Scoliosis & Kyphosis
Children's Orthopaedic and Scoliosis Surgery Associates, LLP’s skilled, board–certified physicians provide the latest and most advanced treatment options for patients with spinal conditions such as idiopathic scoliosis and Kyphosis. Our physicians evaluate each patient carefully to determine the correct course of treatment for both surgical and non-surgical cases.
With two fellowship–trained spine specialists, Children’s Orthopaedics utilizes the most advanced technology available, including minimally invasive surgical techniques and computerized, intraoperative navigation.
Experience and Expertise
Dr. Neustadt and Dr. Hahn have performed over 1,200 scoliosis surgical procedures to date, with over 100 children and adolescents treated annually in recent years. Combined, they have over 30 years experience performing scoliosis surgery.
Cutting Edge Technology
CT-based, intra-operative image guidance allows the surgeon to navigate the spine using “smart tools.” The data from a preoperatively acquired CT scan of the spine is merged with in vivo registration of anatomical reference points that have been determined from the 3D axial and sagittal CT images.
Use of this technology has facilitated rapid and accurate placement of pedicle screws for which there is virtually no tolerance for inaccurate placement. This technology also enables more precise sizing of the screws within the pedicles and the vertebral body, lessening the chances of loosening.
Dr. Neustadt and Dr. Hahn have high use of this technology in scoliosis surgery. Surgeons from around the world visit them at Johns Hopkins All Children’s Hospital to learn about these cutting-edge techniques.
Monitoring Nerve Function in Surgery
Intraoperative neurophysiological monitoring helps protect your child from neurologic damage such as paralysis. The goal of such monitoring is to identify changes in brain, spinal cord, and peripheral nerve function prior to irreversible changes occurring. Motor and sensory monitoring of the spinal cord is conducted with every scoliosis case our surgeons perform in order to complete the case safely and expeditiously.
The Spine Team
Our operating room has been specially-outfitted with advanced imaging technology and specialized instrumentation to accommodate all of our orthopaedic surgical procedures.
The orthopaedic support team consists of knowledgeable professionals who participate in each step of the procedure. This team consists of orthopaedically-trained pediatric nurses and patient care technicians, neuro-technologists, fellowship-trained Pediatric Radiologists and Pediatric Anesthesiologists.
What is Scoliosis and Kyphosis?
Scoliosis is defined as a side-to-side curvature of the spine. Although it is a complex three-dimensional deformity, on an X-ray, viewed from the rear, the spine of an individual with scoliosis may look more like an "S" or a "C" than a straight line. Scoliosis is typically classified as congenital, idiopathic, syndromic, or neuromuscular. This condition affects approximately 7 million people in the United States.
Kyphosis is an abnormal increase in thoracic roundback. When viewed from the side, it may appear as if the person is slouching or has a “hump” on the back.
Scoliosis is usually painless, while severe kyphosis is commonly associated with pain. A parent or doctor may suspect scoliosis if one shoulder appears to be higher than the other or the pelvis appears to be tilted. Untrained observers often do not notice the curving in the earlier stages. Children’s modesty causes them not to undress in front of their parents. When they are in a bathing suit, one may notice a sideways curvature of the spine or an elevation of one shoulder or hip. Kyphosis is much easier to detect with the first parental complaint often being that their child “won’t stand up straight.”
The doctor will ask your child to bend forward to reveal any rotational deformities. This is called the "Adam's Forward Bend Test." He will also check for any limb-length discrepancies, abnormal neurological findings, or other potential causes of scoliosis.
There are three general causes of scoliosis:
Congenital scoliosis, which is present at birth, is due to a problem with the formation of the vertebrae in the embryonic stage of development. It is often associated with congenital fusion of the ribs, and may also be seen in conjunction with a number of other, non-orthopaedic anomalies affecting the heart, kidneys, and gastrointestinal tract.
Neuromuscular scoliosis is caused by problems such as poor muscle control or muscle weakness or paralysis secondary to diseases such as cerebral palsy, muscular dystrophy, spina bifida, and polio.
Idiopathic scoliosis is scoliosis of unknown cause. Idiopathic scoliosis may occur at any age but is most commonly seen in adolescence. It may be genetic, running in some families. If it progresses, it usually does so most rapidly during puberty.
Each child is different, and your physician will suggest the best treatment option for your child. These include:
Continually observing a small curve to check for progression as the child or adolescent grows. X-rays will usually be reviewed every 4 to 6 months.
Advances in orthotics and prosthetics have led to much more comfortable and lighter weight polypropylene plastic. Besides the foam-lined, body jacket-type TLSO of the Boston type, nighttime-only Providence Braces have been shown to be just as effective for certain patterns of scoliosis. Investigation continues to determine the effectiveness of these newer braces in preventing progression of scoliosis. Unfortunately no brace has been shown to actually improve scoliosis. That desired outcome is only available via surgical treatment.
The surgical treatment of idiopathic scoliosis is usually reserved for curves that have progressed beyond 40 to 45 degrees. If left untreated, continued progression of these curves may lead to chronic, severe pain, deformity, psychosocial disability, and pulmonary dysfunction.
When surgery is indicated, our fellowship–trained pediatric orthopaedic surgeons offer the most advanced and proven techniques in reconstructive spinal surgery.
Pedicle screws are used to anchor the correcting rods to the spine to prevent further movement while the spine is being fused with bone grafts. The screws are used to correct rotation as well as to treat deformity in the coronal and sagittal planes. The pedicle screws can be placed at multiple levels throughout the spine depending on the severity of the curve. The rods are then connected to the pedicle screws.
Growing rods are used to stabilize the spine in very young children with severe scoliosis, sometimes called Early Onset Scoliosis. The rods are placed through the muscles around spine spanning the curve and are usually attached with screws. Growing rods allow for continued, controlled growth of the spine in juvenile patients with scoliosis. The rods are then lengthened on a regular basis, approximately every 6 to 12 months.