Spinal Fusion for Adult Scoliosis: What Are Survival Rates?

An article recently published in The Spine Journal found that survival rate for primary spinal fusion in adult scoliosis patients was 89.8 percent at one year postoperatively.

The study examined 59 patients 21 years or older that underwent primary surgery for idiopathic or degenerative curves and were followed for minimum of two years postoperatively. Survival rate at three years was 73.4 percent and 64 percent at five years. At 10 years postoperatively, the survival rate was 60.9 percent.

Over the entire follow-up period, 35.6 percent of patients underwent revision surgery, with the most common reasons for the revision being:

•    Painful/prominent implants
•    Adjacent segment disease
•    Infection

A higher revision rate was found among American Society of Anesthesiologists Type II patients and double surgical approach patients.

Source : Becker's Spine Review , 16th Dec 2013 

Spine and Orthopedic Devices and Implants

Here are seven things for spine surgeons to know...

Budget bill would stall Medicare pay cut, raise physician pay 0.5%.


The House of Representatives passed a bipartisan budget last week that would impact Medicare payment cuts to physicians if passed by the Senate. Under the sustainable growth rate, Medicare announced it would cut physician pay 20.1 percent in 2014. The budget would postpone that pay cut rate until April 1, 2014 and give physicians a 0.5 percent raise during the interim period.

AAOS supports SGR repeal efforts.


The American Academy of Orthopaedic Surgeons supports the recent legislative efforts to repeal the sustainable growth rate. AAOS encouraged Congress to continue to repeal and replace the SGR formula as soon as possible.

Orthopedist compensation decreased by 10% from 2011 to 2012.


Compensation decreased by 10 percent or more than 10 percent for orthopedists from 2011 to 2012. Of the respondents, about 20 percent saw a 10 percent or more decrease and 32 percent saw compensation remain the same.

Spinal fusion survival rates for adult scoliosis as high as 89.8%.


An article recently published in The Spine Journal found the survival rate for primary spinal fusion in adult scoliosis patients was 89.8 percent at one year postoperatively.

Survival rate at three years was 73.4 percent and 64 percent at five years. Over the entire follow-up period, 35.6 percent of patients underwent revision surgery.

FDA committee called for Class 3 device designation on spinal sphere devices.


After meeting recently, a U.S. Food and Drug Administration committee agreed spinal sphere devices should be classified as Class 3 devices, which require premarket approval.


NuVasive announced US launch of ALIF column realignment device.


San Diego-based NuVasive's anterior column realignment device for anterior lumbar interbody fusion launched in the U.S. The ALIF ACR is tasked with correcting the sagittal plane imbalance that advanced degeneration can cause.

Dr. Richard Wohns among first to perform two-level cervical disc replacement using Mobi-C.


Richard Wohns, MD, JD, MBA, performed the first two-level cervical artificial disc replacement surgery in the Northwest and one of the first in the nation, using Mobi-C Cervical Disc Prosthesis.


Source : Becker's Spine Review , 17th Dec 2013

UI researchers: Bracing is effective in adolescents with idiopathic scoliosis

Longer daily wear is best to avoid surgery

A multi-center study led by University of Iowa researchers to determine whether wearing back braces would prevent the need for spinal correction surgery in children with adolescent idiopathic scoliosis (AIS) was cut short when early results were overwhelmingly in favor of bracing.

The study was published in the New England Journal of Medicine today (Sept. 19. 2013).

Stuart Weinstein, MD, Ignacio V. Ponseti Chair and Professor of Orthopaedic Surgery and Professor of Pediatrics at University of Iowa Children’s Hospital, and Lori Dolan, PhD, a research scientist in The Department of Orthopaedics and Rehabilitation at the UI Carver College of Medicine, led a study team that set out to compare the risk of curve progression in patients with AIS who wore a brace with patients who did not. The study team, from the Bracing in Adolescent Idiopathic Scoliosis Trial (BrAIST), recruited patients who were at risk for continued worsening of their spinal curves based on age, skeletal immaturity and curve severity.

AIS is a curvature of the spine with no clear underlying cause. In mild cases, monitoring over time by a physician may be all that is needed. However, in more severe cases – especially when the child is still growing – the use of a brace, or even surgery, may be recommended. Left untreated, more serious curves can be painful and deforming.

Weinstein has been working with scoliosis patients for nearly 40 years, and although bracing has been used as a treatment for curvature of the spine since 1948, he says there has always been some question as to whether it was truly an effective way to avoid surgery.

“The efficacy of bracing was never really proven,” he says. “I wasn’t sure if braces really worked or not, and I’ve treated thousands of patients.”

He says the literature about bracing “wasn’t convincing that it worked.” Additionally, he says, some patients still required surgery after wearing a brace.

For the study, investigators enrolled 383 subjects at 25 institutions in the United States and Canada between March 2007 and Feb 2011. Although the study began as a completely randomized clinical trial, the team eventually added a “preference cohort,” where patients and families could choose their own treatment. About 40 percent of study participants were randomly assigned to bracing or to close observation without bracing. The remaining participants made their own choice regarding bracing or observation.

Patients in the observation arm received no specific treatment, while those in the bracing arm were instructed to wear a brace for 18 hours per day. Treatment was considered to be unsuccessful when a curve progressed to 50 degrees or greater – a point at which surgery is typically recommended. Treatment was considered a success when the child reached the age of skeletal maturity without this degree of curve progression.

In January 2013, the trial was stopped early after finding that bracing significantly reduced the risk of curve progression and the need for surgery, and that more hours of brace wear was associated with higher success rates. Among both the randomized and preference cohorts, 72 percent in the bracing group, and 48 percent in the observation group achieved success. In addition, the results suggest that the more a patient wore the brace, the better the results; wearing a brace more than 13 hours per day was associated with success rates of 90 to 93 percent.

“This study definitely shows braces work and are effective in preventing the need for surgery,” Weinstein says. “Children who are at risk should be treated with a brace, and they should wear it at least 13 hours a day for it to be effective.”

According to the researchers, the findings are clinically relevant to patients for whom bracing would typically have been recommended. But until now, that recommendation had not been based on solid data. “This study presents important evidence addressing the fundamental question facing families and clinicians dealing with the diagnosis of AIS – does bracing prevent the need for surgery? The answer is clearly ‘yes’,” Weinstein says.

The investigators also suggest that current bracing indications may be too broad, since 48 percent of patients in the observation group and 41 percent of patients in the bracing group who wore the brace infrequently also achieved success. “Further analysis will help us identify those AIS patients for whom bracing may be the most beneficial,” Weinstein concludes.

Source : Yotta Fire , 17th Dec 2013

British teenager overcomes extremely curved spine to become a model !

Zoe Blenkinsop, 19, undergoes seven hours of surgery and years of bullying to stand tall. She now strides down the catwalk at British shows.

Zoe Blenkinsop is now fashion model after undergoing drastic surgery to correct her severely curved spine and to remove a protruding lump.

