The specialized team at Shriners Hospitals for Children — Northern California treats spine conditions of all degrees – from a fatigue fracture in the lower spine that requires careful monitoring to a congenital kyphosis that can lead to paralysis. The medical team responds to the individual needs of each patient and works to achieve the best possible outcomes through leading-edge surgical care, therapy and research.
Conditions treated
- Idiopathic scoliosis, including infantile, juvenile and adolescent
- Congenital scoliosis
- Scoliosis with syndromes including:
- VACTERL
- Marfan
- Neurofibromatosis
- Klippel-Feil syndrome
- Thoracic insufficiency syndrome and other rib cage impairments
- Torticollis
- Cervical instability
- Neuromuscular scoliosis associated with:
- Spinal cord injury
- Cerebral palsy
- Spina bifida
- Tethered spinal cord
- Kyphosis, including Scheuermann’s
- Spondylosis and spondylolisthesis
- Curve progression after spine surgery
- Abnormal posture
- Hemivertebrae with fused or absent ribs
- Scoliosis after thoracotomy
Nonsurgical treatment options
Bracing
Nonoperative treatment for idiopathic scoliosis:
- May be combined with prescribed scoliosis specific exercise
- Can be effective in stopping the progression of the curve
- Schedule and type of brace will depend on the location and degree of curve
- Compliance with wearing the brace is vital to the success of bracing treatment
Serial casting
For infantile scoliosis when the curve is progressive:
- Requires cast changes under anesthesia every two to three months
- Casting straightens the spine through the continuous application of external force
- Casting is an option versus bracing for improved compliance
Surgical treatment options
Fusionless surgery
Innovative newest treatment options for children with scoliosis:
- Anterior vertebral body tethering (AVBT) –
AVBT is a minimally invasive procedure, which produces stabilization
for the anterior thoracic and lumbar spine and avoids spinal fusion.
Using bone screws and a flexible cord, the spine curve is gently
straightened during surgery. Additional correction occurs as the spine
is allowed to grow. This device is currently FDA approved for this
indication but long-term data is lacking. Our results to date appear
promising.
Growing systems
Expandable devices used in growing children with scoliosis:
- Vertical expandable prosthetic titanium rib (VEPTR or titanium rib)
– This is a titanium rod curved to fit the back of the chest and spine,
and is designed to primarily be used for growing children with a chest
wall deformity and thoracic insufficiency, helping to correct spinal
deformity and allow for the development of the chest and lungs.
- Growing rods – Growing rods allow for continued and
controlled spine growth. This is performed as a surgical procedure
through the back where the rods are attached to the spine both above and
below the curves with screws. The growing rods will need to be
lengthened under anesthesia every four to six months, depending on the
advancement of the curvature of the spine.
- MAGnetic expansion control (MAGEC) spinal bracing and distraction system –
MAGEC rods are for younger children with curves less than 50 degrees.
With MAGEC rods, a surgical procedure for implantation is required, but
the noninvasive lengthening procedure eliminates the need for repeated
lengthening surgeries. The MAGEC System is composed of two magnetic,
telescoping rods that can be gradually lengthened from outside the skin
after initial implantation. This procedure uses an external remote
controller in the outpatient department.
Spinal fusion surgery
Spinal fusion surgery is recommended to
correct a curve or stop it from progressing when the patient is still
growing and has a curve that is greater than 50 degrees. Rods and screws
are attached to the curved part of the backbone and the spine is
straightened. Small pieces of bone graft are then put over the spine;
this will grow together with the spinal bone, fusing it into the proper
position. In addition to improved internal fixation, posterior spinal
fusion allows earlier mobilization of the patient. A spinal fusion also
helps prevent severe deformity and can avoid years of bracing.
Collaborative approach to care
Patients benefit from the expertise of a multidisciplinary team of professionals that includes:
- Pediatric physiatrists
- Pediatric anesthesiologists
- Pediatric intensive care specialists
- Nurses
- Physical therapists
- Respiratory therapists
- Orthotists
Throughout the Northern California Shriners Hospital, professionals work collaboratively to provide patients and parents with easy access to care. Orthotists custom design and fabricate braces on-site. Physical therapists work side-by-side with doctors. The entire team embraces a family-centered approach to care that distinguishes the pediatric spine program at Shriners Hospitals for Children — Northern California.
The medical team
Eric O. Klineberg, M.D., Orthopaedic Spine Surgeon
Joel Lerman, M.D., Pediatric Orthopaedic Surgeon
Debra Templeton, M.D., Pediatric Orthopaedic Surgeon
Rolando F. Roberto, M.D., Orthopaedic Spine Surgeon
Yashar Javidan, M.D., Pediatric Orthopaedic Surgeon
Prarthana Mysore, PA, Physician Assistant
Melina McCahon, PA, Physician Assistant
Spine research
Research initiatives include a scoliosis outcomes database registry, a study of Scheuermann’s kyphosis, bracing in adolescent idiopathic scoliosis and pediatric spinal deformity. The multidisciplinary team works in concert to conduct orthopaedic clinical research. The team includes:
- Physicians
- Psychologists
- Nurses
- Therapists
- Bio-mechanical engineers
- Clinical research professionals