of life. Surgeons at Morgan Stanley Children's Hospital and other specialized centers, therefore, attempt to avoid spinal fusion in young children with early onset scoliosis. Where spinal fusion has been shown to improve quality of life and life expectancy in adolescents who have achieved normal pulmonary capacity before the onset of scoliosis, this treatment has quite a different result in skeletally immature children. Spinal fusion irreversibly limits growth of the patient's spine, thorax and lungs and may result in progressive pulmonary insufficiency.
In the webcast, "Avoiding Fusion in Early Onset Scoliosis: Growing Rods and the VEPTR (Vertical Expanding Prosthetic Titanium Ribs) Treatment Option for Children Suffering from Early Onset Scoliosis," Morgan Stanley Children's Hospital surgeons discuss why spinal fusion should be avoided and the new techniques that are available to treat young children with early onset scoliosis. These new options offer hope and significantly improve patients' outcomes and quality of life.
Avoidiing spinal fusion is the goal, however, there may be times when it is the only treatment option. As mentioned, all options will be discussed when determining the most effective treatment plan specific to each patient.
VEPTR and Growing Rods
Treating Early Onset Scoliosis with growing rods and/or VEPTR permits continued growth in the spine, maximizes space available for lungs and enhances pulmonary function. VEPTR -- Vertical Expandable Prosthetic Titanium Rib -- is the most advanced treatment option for children with Thoracic Insufficiency Syndrome (TIS). While the condition is rare (less than 4,000 children in the U.S. each year), children with TIS have severe deformities of the chest, spine and ribs that prevent normal breathing and lung development. VEPTR straightens the spine and opens a larger space for the lungs and other internal organs to grow by placing a titanium device between two ribs to push them apart. VEPTR can be expanded through an outpatient surgical procedure as the patient grows.>/p>
"Before VEPTR, we had no way of dealing with the entire chest wall," explains Dr. David P. Roye, Jr. "Straightening the spine without growing the ribcage was not enough. Now we can straighten the spine while we increase room in the rib cage for the lung.
For more details link to The Titanium Rib.
Growing Rods are used in a similar fashion to VEPTR. Rods are attached to the spine and affixed to vertebrae at the top and the bottom. Growing rods are expanded over time using a mechanism that allows the lengthening to be performed in a simple outpatient surgery. The approach minimizes spinal deformity, allows spine growth and most importantly allows lung development to occur to preserve a normal life span for the patient.
By increasing pulmonary capacity as well as straightening the spine, these treatments provide significant quality of life improvements and promote normal respiratory function. The complex care required by children diagnosed with early-onset scoliosis has tended to limit their treatment to children's hospitals offering a convergence of strong orthopaedic, pulmonary and ICU facilities. Morgan Stanley Children's Hospital's orthopaedic teams have significant experience in applying these techniques and are continuing to develop and test techniques, and share in research, with the expectation of even better outcomes in the future.
Spinal Stapling
Morgan Stanley Children's Hospital is one of only a few hospitals in the country to offer spinal stapling, a new treatment alternative for scoliosis patients who have progressive scoliosis at a young age. Spinal stapling modulates growth allowing correction of curves without fusion and without the necessity of multiple procedures. "Stapling not only stops scoliosis from getting worse, but can even correct the curve. While stapling is very new," says Dr. Michael Vitale, "it promises to have a major effect on how we treat young people with scoliosis."
Spinal stapling is a two-hour minimally invasive surgery that involves implanting inch-long metallic staples across the growth plates of the spine. Made of a high-tech temperature-sensitive metal alloy, the staples are implanted using a camera called a thoracoscope with a very limited incision and minimal scar. The procedure is available to children with progressive moderate scoliosis (less than 30 degrees) who are still growing (girls up to age 14 and boys up to age 16).
Spinal Stapling and VEPTR or Growing Rods
For children with larger curves, the benefits of growing instrumentation -- Growing Rods or VEPTR -- can be combined with spinal stapling. This new hybrid technique is being applied for curves greater than 35 degrees and patients are showing tremendous outcomes. Children return to active vibrant lives just months after surgery. Adjustments are made every six to nine months during their growth periods and usually completed on an outpatient basis.
Casting
Our infantile idiopathic casting program utilizes an Amil casting frame and follows the techniques of Dr. Min Mehta to utilize growth as a corrective force in the treatment of progressive infantile scoliosis. Further information about casting including tips for care of the young child in a spinal cast are available at http://www.infantilescoliosis.org/
