Some curving of the spine is normal.
But where a spine might naturally look like a very stretched out letter S, with severe scoliosis — or abnormal curvature serious enough to warrant surgery — the spine can begin to look more like the letter C. In addition to causing issues like low-back pain, severe scoliosis can do even more damage, internally, crunching the chest cavity and leaving less room under the rib cage for the lungs and heart. If not corrected, this can make it difficult to breathe or tax the heart’s ability to pump blood — and it’s associated with a higher mortality rate, according to research.
In young children, this type of deformity limits the space available for the lungs to grow. “If the lungs can’t grow, they become hypoplastic, and they become stiff … a condition that is called thoracic insuffiency syndrome,” explains Dr. Brian Snyder, a professor of orthopedic surgery at Harvard Medical University and an orthopedic surgeon at Boston Children’s Hospital. Left untreated, this can be life-threatening in babies and kids.
[See: 10 Concerns Parents Have About Their Kids’ Health.]
So while most kids with scoliosis have a mild variety and fare fine without treatment, clinicians say it behooves parents to talk with the child’s primary care doctor — who should notice the issue — and follow-up with orthopedic specialists well-versed in treating scoliosis, as needed.
For young kids with severe scoliosis who ultimately require surgery, there’s now technology that may reduce the number of procedures the child needs through the use of magnets.
Spinal surgery is different in kids who are still growing, compared with adults, says Dr. Brian G. Smith, a professor and director of pediatric orthopedics and rehabilitation at Yale Medical School, and a spokesperson for the American Academy of Orthopaedic Surgeons. Clinicians have long since realized that it’s not optimal to do spinal fusion surgery — essentially fusing vertebrae together — to straighten a curved spine, for kids under 10, as would be done for older patients. Such a procedure in younger patients wouldn’t allow their chest to grow to its normal height, and that impairs lung growth, Smith says.
So today, it’s standard practice to put in so-called “growing” rods in younger pediatric patients. “Rather than doing a fusion we put in anchors at the top and the bottom of the curve, and then put the rods in,” says Dr. Peter Sturm, a professor of pediatric orthopedic surgery and chair of spine surgery at Cincinnati Children’s Hospital Medical Center. “The rods are set up in a way that it lets us go back every six months, and in a smaller procedure, just loosen screws here or there and lengthen the rods out.” Adds Snyder: “Essentially you’re trying to mimic what normal growth should be.” The problem is, this still means doing additional surgical procedures each time the rod is lengthened — commonly a couple times annually over the course of several years, depending on factors like the age of the child (and how much more spinal growth they’d typically have left).
However, magnetically controlled growing rods now allow clinicians to lengthen the spine without making an incision or sedating the child. “We’re able to actually continue to grow the spine, gain some control of the curve — usually get some correction … with the child wide awake and really with no pain,” Smith says. This involves using magnets to increase the rod length by about 3 millimeters every two to three months, he notes.
[See: 10 Ways to Prepare for Surgery.]
“The way the rod works is that it has an internal magnet built into it. We put a large external magnet on the patient’s back and it drives the rod’s internal magnet which lengthens the rod,” explains Sturm, who has a consulting agreement with the San Diego-based medical device company NuVasive, which owns the technology, called the MAGEC system. “The magnetic force lengthens the magnet in the rods which then pushes the rods out longer.” The company that originally developed the system, Ellipse Technologies in Irvine, California, received clearance from the Food and Drug Administration in 2014 to market the system, and last year NuVasive, which has since bought the technology, received FDA approval for the system to be surgically implanted using its Reline posterior fixation system for treating patients with severe spinal deformity conditions. “The magnetic ability to elongate [growing rods] has really changed our ability to manage children with what we call early onset scoliosis in particular,” Smith says. “That’s typically children who have scoliosis starting before age 5, or juvenile onset scoliosis, which is before age 10.” (The same technology is also being used to lengthen limbs, such as when one child’s leg is congenitally shorter than another.)
Pediatric orthopedic specialists say the magnetically controlled rods allow them to lengthen the spine in younger pediatric patients without making an incision for each adjustment, improving comfort — even reducing mental difficulties some kids face from having frequent procedures to adjust traditional growing rods — while also enhancing safety for pint-sized patients. “Research indicates they have fewer complications, hospitalizations and even psychologic issues compared to treatment with the traditional growing rods,” Smith says. “They come in and they play with their iPad or their parent’s cell phone while we’re doing it. We just lie them on their stomach and do it right in the office and off they go home. No anesthesia. No risk of infection.”
Fewer procedures means less chance for complications as well. However, experts note that complications are still common from the initial procedure to put in growing rods — including the need to surgically fix screws or other parts as they come loose. And though the new system may delay the need for further surgery, clinicians note that fusion is still ultimately performed in older kids and adults to stabilize the spine.
Another technique now being used in clinical settings to a limited extent is so-called growth modulation — essentially slowing growth on the convex side of the spinal curve, and enhancing growth on the concave side of the curve, to straighten the spine out. While initial research shows some promise for this technique, experts say it’s important parents understand that the FDA has not yet approved any devices specifically for this. Instead devices are being used “off-label,” like using staples to affix vertebral growth plates together.
Given the risk involved with any surgery, other, comparatively low-tech options may serve as suitable alternatives or ways to delay surgery for some very young patients with scoliosis. “We start usually with bracing them, and we’ll often even do casting in the younger kids, under age 5,” Smith says.
[See: Top Reasons Children End Up in the Hospital.]
A cast basically goes from under a child’s arms to the hips, Sturm says. The effectiveness of this technique tends to depend on the severity of the curve, as well as the age of the child. “Then there’s another subgroup of kids that we can actually control the curve with casting to the point that we can at least put off surgery until they’re older,” Sturm says. “It’s most effective in kids under 2. …We start usually at around age 1 with some of these kids. Then there are other kids we’re still casting when they’re 4- or 5- or 6-year-olds, just to try to control their curve, to try to postpone surgery.”
High-tech or low-tech, the key, experts say, is that parents discuss treatment options early to keep their kids ahead of the curve in addressing severe scoliosis.
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For Some Kids With Severe Scoliosis, Magnets Mean Less Surgery originally appeared on usnews.com
