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 not FDA approved for this indication and long-term data are 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