UH Rainbow Division of Pediatric Orthopaedic Surgery Embraces Complex Cases, Adds Advanced X-ray System

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Vertebral column resection likely most complex ever performed in Northeast Ohio

Innovations in Pediatrics | Winter 2021

Michael Glotzbecker, MD Michael Glotzbecker, MD

A successful, complex vertebral column resection (VCR) surgery and the addition of state-of-the-art X-ray technology are among the recent positive developments in the Division of Pediatric Orthopaedic Surgery at UH Rainbow Babies & Children’s Hospital.

A 15-year-old boy diagnosed with congenital kyphosis and scoliosis as an infant was the first teenager to undergo a complex vertebral column resection surgery in Northeast Ohio. Over 12 hours, Michael Glotzbecker, MD, Division Chief of Pediatric Orthopaedic Surgery at UH Rainbow, partnering with Christopher Furey, MD, Chief of the Spine Center at UH Cleveland Medical Center, rebuilt the teen’s spine. The surgery involved two foot-long titanium rods, 16 screws, removing all of the bone 360 degrees around the spinal cord and an expandable cage to remove the curvature from the patient’s spine and the hump from his upper back. Dr. Glotzbecker is also Associate Professor of Orthopaedics at Case Western Reserve University School of Medicine.

“The goal of the VCR procedure is to remove all of the bone completely from around the spine (in front and behind the spinal cord),” Dr. Glotzbecker says. “This disconnects the spine above and below the curvature and allows us to correct severe, complex deformities. We then need the bone to grow within and around the cage, eventually encasing it in new bone and bridging the gap in the spine where it once curved. Clearly, this was unique and the first pediatric VCR at UH Rainbow and likely the most complex pediatric VCR done in Northeast Ohio.”

Pre-surgery acute kyphosisPre-surgery radiographs including 3D CT reconstruction showing the congenital vertebral abnormality causing acute kyphosis.
“This procedure is risky, because it involves removing the bone completely around the spinal cord,” Dr. Glotzbecker adds. “The spinal cord is often ‘sick’ given that is put in a position of severe curvature. We have to carefully remove all of the abnormal bone around the spinal cord. We also destabilize the spine by entirely removing this bone. Finally, by doing this, we are able to get a significant correction of a severe deformity. This is associated often with high blood loss, but also carries significant risk to the spinal cord for all the reasons previously stated. But it is often our only option to correct severe curves with abnormal bone around the spinal cord.”

Kyphosis corrected post-surgeryPost-surgery radiographs after complete resection of the abnormal bone from around the spinal cord and replaced with a metal cage, with the kyphosis corrected and stabilized with spinal instrumentation.

As for results, the patient was discharged from UH Rainbow a week after surgery. Just two months after that, he was playing trumpet with his high school marching band. He has returned to all of his activities and is pain-free.

For Dr. Glotzbecker, this case is emblematic of the advanced capability present within the Division of Pediatric Orthopaedic Surgery at UH Rainbow.

“We have an increased ability to take care of some complex issues,” he says. “We are able to take care of any spinal issue for any child of any age, and we have the strongest team in the region to be able to do that.”

Another indicator of quality within the division, Dr. Glotzbecker says, is the recent arrival of the EOSedge X-ray system. Orthopaedic surgeons at UH Rainbow and the University Hospitals system in general are the first in Northeast Ohio to put this newest generation system to work. EOSedge delivers exceptional 2D/3D frontal and lateral full body images, while providing a profound reduced radiation exposure compared to traditional X-rays. The new second- generation system offers improved image quality and further radiation reduction compared to the first-generation system.

“The Department of Orthopaedic Surgery at UH and UH Rainbow Babies & Children’s Hospital continues to invest in new technologies to provide safe and high-quality care to treat patients in Northeast Ohio,” says James Voos, MD, Chairman, Department of Orthopaedic Surgery. “The EOS technology protects our children and adults who require X-rays by reducing radiation while producing state-of-the-art images for treatment,”

“EOSedge has several advantages,” adds Dr. Glotzbecker. “We get better information at a lower radiation dose. It allows you to get X-rays from the front and the side at the same time at a lower radiation exposure, and those images can be used to reconstruct images in three dimensions so you can actually get 3D modeling of the spine. For scoliosis and other spine conditions, this helps us in pre-surgical planning and ultimately, providing the best treatment. The only way to get 3D images without this technology would be a CT scan, which has significantly more radiation than a typical X-ray.”

Going forward, Dr. Glotzbecker says he expects the EOS system to be invaluable in continuing to offer pediatric patients solutions for complex orthopaedic problems, such as the VCR – and to orthopaedic surgeons like himself in continuing to refine their work.

“This can also be used from a research perspective to gain a better understanding of the underlying pathology and what we’re able to achieve with our surgical treatments as we correct spinal curvature with surgery,” he says. “We’ll have a better understanding of 3D anatomy of the spine and how to optimally correct it, which will benefit the patient immediately and in the long term by improving their surgical outcomes.”

For more information about the Division of Pediatric Orthopaedic Surgery at UH Rainbow, please email Peds.Innovations@UHhospitals.org.

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