A British teenager who was bullied as a child after an agonizing spine condition left her with a hunched back and a severe limp has had the last laugh  — after landing a job as a catwalk model.


Zoe Blenkinsop, 19, from North Shields, has suffered scoliosis since childhood and was bullied throughout school because she had a lump which protruded from her back where her spine curved.


She would spend hours practicing her poses and catwalk runs but struggled as her curved spine, which left her with a limp, shattered her confidence.


When she was diagnosed with the condition at age 11, doctors said they could perform an operation on her, but she would have to wait until she had finished growing.

An x-ray of Zoe Blenkinsop’s spine shows her drastically curved back. Seven hours of surgery corrected the deformity and the British teenager now commands the catwalk.

******************************************************

And now, after undergoing a gruelling seven-hour surgery, she is finally walking tall.


"I was always so conscious about my back because there was such a huge lump sticking out from it," she said.


"I never allowed anyone to take pictures of me because I didn't want them to see it. In PE (physical education) I would hide in a corner to get changed so that no one saw it as I was already being bullied.

"When I was told I could have the operation I was so happy, but I knew I had to wait a long time for it."

Zoe Blenkinsop, 19, after back surgery to correct her severe scoliosis. She is now a fashion model. 

 

******************************************************

In July 2011 Zoe was finally able to go ahead with the operation and was in surgery for seven hours while they fitted metal rods to straighten her spine.


It took her a year to recover from the major surgery and she had to teach herself how to walk, sit and stand all over again.


Zoe is now able to live her dream of modelling and is no longer worried about what others think of her.


"I used to look at everyone else in school and think about when I would be normal like them," she said.

This x-ray, taken after Zoe Blenkinsop’s operation, shows the metal rods implanted to straighten her spine.


*****************************************************

"The pain would be horrible some days and I wasn't able to sit or stand for a long time. The only way to ease it was to lie down, which was pretty embarrassing. I felt like an old lady."


"Recovering from the operation took a long time," she said, "and it was really hard."


Scoliosis causes the spine to curve sideways and impacts about four percent of the population.


If left untreated it can lead to fatal heart and lung problems and damage mobility.


Treatment for the condition is usually a major operation which is very risky but is the most frequently used method.


Blenkinsop had her first taste of modelling success when she stepped on to the catwalk for Newcastle Fashion Week.


"Modelling has always been a dream of mine, but I never thought it was possible," she said. "I knew that standing and posing for shoots would be impossible and I would have been far too scared to walk down the catwalk with my limp."



Source : Daily News , 22nd Nov 2013

Researchers identify mechanism of brachial plexus injury in scoliosis surgery

Researchers in this study retrospectively analyzed pediatric patients who received distraction-based growing implants to treat early-onset scoliosis and identified the mechanism of injury for 4 patients with an intraoperative brachial plexus injury.

“Patients with Sprengel deformity appear to be at increased risk for brachial plexus injury when undergoing distraction-based spine instrumentation with rib anchors. Injury to the brachial plexus can occur with scapular elevation alone, presumably by direct compression of the superior end of the scapula on the brachial plexus,” Elizabeth R.A. Joiner, BS, and colleagues wrote in the study abstract. “Brachial plexus injuries may be ‘hidden’ during monitoring of an arm in shoulder abduction but symptomatic with shoulder adduction, as the brachial plexus is draped over the elevated first rib.”

Joiner and colleagues performed a single-center review of 41 pediatric patients who underwent scoliosis correction surgery with distraction-based growing implants with rib anchors between 2001 and 2011.

They found three mechanisms of injury associated with brachial plexus injuries that occurred 4 patients, which were “injury of the brachial plexus by the first rib being pushed superiorly by rib-anchored growing instrumentation, direct injury to the brachial plexus by the superior pole of the retracted scapula, and injury of the brachial plexus when the scapula was moved inferiorly during Sprengel deformity reconstruction,” according to the abstract. The last two mechanisms of injury were independent of spinal instrumentation, the researchers noted.

Two patients with a brachial plexus injury had neurological symptoms or neuromonitoring signal changes with their arm in an adducted position, but not when it was abducted, and all the patients recovered completely, according to the abstract.

Disclosure: One of the authors (Skaggs) received a consulting fee or honorarium from Biomet, Medtronic and BeachBody LLC.


Source : Healio , 21st Nov 2013

'I was terrified I'd become a hunchback': Teenager, 18, overcomes agonising spine condition to become a model

Leanne Roberts, 18, has scoliosis which makes her spine S-shaped

It caused her severe pain every time she moved and damaged her confidence

Doctors said she'd need a risky 12-hour operation to straighten her spine

Turned down the surgery as she thought it would end her modelling career

Instead, she found relief in exercises specially designed to strengthen the muscles around her spine

********************************************************************************


A teenager who was terrified of becoming ‘a hunchback’ because of her misshapen spine has achieved her dream of becoming a model.


Leanne Roberts, 18, suffers from severe scoliosis which makes her spine curved.
The schoolgirl would spend hours in front of a mirror attempting to improve her posture.

Leanne Roberts, 18, has scoliosis which causes her spine to bend in an S-shape. It caused her severe pain when she moved and she feared she would end up in a wheelchair.

*****************************************************************************

When she was diagnosed with the condition at 16, doctors told her she would need a 12-hour operation and she feared it would end her dreams of becoming a successful model.

Scoliosis causes the spine to excessively curve sideways. The condition affects around four per cent of the population and if left untreated it can lead to fatal heart and lung problems.

Current treatment techniques centre on having major operations, which are risky procedures involving metal rods being inserted either side of the spine.

Doctors told Leanne that she would need a risky 12-hour operation to correct the curvature in her spine (pictured) but she refused to have the surgery as she thought it would end her chances of being a model..


*******************************************************************************

Instead, she turned to a non-surgical treatment to improve her condition, and has stunned medics with her remarkable progress.


Leanne of Barnsley, South Yorkshire, said: ‘It was awful how much time I would spend crying and I was terrified of what would happen to me when I was first diagnosed.


‘I was paranoid I would end up looking awful and would end up in a wheelchair.’
Leanne, who often modelled in fashion catalogues, has a double S-shaped curved spine.



Leanne has now found relief from the pain in her back by doing exercises to strengthen the muscles around her spine


*******************************************************************************
She first noticed aching pains when she was 14, but put them down to growing pains.
It was only when she started to suffer agonising sharp pains during photo shoots that she mentioned it to her mother and went to see her GP.


She was told by a consultant she would need surgery but instead discovered a clinic called Scoliosis SOS on the internet. The idea is that various exercises can strengthen the muscles surrounding the spine, stabilising the condition.


Leanne said: ‘I was ecstatic and I couldn’t wait to start the treatment. I think everyone should consider exercise before putting themselves through a risky operation.


‘I could feel the difference in my back after the first few days, and I could see the difference.


‘As long as I keep up with the exercises I shouldn’t suffer from pain and my scoliosis should stabilise. I feel like I am back in control again.’


