Advanced procedures promote spine growth and are more tolerable

Traditional surgical techniques for pediatric patients with severe spinal deformities can cause unfavorable effects on the development of the thorax, lungs and trunk, as well as increased pain and morbidity, according to the Scoliosis Research Society.

Orthopaedic surgeons at University Hospitals Rainbow Babies & Children’s Hospital are using advanced surgical techniques: growing rods, video-assisted thoracoscopic surgery (VATS) and posterior-only spinal fusion with spinal osteotomy to correct severe spinal deformities in an attempt to minimize the negative sequelae of more traditional techniques.

With these advanced surgical techniques, the team is successfully treating patients with idiopathic scoliosis and a high-magnitude curve who are under the age of 10, as well as pediatric patients with severe spinal deformities who have an underlying neuromuscular disorder (e.g. cerebral palsy, spina bifida or neurofibromatosis). Although these patients are usually asymptomatic, it is crucial to treat them because once the spinal curve reaches about 45 degrees it will continue to progress and is likely to interfere with cardiac and respiratory function.

In patients who are not candidates for growing rods, VATS and posterior-only spinal fusion, UH Rainbow Babies & Children’s Hospital orthopaedic surgeons perform traditional spinal fusion procedures.

Promoting Spinal Growth in Young Patients

Growing rods, a good treatment option for young patients with high magnitude curves and those with a severe spinal deformity due to an underlying neuromuscular disorder, allow the spine to continue to grow, according to the Scoliosis Research Society. The procedure, usually done around age 6, involves a posterior approach and the insertion of one or two rods under the back muscles. The rods are attached above and below the spine’s curve with hook or screws.

“Every six months or so we’ll expand the rod until they reach their skeletal maturity, when we convert them to the definitive procedure with multiple fixation points,” said Jochen Son-Hing, MD, pediatric orthopaedic surgeon at UH Rainbow Babies & Children’s Hospital and assistant professor of orthpaedic at Case Western Reserve University School of Medicine.

This is done through a small incision, usually as an outpatient procedure, he said. The final age is generally between 12 to 14 in girls and 14 to 16 in boys.

Dr. Son-Hing and other orthpaedic surgeons at University Hospitals Case Medical Center are among the most experienced in the country in performing growing rod procedures.

“Unlike treatment options such as casting and halo traction, growing rods enable pediatric patients to integrate easily into school and their social environment,” he said.

Fewer Operations Required

The correction of severe spinal deformities has traditionally required an open anterior procedure through a large thoracotomy incision, in addition to a posterior procedure. Orthopaedic surgeons at UH Case Medical Center are using minimally invasive VATS instead of a thoracotomy, as well as posterior-only approaches, with spinal osteotomy.

UH Case Medical Center is one of the few centers in Northeast Ohio that offers VATS, a technically demanding procedure, for anterior-only spinal fusion in scoliosis.

“VATS is a reasonable alternative to thoracotomy for severe curves that affect the thoracic part of the spine where we need to improve the flexibility of the curve,” Dr. Son-Hing said.

The minimally invasive procedure enables surgeons to improve flexibility of the spinal deformity through several portals of two to three centimeters. Advantages include far less deficit in lung function at medium- to long-term follow-up than with thoracotomy, and less pain and morbidity during recovery.

Spinal osteotomy, as part of posterior spinal fusion, enables surgeons to increase the spine’s flexibility in appropriate candidates. UH Case Medical Center is one of a number of specialized centers that do this procedure regularly in pediatric patients.