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Return to New Treatments May Help Reverse Early Onset Scoliosis Overview

More on New Treatments May Help Reverse Early Onset Scoliosis

New Treatments May Help Reverse Early Onset Scoliosis

New York (Apr 15, 2009)

About Early Onset Scoliosis

Scoliosis is a musculoskeletal condition that primarily affects children and adolescents in which there is an abnormal lateral curvature of the spine, causing the spinal column to bend to the left or right. There are two types of scoliosis: Early onset scoliosis is idiopathic, which means the causes for it are not known. Early onset scoliosis occurs before the age of five, and generally affects boys more often than girls. Patients with early onset scoliosis can develop a severe, complex spinal deformity that distorts and reduces the volume of the thorax or chest area that can compromise respiratory function and be life threatening. Adolescent idiopathic scoliosis occurs at age 10 or older, and may begin at puberty or during a growth spurt. With adolescent idiopathic scoliosis, girls are at a higher risk than boys.

Spinal Stapling: A New Treatment for Early Onset Scoliosis

Morgan Stanley Children's Hospital is one of only a few hospitals in the country to offer spinal stapling, a new treatment alternative for young people with scoliosis. Spinal stapling is one of a number of techniques, including VEPTR (Vertical Expandable Prosthetic Titanium Rib) and growing rods, which promises improved outcomes for children with early onset scoliosis. The Center for Early Onset Scoliosis, under the direction of Michael G. Vitale, MD, MPH, treats some 400 patients per year under the age of five with the condition.

When the curvature is moderate, spinal braces can be used to slow or decrease the chance of progression. Until now, however, there was no way to reverse progression and straighten the spine.

"Braces can be uncomfortable and embarrassing for children," said Dr. Vitale. "The custom-made plastic corset is usually worn all but one or two hours a day, and its tight fit presses against the stomach, making eating and any sports difficult."

Spinal stapling is a two-hour minimally invasive surgery that involves implanting inch-long metallic staples across the growth plates of the spine. Made of a high-tech temperature-sensitive metal alloy, the staples are implanted using a thoracoscope, a camera that is inserted into the chest, with a very limited incision and minimal scar. The procedure is available to children with progressive moderate scoliosis (less than 30 degrees) who are still growing (girls up to age 14 and boys up to age 16).

"Stapling not only stops scoliosis from getting worse, but can also even correct the curve," said Dr. Vitale. "While most children do well with spinal fusion which permanently connects several vertebrae, we are on the cusp of a new era in the treatment of scoliosis. For the first time, we have a way to potentially reverse the scoliosis."

According to Dr. Vitale, spinal fusion has its drawbacks. "We recently demonstrated evidence that spinal fusion in young children can lead to significant issues in quality of life and pulmonary function over the long term," said Dr. Vitale, who presented the findings at the International Conference on Early Onset Scoliosis in Montreal. The study followed 27 patients who received spinal fusion. After 10 years, their pulmonary function, measured by lung volume, and reported quality of life were significantly less than that of a healthy child.

Additional treatment approaches to correct early onset scoliosis include:

  • VEPTR – The Vertical Expandable Prosthetic Titanium Rib straightens the spine and opens a larger space for the lungs and other internal organs to grow by placing a titanium brace between two ribs to push them apart. VEPTR can be expanded as the patient grows through an outpatient procedure.
  • Growing Rods – attached to the spine and affixed to vertebrae at the top and the bottom – are expanded over time using a mechanism that allows the lengthening to be performed in a simple outpatient surgery. The approach minimizes spinal deformity, and most importantly, allows lung development to occur to preserve a normal life span for the patient.

"Having the full gamut of options, from growing rod to limited fusion to VEPTR, allows us to cater the specific treatment and implant approach – implant choices that were not available even five or 10 years ago – to the needs of our patients," said Dr. Vitale. "The menu of treatment options is much greater than ever before, and we have the ability to promise significantly different and hopefully better results for children with early onset scoliosis."

Faculty Contributing to this Article:

Michael G. Vitale, MD, MPH is Chief of Pediatric Spine and Scoliosis Surgery at the Morgan Stanley Children's Hospital, and the Ana Lucia Associate Professor of Clinical Pediatrics and Orthopaedic Surgery at Columbia University College of Physicians and Surgeons.

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