***********************************************************************

'I lost interest in everything and I had no quality of life at all. I had gone from being really confident in my body to wanting to hide away at every opportunity. As long as I keep up with the exercises I shouldn’t suffer from pain and my scoliosis should stabilise. I feel like I am back in control again'

- Leanne Roberts 

***********************************************************************

The condition is likely to get worse, but Leanne has thrown herself back into modelling regardless.


She said: ‘I am so happy now - it's remarkable how far I have come. I was in constant pain on a daily basis and my whole world had fallen apart.

‘I lost interest in everything and I had no quality of life at all. I had gone from being really confident in my body to wanting to hide away at every opportunity.

‘I feel I can now finally look forward.’


A spokesman for Scoliosis SOS said: ‘Leanne decided our treatment could not do any harm and if it worked it could change her life.


‘Within weeks of being on the course, Leanne’s condition dramatically improved. She was no longer lying awake at night with pain and her confidence soared.


‘Since completing her treatment, Leanne has returned home and has been able to shop and feel confident in her clothes again for the first time in months.


‘She has regained all of her passion for life and has bounced back to her normal, fit and sociable self. She has also re-started her modelling career and is very excited about what the future holds.’

^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^
WHAT IS SCOLIOSIS AND WHAT ARE THE SIGNS OF THE CONDITION?

1.Scoliosis is the abnormal curvature of the spine in an S-shape.


2.Signs include a visible curve in the spine, one shoulder or hip being more prominent than the other, clothes not handing properly and back pain.


3.Pain usually only affects adults with the condition.


4.In most cases, the cause of the scoliosis is not known but it can be caused by cerebral palsy and muscular dystrophy.


5.In the UK, scoliosis affects three to four children could of every 1,000.

6.It is also thought that as many as 70 per cent of over 65s have some degree of scoliosis.


7.It is more common in women than in men.


8.Most children with the condition do not require treatment as it is mild and corrects itself as the child grows.



9.However, in severe cases the child may need to wear a back brace until they stop growing.


10.Occasionally, a child needs surgery to straighten their spine.

11.In adults, it is usually too late to treat the condition with a back brace or surgery so treatment revolves around reducing pain.

***********************************************************************

Source: Mail Online ( Health ) , Via NHS Choices ; 4 Nov 2013

Scoliosis Systems Highlights Research Showing Elastic Tension Bracing is as Effective as Hard Bracing

Scoliosis Systems, a specialist in the non-surgical treatment of scoliosis, offers patients a flexible, dynamic Spinecor tension brace that research has shown to be as effective in treating the curvature of the spine and traditional hard braces. This treatment approach is completely different to that of traditional three-point pressure rigid braces. It is the first and only true dynamic bracing system for idiopathic scoliosis.








This Spinecor uses a corrective movement principle which has been shown to help reduce the scoliosis curvature even after the brace has been removed. Through the use of elastic tension bands, Spinecor helps reeducate muscles and allows the force of gravity to permanently influence the growing spine. In adults, Spinecor can effectively reduce pain and fatigue, and improve postural control, thereby effectively reducing the degree of curvature even without affecting the shapes of the spinal bones.


The unique approach to treatment by global postural re-education has been shown to give progressive correction over time which, unlike any previous brace treatment, is extremely stable post brace weaning.


The dynamic tension brace option is also a more comfortable and less intrusive means of treating scoliosis. Spinecor allows patients to take the brace off for up to four hours a day, it offers total freedom of movement, can be well concealed by clothing and is cool to wear. Clinical experience to date also shows better compliance and cosmetic results.


To learn more about this effective scoliosis treatment and to find a doctor, visit www.scoliosissystems.com.


About Scoliosis Systems:


Dr. Lamantia, Dr. Deutchman and Dr. Brett Diaz are founding members of the International Society of Scoliosis Orthopedic Rehabilitation (SOSORT) and are the world's experts in alternative Scoliosis treatment for both children and adults. They make themselves available in 15 regional centers throughout the United States, seeing all scoliosis patients personally. They designed the S.T.A.R.T. Smart program to reduce and stabilize Scoliosis using a flexible dynamic brace, specially designed exercises and breathing techniques. Patients and families are given the tools and information necessary to live successfully with Scoliosis, while avoiding the need for rigid braces or surgery.



Source :  Prleap

Top Scoliosis Surgeon and Orthotics Technician Visit HMC

******************************************************
Top French orthopedic surgeon Dr. Michel Onimus from France recently visited Hamad Medical Corporation 's ( HMC ) Orthopedic Department, and is accompanied on the present visit by Orthotics Technician Mr. Francois Dubousset. Dr. Onimus has been regularly visiting HMC since 1999 as part of HMC 's efforts to provide local patients with top expertise and enable them to avoid the need to travel abroad for specialized care.

******************************************************

From left, Mr. Francois Dubousset and Dr. Michel Onimus



****************************************************

Hosting visiting physicians and surgeons such as Dr. Onimus also promotes exchange of expertise and continuing education for medical residents.



Currently Honorary Professor of Pediatric Orthopedic Surgery in Besancon University in France, Dr. Onimus visits HMC three or four times a year to conduct surgery and consult with patients on a fixed appointment basis. He is planning to return in February 2014. "Usually I come in June when we have many children who can then undergo surgery without it interfering with their school time," said Dr. Onimus, who in addition to routine cases of scoliosis in children, also performs surgery on complicated and rare cases.

Scoliosis is a condition in which a person's spine is curved from side to side. It can be congenital, idiopathic (of unknown cause), or caused by conditions such as cerebral palsy and muscular dystrophy. About 1-5 per 1,000 children worldwide have spinal deformities, said Dr. Onimus. Severe scoliosis can be disabling. "When we are treating spinal deformities especially in children, there is no easy surgery. The orthotic treatment, or treatment using braces, for scoliosis is a conservative treatment that is very important because in many cases especially in small children, braces can be sufficient to prevent the spinal curve from progressing, and to avoid the need for surgery," said Dr. Onimus, who added that Mr. Dubousset will provide his expertise to help develop the orthotics services at Hamad General Hospital.




Dr. Onimus sees between 80 and 100 patients in the clinics during each visit to HMC , and operates on several major and complicated cases of children with spinal deformities, according to Dr. Alaa Zakout, Spine Specialist at HMC . "Our collaboration with Dr. Onimus is part of our efforts to develop our department, particularly services for patients with spine problems. We are aiming for more specialization so we can continue to provide the best care possible for our patients."



Dr. Zakout said the department is now starting to do research on spine problems in adults. One of the research studies involves comparing fixation methods to treat spine fractures, and another study analyzes cases where patients went abroad and came back with complications. "People usually go abroad thinking they can get better service. However, many of these cases return with complications or their operations were not done properly, and so there is increased interest in developing spine surgery locally."





