The Cutting Edge - Summer 2004




Fall 2006

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Cleveland, OH
44106
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(800) 552-8338

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Spinal Deformity in Children

Dear Colleagues,

I am pleased to introduce you to Dr. Douglas Armstrong, the newest member of the Division of Pediatric Orthopaedic Surgery at Rainbow Babies & Children’s Hospital and Assistant Professor of Orthopaedic Surgery at the Case School of Medicine. In this issue of The Cutting Edge, Doug provides a thoughtful and comprehensive update about spinal deformity in children – where we have been, where we are now, and where we are going.

Doug earned his medical degree from the University of Ottawa and interned at Memorial University of Newfoundland. He completed an Orthopaedic Residency at McGill University and is fellowship-trained in Spinal Surgery (University of Ottawa) and Pediatric Orthopaedic Surgery (Children’s Hospital of Buffalo).

Doug came to Rainbow this year from the Children’s Hospital of Buffalo, where he had served as a member of the Division of Pediatric Orthopaedic Surgery since 1991. His special expertise is in pediatric and adolescent spinal problems, scoliosis, clubfoot and neuromuscular problems, as well as Minimally Invasive Thoracoscopic Spinal Surgery.

The enclosed lecture on spinal deformity contains information that will be of interest both to the casual reader and the expert in the field. To view this narrated presentation, click on the CME tab at the top of the page. You can earn continuing medical education (CME) credit from Case Western Reserve University School of Medicine by answering a few questions on-line. To contact Doug, or any of the Rainbow surgeons, click on the Divisions tab above.

I hope you will find this issue of The Cutting Edge useful in your practice.
Alan R. Cohen, MD	Sincerely, Alan R. Cohen, MD, FACS, FAAP Surgeon-in-Chief and Chief of Pediatric Neurological Surgery Reinberger Chair in Pediatric Neurological Surgery Rainbow Babies & Children's Hospital Case Western Reserve University School of Medicine

Spinal Deformity in Children and Adolescents

— The Perspective in 2004

Douglas G. Armstrong, MD

Division of Pediatric Orthopaedic Surgery

Disorders of the spine in children and adolescents are common and are a frequent reason for referral to a Pediatric Orthopaedic surgeon. In recent years, many of our ideas about spinal deformity have changed, as Orthopaedic surgeons have come to a better understanding of normal spinal physiology, and its role in normal human growth and development.

Adolescent Idiopathic Scoliosis, a condition that develops spontaneously in teenagers, is the most common spinal deformity. Intensive research into AIS has led to a better understanding of all spinal deformities. Our current knowledge of normal spinal growth and development and its relationship with trunk and limb growth also has contributed immensely to how deformity is perceived and treated. If a spinal curvature occurs in a 5-year-old there will be considerably different effects on the patient’s trunk and chest development than would occur in an 11-year-old. Goals of treatment now include achievement of normal spinal balance in all three planes and maintenance of mobility and flexibility for optimal long-term function. Modern techniques of bracing and surgical intervention, including minimally invasive approaches, are discussed in this presentation. With the available surgical techniques, satisfactory curve correction can be achieved for most patients.

The prognosis and treatment for scoliosis vary according to magnitude of the curve and age of onset. In the case of the very young patient with a severe, progressive curve, early operative intervention rather than prolonged bracing is currently advocated. There is a long history of treatment of spinal deformity at Rainbow Babies & Children’s Hospital. Under the leadership of George Thompson, MD, the Division of Pediatric Orthopaedic Surgery has developed an interest in Infantile and Juvenile Scoliosis. We continue to perform research as part of a large "growing rod" study group. In addition, a protocol that minimizes blood use in spinal surgery has been successfully developed.

Click here For AudioVisual entitled "Spinal Deformity in Children and Adolescents - The Perspective in 2004" presented by Douglas G. Armstrong, MD

Announcements

Rainbow Best in the Midwest

According to U.S.News & World Report’s latest hospital rankings, Rainbow Babies & Children's Hospital is once again ranked #1 in Ohio and #1 in the Midwest, ranking sixth among all pediatric programs in America.

Dr. Palmer Gets Leadership Position

Jeffrey S. Palmer, MD has been elected to the Ohio Urological Society Board of Directors Executive Committee. Dr. Palmer is Director of Minimally Invasive Pediatric Urology at Rainbow and Assistant Professor of Urology and Pediatrics at the Case School of Medicine.

Dr. Robinson Awarded NIH Grant

Shenandoah "Dody" Robinson, MD has received a five year K08 Research Career Development Award from the National Institutes of Health to study disruption of neural cell development after systemic perinatal insult. This work focuses on novel neonatal interventions to prevent cerebral palsy, cognitive delay and epilepsy. Dr. Robinson is Surgical Director of Rainbow's Epilepsy Center and Assistant Professor of Neurological Surgery and Neuroscience at the Case School of Medicine.