About HMC :


Hamad Medical Corporation ( HMC ) is the principal public healthcare provider for the State of Qatar. The Corporation manages eight hospitals along with further specialist clinical, educational and research facilities, and is growing in capacity each year around the diverse needs of the evolving population. HMC 's ambition is to become an academic health system; a world leading center of excellence in clinical care, medical education and research that transforms into significant clinical advancements.



HMC believes in excellence in healthcare, education and research with each supporting the other to provide world-class quality patient care in a safe and healing environment.



As well as four general hospitals situated in the most densely populated areas of Qatar, HMC also manages four specialist hospitals, looking after patients with the most prevalent conditions, including cancer, heart conditions, rehabilitation, and a hospital providing specialist treatment for women. HMC also operates the national Ambulance Service and a home healthcare service.



The Corporation was the first public healthcare system outside the United States to achieve Joint Commission International (JCI) accreditation for all hospitals simultaneously. JCI accreditation is based on quality and safety across all clinical and management functions.



HMC is also the first hospital system in the Middle East to achieve institutional accreditation from the Accreditation Council of Graduate Medical Education - International (ACGME-I), which demonstrates excellence in the way medical graduates are trained through residency, internship and fellowship programs.


www.hamad.qa
For more information, please contact:
Joan Pauline Acevedo at jacevedo@hmc.org.qa
Corporate Communications Department
Hamad Medical Corporation



 
Source : Zawya , 20th October 2013

Scoliosis Can Hit Well Past Adolescence

On a family trip to the Grand Canyon three summers ago, my son Erik, who was hiking behind me, remarked, “Mom, your right hip is higher than your left.”

“I know,” I replied, promptly dismissing this observation. But it returned to haunt me many months later, when I had two related realizations: My left pant legs were now all too long, and I had shrunk another inch.

Diagnosis: Adult-onset scoliosis, an asymmetrical curvature of the spine that, if unchecked, could eventually leave me even shorter and more crooked, disabled by an entrapped spinal nerve, and dependent on a walker to maintain my balance.

Determined to minimize further shrinkage and to avoid pain and nerve damage, I consulted a physiatrist who, after reviewing X-rays of my misshapen spine, said the muscles on my right side, where the spinal protrusion is, were overdeveloped relative to the left. He prescribed a yoga exercise — a side plank — to strengthen the muscles on the left and exert enough of a tug on my spine to keep it from protruding farther to the right. He suggested that the exercise might even straighten the curve somewhat.

I’ve been doing this exercise, along with two others suggested by a physical therapist, every day for the last eight months. The therapist also told me to have heel lifts put in or on all my left shoes to help even out my hips and shoulders. While it is too soon to say whether there has been a significant reduction of my spinal curve, it has definitely not worsened and, unless my mirror lies, I look less lopsided.

Although scoliosis is generally thought of as a problem of adolescents, who often require bracing or surgery to correct the curvature, the condition is actually far more prevalent in older adults. In a study by orthopedists at Maimonides Medical Center in Brooklyn of 75 healthy volunteers older than age 60, fully 68 percent had spinal deformities that met the definition of scoliosis: a curvature deviating from the vertical by more than 10 degrees.

Previous studies had reported a prevalence of scoliosis in older adults of up to 32 percent. These reviews may have included adults who were younger than those in the Brooklyn study, whose average age was 70.5 and who had no pain or impairment related to their spinal condition.

Whichever is the real rate, the prevalence of scoliosis in adults is high and expected to increase as the population ages. The most common underlying cause of spinal deformities arising in midlife or later is the degeneration of the discs between vertebrae and sometimes of the vertebrae themselves.

Unlike scoliosis in youth, which afflicts many more girls than boys, adult-onset scoliosis affects men and women in roughly equal proportions. Some had scoliosis as children; it had stabilized, only to progress again gradually as advancing age took its toll on the spine. But the vast majority of adults with scoliosis had normal spines in their youth.

A misshapen body is the least serious consequence of scoliosis. It can result in disabling pain in the buttocks, back or legs, and neuropathy, a disruption of feeling and function when a spinal nerve is compressed between vertebrae. Neuropathy must be treated without delay to prevent nerve death and a permanent loss of function.

While there are no surefire ways to prevent all cases of adult scoliosis, certain conditions that are preventable increase the chances it will develop. One is being overweight or obese, and another is smoking. A third cause is a lack of physical fitness, resulting in weak core muscles of the trunk.

Other risk factors include the wear-and-tear of osteoarthritis and osteoporosis, a thinning and weakening of the bones that can cause the vertebrae to break down and compress unevenly. People who undergo spinal surgery to remove tissue pressing on nerves sometimes develop spinal imbalance. A spinal injury that deforms vertebrae can also lead to scoliosis.

Typically, adults don’t seek treatment for scoliosis until they develop symptoms, the most common of which are lower back pain, stiffness and numbness, cramping or shooting pain in the legs. Those affected often lean forward to try to relieve the pressure on affected nerves.

Others with scoliosis may lean forward because they lose the natural curve in their lower back. This compensating posture, in turn, can strain the muscles in the lower back and legs, causing undue fatigue and difficulty performing routine tasks.

Exercises that strengthen core muscles — those of the abdomen, back and pelvis — help to support the spine and can reduce the risk of developing scoliosis, as well as prevent or minimize its symptoms.


Demonstrations of core exercises that can be done at home, with or without an exercise ball, are easily found online.

As many of you know, I am a swimmer, and my physical therapist insisted that I add the backstroke to my daily workout in the water, both to further strengthen my core and to develop upper back and shoulder muscles that will keep me from becoming bent forward as I age.

I soon discovered that the backstroke is more challenging than freestyle, and in doing it for half of my 40-minute swim, I’ve lost weight as well as gotten stronger.

Most people who develop symptoms of scoliosis can be treated effectively with over-the-counter pain medication and exercises to increase strength and flexibility. Bracing is not recommended for adult scoliosis because it can further weaken core muscles.

Surgical treatment is reserved for those with disabling symptoms not relieved by noninvasive remedies. Surgery often involves spinal fusion to relieve pressure on the affected nerves. It is riskier in adults than in adolescents with scoliosis; complication rates are higher and recovery is slower, according to the Scoliosis Research Society.

But progress is being made in developing less invasive measures, including the use of biologic substances that stimulate bone growth in degenerated vertebrae.



Source : The New York Times ( Well Blogs ) , 21st October 2013

Are Pedicle Screws Best for Scoliosis Surgery?

A study published in the October issue of Spine evaluates whether adolescent idiopathic scoliosis patients treated with pedicle screws have fewer readmissions when compared with patients who receive hybrid constructs.

The study examined 627 patients in a prospective multi-center database that was retrospectively queried to identify consecutive patients who underwent posterior spinal fusion for AIS.  The researchers found:

•    Reoperation rate among pedicle screw patients was 3.5 percent, compared with 12.6 percent in the hybrid group.


•    Early return to the OR was 2 percent among the pedicle screw group versus 9.2 percent among the hybrid group.


•    Longer operating time was an independent risk factor for an unplanned return to the operating room among pedicle screw patients.


•    The majority of returns to the operating room among the pedicle screw group were in less than 60 days, while the hybrid group had most of the returns 60 days after surgery.



Source : Becker's Spine Review , 30th September 2013

5 Findings on XLIF for Scoliosis Surgery

In a recent study published in the journal Spine, researchers set out to examine extreme lateral interbody fusion as a treatment for adult degenerative scoliosis.

The prospective, multicenter, single-arm study was conducted through evaluation of clinical and radiographical results of 107 patients undergoing the XLIF procedure. On average, there were three levels treated per patient.

The study found:

•    85 percent of patients were satisfied with the procedure and would choose it again.


•    The complication rate for XLIF was found to be overall lower than that of traditional surgical approaches to degenerative scoliosis.


•     All clinical outcome measures showed significant improvement at 24 months.


•    Overall Cobb angle was corrected from 20.9 degrees to 15.2 degrees.


•    The greatest Cobb angle correction was observed in patients supplemented with bilateral pedicle screws.

The study provides supporting evidence that the XLIF procedure leads to good clinical and radiographical outcomes, without the high complication rate often associated with traditional surgical treatment of degenerative scoliosis.

The researchers included Frank Phillips, MD, Robert Isaacs, MD, William Blake Rodgers, MD, Kaveh Khajavi, MD, Antoine Tohmeh, MD, Vedat Deviren, MD, Mark Peterson, MD, Jonathan Hyde, MD, and Mark Kurd, MD.



Source : Becker's Spine Review , 30th September 2013

Study finds braces twice as effective in preventing corrective surgery for scoliosis

In the first large-scale test of whether wearing a brace helps to prevent an already-curved childhood spine from twisting further, bracing was nearly twice as effective as a watch-and-wait approach at preventing kids from needing corrective surgery.

But the study also found that too many children with scoliosis are being given a brace when they don't need one. Data from the new research may help doctors identify which children need to wear the brace and when it is better to just keep tabs on the child.

The study "really answers the question that parents raise - 'If you're going to prescribe a brace for my child, does it work?'" said Dr. Stuart Weinstein, lead author of the study, which was published online by the New England Journal Medicine and reported Thursday at the Scoliosis Research Society's annual meeting in Lyon, France. "The answer is that braces have a very high success rate," he told Reuters Health.

"We also found that the longer the child wore the brace, the more likely you were to achieve success," he said. "Children who wore it more than 13 hours a day had a 90 percent to 93 percent chance of success for avoiding having the curve progressing to a surgical threshold."

The results were so pronounced, the test of 242 youngsters in the U.S. and Canada was halted early.


"It certainly reinforces our present approach to bracing in these at-risk adolescents," Dr. Allan Beebe, an orthopedic specialist at Nationwide Children's Hospital in Columbus, Ohio, who was not connected with the research, told Reuters Health in an email. "This study appears to be better science" than the previous research on bracing.


About 2 to 3 percent of children have some degree of spine curvature, but only 0.3 to 0.5 percent have progressively worsening curves that make them candidates for treatment aimed at avoiding the need for surgery.


Once the spinal curve gets beyond 50 degrees, there's a high risk it will continue worsening into adulthood unless corrected surgically. So treating the problem early is preferable, and less expensive.


Weinstein and his colleagues point out in their report that there were more than 3,600 spinal surgeries to correct adolescent scoliosis in the U.S. in 2009. At a total cost of $514 million, the procedure "ranked second only to appendicitis" for children 10 to 17 years old.


"Bracing has been the standard method of trying to protect patients from needing surgery ever since a brace was developed in the 1940s, said Weinstein, of the University of Iowa. "But it was never really proven if it was effective. There was never a randomized trial where some children were braced and some weren't. The data were inconsistent."


The original plan for the study was to randomly assign some children to a brace and to simply watch others to see whether the curve of the spine became too severe. In either case, progression of the curve to 50 degrees or more indicated that the assigned treatment had not worked.


But many parents had strong feelings about how they wanted their child treated and declined to allow a treatment to be randomly selected for them. So the research team let those parents choose a treatment; 70 percent chose a brace.


"The interesting fact was that when you looked at both the randomized children and those who chose their preference, bracing produced an overwhelming 72 percent success rate when it came to preventing the need for surgery," Weinstein said. The success rate in the observation group was 48 percent.


The success rate among children randomly assigned to bracing was even higher, at 78 percent.


A temperature sensor logged the amount of time the child wore the brace.


"The study provided pretty overwhelming evidence that braces are effective," Weinstein said.


But it was also clear from the results that many bracing treatments are unnecessary.


Nearly half of the participants in the watch-and-wait group during the trial did not have curve progression to the point of needing surgery. The same was true for 41 percent of kids in the bracing group who actually spent very little time wearing their braces.


"We're unnecessarily bracing two patients to get the one patient who actually needs it. We are still overtreating patients," Weinstein said.


A further analysis of the data might prevent some of that unnecessary treatment, he said.


"We will probably, in the next year or so, be analyzing all the factors so we can hone down better who the ideal candidate for bracing is," Weinstein said.



Source : Medcitynews , 23rd September 2013

10 Pivotal Cost-Effectiveness Studies on Spine Surgery to Know

Here are 10 studies published and presented in the past five years on cost-effectiveness of spine surgery.

Spinal Deformity: Dr. Richard Hostin. Published in May 2013, this article in Spine Deformity: The Official Journal of the Scoliosis Research Society includes several co-authors and the International Spine Study Group. The authors aimed to calculate the cost of improvement in health-related quality of life by examining consecutive patients with adult spinal deformity in a single center over a five year period: 2005 to 2010. They collected costs from hospital data on total costs incurred during the episode of care and found that cost-effectiveness ranged from an average of $5,658 per 1-point improvement in the SRS Self-image to an average cost of $25,918 per 1-point improvement in the SF-36 Physical Component Score. There were 164 patients examined in the study with an average of 3.2 years follow-up. Authors concluded surgical treatment for adult spinal deformity could be more cost effective for select proposes like pain reduction and less cost-effective for other purposes, such as improved functional activity.

Intervertebral disc herniation: SPORT. Jon D. Lurie, MD, Gunnar B. Andersson, MD, Sigurd Berven, MD, James Weinstein, DO, were co-authors on this article. As part of the Spine Patient Outcomes Research Trial, these surgeons and research partners examined the cost-effectiveness of surgical versus nonoperative treatment for lumbar disc herniation over a two-year period. The researchers examined 775 patients who underwent surgery and 416 who underwent nonoperative treatment for intervertebral disc herniation and found the average difference in QALYs over the two-years after treatment was 0.21 in favor of surgery. Surgery was more costly than nonoperative care — $14,137 more expensive for adult surgery and $34,355 for Medicare populations. The estimated economic value of surgery varied considerably, according to the study authors, but overall found surgery moderately cost-effective.

Spinal stenosis: SPORT. Published in a 2011 Issue of Spine and reported in Medscape, this article examined cost-effectiveness of spinal stenosis and two other disorders as part of the Spine Patient Outcome Research Trial. The patients were followed for two years and researchers calculated cost per quality-adjusted life year gained in 2004 US dollars, comparing that number to nonoperative care using a societal perspective with costs and QALYs discounted at 3 percent per year. Surgery was performed initially or over a four-year period for 414 of the 634 patients for spinal stenosis. QALY gained for spinal stenosis patients was 0.22 and costs per QALY gained decreased for spinal stenosis from $77,600 at two years to $59,400 at four years. The study authors include Jon D. Lurie, MD, Gunnar B. Andersson, MD, Sigurd Berven, MD, James Weinstein, DO, Harry Herkowitz, MD, Todd Albert, MD, Keith Bridwell, MD, and other non-physician authors.

Degenerative spondylolisthesis: SPORT. Published in a 2011 Issue of Spine and reported in Medscape, this article examined cost-effectiveness of surgical treatment for degenerative spondylolisthesis and two other disorders as part of the Spine Patient Outcome Research Trial. The patients were followed for two years and researchers calculated cost per quality-adjusted life year gained in 2004 US dollars, comparing that number to nonoperative care using a societal perspective, with costs and QALYs discounted at 3 percent per year. Surgery was performed initially or over a four-year period for 391 of the 601 patients for degenerative spondylolisthesis. QALY gained for degenerative spondylolisthesis patients was 0.34 and costs per QALY gained decreased for degenerative spondylolisthesis from $115,600 at two years to $64,300 at four years. The study authors include Jon D. Lurie, MD, Gunnar B. Andersson, MD, Sigurd Berven, MD, James Weinstein, DO, Harry Herkowitz, MD, Todd Albert, MD, Keith Bridwell, MD, and other non-physician authors.

Outpatient cervical disc arthroplasty: Dr. Richard Wohns. Richard Wohns, MD, founder of NeoSpine in the Puget Sound Area, Wash., published an article describing the cost-effectiveness of outpatient cervical disc arthroplasty in Surgical Neurology International in 2010. The article reviewed 26 patients who underwent outpatient cervical disc arthroplasty and found 100 percent of patients improved after the surgery and no postoperative complications. The cost of outpatient single-level cervical disc arthroplasty was 62 percent less than outpatient single-level cervical anterior discectomy with fusion using allograft and plate. The arthroplasty procedure cost 84 percent less than inpatient single-level cervical disc arthroplasty.

Posterior spinal fusion compared to hip and knee arthroplasty: Sonoran Spine Research and Education Foundation. In 2012, researchers and surgeons at the Sonoran Spine Research and Education Foundation in Mesa, Ariz., published an article online examining the cost-effectiveness and outcomes for spinal fusion and joint replacement patients. The study used a Markov model of 1,000 patients for the three cohorts: spinal fusion, knee replacement and hip replacement. The cost of revision surgery was neglected. Researchers found the total hip arthroplasty group had a cost of $27,450.93 per change in QALY and the total knee arthroplasty group had a cost of $59,165.40 per change in QALY. The posterior spinal fusion group reported a cost of $34,110.03 per change in QALY. The cost of the index procedure was more expensive for the spinal surgery, but when adjusting for the improvements in quality of life, the spine surgery had similar costs to the total hip and knee arthroplasty.

Image-guided spine surgery: Dr. Robert G. Watkins IV. Robert G. Watkins IV, MD, teamed with Robert G. Watkins III, MD, and Akash Gupta, MD, to examine the cost-effectiveness of image-guided spine surgery in this study. The surgeons examined 100 patients undergoing thoracolumbar pedicle screw instrumentation using image guidance and compared them to a retrospective group of 100 patients who underwent screw placement prior to the use of image guidance. Revision reduced from 3 percent to 0 percent when the image guidance was used, and the cost-savings for the placement of pedicle screws as $71,286 per 100 cases. The time required to place screws with image guidance was 20 minutes for two screws, 29 minutes for four screws, 38 minutes for six screws and 50 minutes for eight screws. The researchers calculated cost-savings for the time spent placing pedicle screws with image guidance by subtracting the time required with the current non-guidance techniques from the averages with guidance and multiplying that number by $93 per minute. The article was published in The Open Orthopaedic Journal in 2010.

Spinal fusion surgery: The Ohio State University. Surgeons from the department of orthopedics at The Ohio State University published this 2012 article in the Journal of Bone and Joint Surgery examining the most cost-effective graft option for spinal fusion to treat L4-L5 degenerative spondylolisthesis. They used a Markov decision model to identify the cost and effectiveness of spinal fusion surgery and revision surgery associated with each graft option. The incremental cost-effectiveness ratio for each graft option when compared with living with chronic back pain was $21,308 per QALY for iliac crest bone graft; $16,595 per QALY for rhBMP-2; $21,204 per QALY for local bone alone; $21,287 per QALY for demineralized bone matrix with local bone; and $28,153 per QALY for corticocancellous allograft chips.

Artificial disc replacement: Dr. Richard Delamarter. Richard Delamarter, MD, co-director of the Cedars-Sinai Spine Center, reported a 2011 study in which he found that artificial disc replacement for patients with degenerative disc disease had a more positive economic impact than spinal fusions. The study examined 209 patients with damaged cervical spine discs who underwent either cervical disc replacement or spinal fusion. Four years after the surgery, the fusion patients were four times more likely to need additional surgery and half of those operations were necessary because of new disc complications occurring at levels adjacent to the fusion. Another study focused on patients suffering from three-level lower back disc disease, comparing the cost of care between disc replacement and fusion. The total hospital costs for the disc replacement patients were, on average, 49 percent lower than fusion patients.

Transforaminal lumbar interbody fusion: Dr. Matthew J. McGirt, MD. Dr. McGirt partnered with Alexandra Paul, MD, Brandon Davis, MD, Oran Aaronson, MD, Clint Devon, MD, and Joseph Cheng, MD, and non-physician researchers to conduct this study into the cost-effectiveness of transforaminal lumbar interbody fusion. The study was presented at the American Association of Neurological Surgeons annual meeting in April 2011, which discussed the economic benefits for patients with leg and back pain associated with grade 1 degenerative spondylolisthesis to receive TLIF. Researchers followed patients for two years to see where the postoperative economic impact lay:

•    Patients reported less disability and improved quality of life according to questionnaires they were given.


•    The mean two-year direct medical cost was $25,251.


•    The mean surgical cost was $21,311±2,086, and the mean outpatient resource cost was $3,940±2,720.


•    The average total two-year cost of TLIF was $36,835±11,800.


•    The average reported annual income prior to surgery was $50,000. Patients missed an average of 60 work days, representing a two-year societal cost of $11,584.


•    At two years after surgery, the total cost per Quality Adjusted Life Years gained of TLIF was $42,854, well below the accepted $50,000 cost-effective threshold.



Source : Becker's Spine Review , 4th October 2013

Back bracing for scoliosis needs work, studies show : NEW YORK

Bracing for scoliosis has been so controversial that until now, one recognized medical group advised against it. But braces have been used for years to prevent spine surgery for the problem, and now a report in the prestigious New England Journal of Medicine racks up scientific evidence that braces do indeed need work.

You can see the scoliosis, curvature of the spine, as 12-year-old Shannon White bends forward. It started when she was very young.

"I was going to my doctor and she noticed that my shoulders weren't even, and I was about 5 or 6 at that time," said Shannon.

She went to a pediatric orthopedist.

"He started bracing me and hope that as I grew, it would decrease the curvature," said Shannon.

The new report backs up the idea of wearing a brace like this for 13 to 18 hours a day.

The report compared kids Shannon's age to see if bracing versus no bracing prevented progression of spine curvature. The results favored bracing so much that the study was stopped so all the kids could use the braces.

It's very flexible as well. Shannon has been wearing it for the hours that she sleeps, and for several hours after school.

"At sleep overs it's a little uncomfortable on the ground or in a sleeping bag," said Shannon.

But she told me she's now used to it, and she's able to take it off for sports, including gymnastics. She's had it two years. She'll wear it another year until her spine and the rest of her bones stop growing. She's had no progression of the curvature in the years she's worn the brace.

"That was our number one goal, to prevent the need for surgery on her back, and the brace has accomplished that," said Shannon's mom, Valerie White.

Scoliosis has a big genetic factor, Shannon's father had the problem. Because of that, she had a one in five chance of getting it too. In the pipeline is some DNA research that may help doctors figure out which patients will go on to progression of spine curvature, and which kids won't.

Dr. David Konigsberg THE VALLEY HOSPITAL



Source : ABC Local , 4th October 2013

Study supports use of back braces to treat scoliosis

Adolescents with scoliosis – curvature of the spine – may be able to benefit from treatment with a back brace and avoid surgery, according to a study published in the Sept. 19 online edition of the New England Journal of Medicine.

More likely to occur in girls than in boys, adolescent idiopathic scoliosis (AIS) is a curvature of the spine with no clear underlying cause. Doctors have recommended bracing as a treatment for more than 50 years, but until now, studies of its effectiveness have produced mixed results.



A new study from the National Institutes of Health (NIH), however, should help to clear up any doubts about the efficacy of bracing.



According to an NIH news release, researchers set out to compare the risk of curve progression in adolescents who had AIS and wore a brace with those who did not wear one. The study team, led by Stuart Weinstein, MD, a professor of orthopedic surgery at the University of Iowa, recruited patients who – based on their age, skeletal immaturity and curve severity – were at high risk for continued worsening of their spinal curves.



Study investigators analyzed data on 242 patients at 25 sites across the U.S. and Canada between March 2007 and February 2011. The children in the study were aged 10 to 15, still growing, and had spinal curvatures of 20 to 40 degrees.



In the study group, 116 patients were randomly assigned to observation or bracing for at least 18 hours a day. Because some parents did not want to wait and see how their child’s curve progressed, a group of 126 patients were allowed to choose for themselves if they wanted bracing or observation.



Bracing was considered a failure if a child’s spinal curvature progressed to 50 degrees or more, when surgery, which entails putting screws and rods in the spine to straighten it, is often suggested. Bracing was deemed a success if the child reached skeletal maturity without this degree of curve progression.



Study results showed that in the combined randomized and preference groups, 72 percent of the patients who wore braces reduced the risk of curve progression and the need for surgery. Wearing a brace more than an average of 13 hours a day was associated with success rates of 90 to 93 percent. Results showed that the more hours the brace was worn, the higher the success rate.



In addition, the researchers found that 48 percent of patients in the observation group, and 41 percent of the patients in the bracing group who wore a brace infrequently also had positive outcomes.



“There are a lot of doctors like me who treat scoliosis as the primary focus of their practice who had doubts about whether bracing was effective. Now the jury is in,” Weinstein told the New York Times.



For one doctor, the study helps prescribe bracing for image-conscious teens.



“When you have a teenager who is anxious about wearing a brace to school or what their friends will say, it gave us a bit of heartache to try to convince them if we weren’t certain ourselves,” said Dr. Paul Sponseller, the director of orthopedic surgery at Johns Hopkins Children Center, in the New York Times article.



“In light of this new evidence, we can say we really do have a basis for putting them through bracing,” added Sponseller, who was not involved in the study.

Source : Examiner.com , 19th September 2013

Minimal access spinal technology has revolutionized the world : Chandigarh

Physical independence is of significant importance to human beings. Impaired mobility due to pain, disabilities, injuries or infections can affect an individual physically, psychologically and emotionally. Spinal deformity or trauma is such a condition that can be life changing if not taken care of, with patients shying away from their social lives.

 

However now with the changing face of vertebral surgeries, there is hope for spinal patients to live a life free of pain and stigma and embrace the company of others. One such cutting edge technique, minimal access spinal technology (MAST) has revolutionized the traditional spinal surgery norms. With minimal scarring and quick recovery, MAST is one of the most widely used spinal surgery procedures in the world.

"Most of the patients I have treated with spine problems used to shy away from the company of other people because they were afraid of being stared at and ridiculed, and this was detrimental for their self esteem and confidence," said Dr. Amit Kapoor,Orthospine, Ivy Hospital,Mohali. "Those patients who opted for MAST surgery experienced a total transformation since their spinal issues were resolved and there were no ugly scars that would prompt them to cover up their backs," he added.

Compared to the traditional spinal surgery, MAST stands out with its benefits, the doctor explained. "Scars affect an individual greatly, especially when it comes to wearing clothes. With minimal access spinal surgery or keyhole spinal surgery there is less or no scar formation. This is a boon for patients as they can now wear summer clothes without feeling awkward. Earlier with traditional spinal surgeries the recovery period was much longer and was an ongoing process associated with back pain," he said.

According to Dr. Amit Kapoor the most beneficial aspect of MAST is the quick recovery time that allows the patient to go home the very next day, and they can resume their normal routine within a week.

"Patients now feel confident, empowered and independent after the surgery, unlike with traditional spinal surgeries," he said, going on to explain that, " Spinal surgery is required in case of various injuries, infections and deformities. Awareness about the medical condition with prompt action can help the patient greatly."


Source : T.O.I , 19th July 2013

City doctors perform spine straightening surgery : Vishakha Patnam

In a complex four-and-a-half hour surgery, a severe spinal deformity of a 14-year-old girl from Anakapalle was completely corrected by doctors in the city recently. Neeraja, a ninth standard student of a local government school, had developed a small hump on the right side of her back a couple of years ago that kept getting progressively worse.

She was diagnosed with a severe case of scoliosis, in which the spine gets bent to one side, twisting the back into an abnormal shape. While scoliosis usually affects adolescent girls, one out of 10,000 cases of the ailment are severe, where there is a large curve of the spine. Though moderate curvature can be prevented from progressing by wearing braces, in severe cases the curvature progresses rapidly and needs to be operated upon early. Large curves also cause respiratory problems later in life apart from causing fatigue and mental stress due to social stigma, say doctors.

The curvature of the spine was corrected by inserting 23 titanium pedicle screws into the vertebrae that were connected to rods, which in turn were de-rotated to unbend the spine, explained Dr B Leela Prasad, who along with Dr M Muralimohan and Dr J Naresh Babu operated on Neeraja on June 30 and kept her under observation for almost a week.

"Bone grafts were also placed to prevent worsening of the deformity in the future. After the surgery she was kept under observation and made to sit up and walk from the second day. Follow-up showed that her spine got back its shape and she can go back to school after a month," said Dr Leela Prasad.

"I had assumed it was due to the weight of the school bag carried by her. But the size of the hump kept on increasing and she developed an obvious deformity. Neeraja was depressed and confined herself indoors to avoid being made fun of. Local doctors diagnosed it as scoliosis but said this was major surgery that could leave her paralysed for life and advised us to approach doctors in any of the metro cities," said her mother Subhadra.

"We then consulted Dr Leela Prasad, who after examining the patient and reviewing the x-rays suggested surgical correction of the deformity. We were scared that the surgery would cripple her permanently and feared for her life. But Neeraja was brave enough and was determined to get her deformity rectified," said her father Satyanarayana.

Source : TOI , 9th July 2013

Miracle Spine Surgery of Little Girl at Chennai !

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Girl gets spine corrected

Source : Deccan Chronicle , 29th June 2013

One in 3,000 girls is affected by scoliosis, the curving of the spine from side to side. But only a few visit hospitals for surgery, says Dr Nalli R. Uvaraj,  professor of spine surgery, department of orthopedics, Rajiv Gandhi government general hospital (RGGGH).

Dr V. Kanagasabai, dean, RGGGH (left) and Dr R. Uvaraj, professor of spine surgery, department of orthopedics, greet Abitha, who underwent growing rod technique procedure, on Friday.

“If left untreated, the lungs and heart get affected and one’s lifespan also comes down. Scoliosis is more common among girls than boys,” said Dr Nalli who performed dual growing rod technique procedure on nine-year-old P. Abitha from Porur.

While a few corporate hospitals perform surgery for scoliosis, this is the first time the government hospital has performed it on a nine-year-old with the new technique.

“We usually operate on 13 or 14-year-old girls. This patient visited us with acute back pain and we performed the procedure in March. While most operations for spinal deformity on young children affect their growth, this particular technique is to allow for continued, controlled growth of the spine,” informed Dr Nalli, adding that screws are inserted into the bones of the vertebral column at the level of the deformity and the correction is done.

The child needs to visit the hospital every six months to have the rods lengthened. “This is mainly to keep up with the child’s growth.  She is only nine years now and till she reaches 14 years, the rods will be lengthened every six months in a simple procedure. When she reaches 20, the rod can be removed,” explained Dr V. Kana­gasabai, dean, RGGGH.

While the surgery would have cost Rs4 lakh and the follow-up every six months more than Rs70,000, the procedure was done free of cost at the general hospital. Abitha, daughter of car driver Prabhu, said she could play well and would go back to school from Monday.



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GH docs do rare surgery on kid with bent spine

Source : The New Indian Express , 29th June 2013

Nine-year-old Abitha found it hard to run around and play her favourite games with her friends at school as she often had unbearable pain on her back. Her father Prabhu, a car driver, approached doctors at the Rajiv Gandhi Government General Hospital a few months ago after he found that his little girl was suffering from scoliosis, a spinal deformity since birth.





               Top docs at RGGGH show Abitha’s progress post surgery

Today, Abitha can run and play around just like any other child without pain. Thanks to the dual growing rod technique, a rare spine treatment given to her.

Doctors at the RGGGH performed the procedure which would otherwise cost her Rs 11 lakh in total, free of cost. “Scoliosis is the bending of the spine on its side. The girl’s father approached us after seeing newspapers about a 22-year-old woman with the same deformity we had operated on earlier,” said Dr V Kanagasabai, Dean, RGGGH.

With highly expensive equipment procured through government funds, the doctors cut and opened the lower part of her back, inserted rods with a length of about 15cms each and four screws. They then created an opening near the neck to adjust the rods up through tunneling method and fixed some hooks. Within a month after the first surgery was done on March 1, the girl was able to move around freely, doctors said.

But since Abitha was just nine, she would require four to five surgeries in intervals of about six months. While the first surgery cost  about Rs 4 lakh, the subsequent ones will cost about Rs 70,000 each if charged. “If the girl grows about one cm, we can extend the rod to keep pace with her growth. This can be performed through a small incision and will not affect the girl’s growing organs like heart and lungs. In the first surgery itself, we were able to achieve 50 to 60 per cent correction,” explained Prof Nalli R Uvaraj, Ortho Spine Surgery Unit, RGGGH.

Once the girl reaches her full height at the age of about 14 or 15, she will undergo a  complete procedure where the rods will be fused and fixed permanently, doctors said.  They added that though it was a long, difficult therapy for the child, the complication of hook dislodgement and rod breakage was low. “The size of the rod would be double the size for adults than the ones used on her. After 14 or 15, the growth rate is less and it won’t affect her or the rods. There is no reason why such a deformity occurs but it happens one in 3,000 people and more on women,” the professor explained.

The little girl said she was comfortable walking around. “I study class four and I love playing with my friends. Earlier I had pain, now I don’t. I am going to get back to school on Monday,” she said with a smile.

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Surgery straightens 9-year-old’s spine

Source : The Hindu , 29th June 2013

For years now, P. Prabhu, a car driver, has been spending sleepless nights trying to find a solution to his nine-year-old daughter’s condition – a spinal deformity. All through her formative years, Prabhu watched Abitha walk with a slight hunch and struggle with intense pain.

On Friday though, three months after the child underwent a surgery at Rajiv Gandhi Government General Hospital (GH), Prabhu was looking forward to the day she would fully recover.

“When Abitha was three, we noticed she walked with a slight hunch but we did not know the extent of the problem. She used to complain of pain. We found out that she had a spinal deformity only when she was six,” he said.

Doctors at GH diagnosed Abitha with scoliosis — a sideways curvature of the spine, and performed a surgery using the ‘growing rods’ technique, in March.

“Abitha was brought to us last November. She had an ‘s’-shaped curve in her spine. We opened up the upper end and lower end of the curve. Screws and hooks were inserted at both ends and we tunnelled four rods under the skin. The screws held on to the rods on either ends. The rods will be lengthened every six months to keep up with the child’s growth,” said Nalli R. Uvaraj, professor of spinal surgery at GH.

When the child is older, doctors will remove the rods and perform a spinal fusion operation. Abitha, who is in class IV at a school in Porur, said she felt much better after the surgery.