Crosslinks Unhelpful in Spinal Fusion for Scoliosis

Crosslinks didn't improve outcomes, but added bulk and cost.

 In posterior spinal fusion for adolescent idiopathic scoliosis, crosslink use in conjunction with pedicle screw constructs did not improve outcomes, researchers reported here.

A multicenter analysis revealed no obvious improvement for young patients who had crosslinks compared with patients who didn't, and discontinuation of crosslink use could save roughly $1,000 per surgery, according to Cameron R. Niswander, BA, of the University of Colorado, and colleagues.

"Traditional constructs utilizing pedicle posts and wires suffer from a lack of rotational stability. Crosslinks are traditionally utilized as a way to reduce that motion," Niswander said in a presentation at the annual meeting of theAmerican Academy of Orthopaedic Surgeons. "However, with the implementation of more modern systems such as the pedicle screws it's unclear whether crosslinks still need to be utilized."

"We found no differences in radiographic outcomes, clinical outcomes, or complication rates between groups. Therefore, crosslinks are no longer utilized in adolescent idiopathic scoliosis surgery with pedicle screw constructs at our institution," he added. "This has resulted in a cost reduction of about $1,000" per patient.

For the study, Niswander and colleagues -- who included Sumeet Garg, MD, and Mark Erickson, MD, of Children's Hospital of Colorado in Aurora -- searched a multicenter database for patients who underwent posterior spinal fusion for adolescent idiopathic scoliosis both with and without the use of crosslinks.

Inclusion criteria required pedicle screw fixation with more than 90% fixation points, no three-column osteotomy, no sacrum/pelvic fixation, and a minimum follow-up period of 2 years.

In a final sample of 500 patients, 377 with crosslinks and 123 without crosslinks, the researchers matched patients between groups based on age, BMI, and gender, as well as Lenke classification (P=0.6743), riser sign (P=0.2599), and preoperative radiographic measurements.

Implant density was 1.67 in in the crosslink group, and 1.70 in the non-crosslink group (P=0.3611).

At the 2-year follow-up, the crosslink group had a slightly decreased lumbar Cobb angle of 2.7 degrees compared with the non-crosslink group, but no other radiographic measures differed between groups in coronal balance, shoulder height, trunk shift, or sagittal balance.

Complications were reported in 21 patients in the crosslink group, and nine patients in the no-crosslink group (P=0.478). One infection was reported in the crosslink group, but none were reported in the no-crosslink group.

Reoperations were necessary for four patients, all of whom had crosslinks, and three of those surgeries were to remove implants at the patient's own request.

Scores on the Scoliosis Research Society-22r questionnaire from pre- and postsurgery were similar between groups (P=0.4634). However, self-image scores were slightly improved for non-crosslink patients, and function scores were slightly higher in the crosslink group.

The only difference that reached statistical significance was the improvement in mental health scores in the crosslink group (P<0.05).

Spinal Appearance Questionnaire scores were also similar for appearance (P=0.2125), expectations (P=0.5007), and improvement in appearance (P=0.1651) and expectation (P=0.1133).

"Since both groups were around that same 1.7 mark, it's hard to know whether more pedicle screws were used, if they were using fewer crosslinks, or no crosslinks for that matter. From our data, we can't say, if we use fewer pedicle screws, can we get away with fewer crosslinks," Niswander said.

The authors reported that the list price for crosslinks used at their institution ranged from $1,000-$2,000 per unit, depending on the specific type.

Source: Medpagetoday , 27th March 2015 

First U.S. Course on Updated Schroth Method to Be Held at Scoliosis3DC

Dr. Marc Moramarco, of Scoliosis 3DC, will host the first U.S. Schroth Best Practice® course in Woburn, MA from April 11-15, 2015. Dr. Hans-Rudolf Weiss will travel from Germany to instruct attendees alongside Dr. Moramarco. Several national and international professionals are scheduled to attend the five-day event to earn certification as Schroth Best Practice® practitioners. 

                                          Schroth method experts Dr. Hans-Rudolf Weiss and Dr. Marc Moramarco

We are excited to announce that we are hosting a Schroth Best Practice® course in April, in order to certify practitioners who wish to conservatively treat and empower scoliosis patients around the world.

The course will outline the newest updates to the Schroth method for scoliosis – Schroth Best Practice®. These technique advancements by Dr. Weiss allow scoliosis patients a simpler experience when learning the Schroth method and offer techniques for easier integration of the principles.

For the scoliosis patient, the benefits of Schroth Best Practice® techniques are numerous. The program is multi-modal and according to curve pattern. In addition to Schroth exercises, components are included which address a patient’s regular activities – how to sit, stand, and lie down, comprehensive postural education for specific activities and sports participation, as well as instruction for movements as simple as walking, carrying a back pack or pulling luggage through an airport. The overall goal is to teach patients to avoid curve-stimulating behaviors.

The course comes at an important time because patients and families are tired of the historically limited scoliosis treatment options. Therefore, it is crucial to certify more Schroth Best Practice® practitioners so patients who want to proactively manage scoliosis using exercise have improved access to practitioners who are knowledgeable about the latest advancements.

Dr. Weiss is the former medical director of the Asklepios Katharina Schroth Clinic – an in-patient facility bearing the name of his grandmother – Katharina Schroth, the creator of the Schroth Method. There is no greater authority worldwide on the nonsurgical treatment of scoliosis. The Schroth method is rapidly gaining acceptance by patients internationally as an effective, nonsurgical treatment option for scoliosis. Dr. Moramarco introduced Schroth Best Practice® in the U.S. in 2007 after gaining his Schroth Method certification in Germany.

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Source: PR Web , 30th March 2015 

Girl (14) undergoes groundbreaking spinal treatment to fulfil sporting dream

HOPEFUL: Rebecca Amass who suffers from scoliosis. Inset, a previous piece in the Telegraph about the brave youngster.

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A GROUNDBREAKING spine treatment has revived the shattered ambitions of a hockey fanatic who had dreamed of becoming a PE teacher.

Rebecca Amass, 14, of Yarborough Road, Grimsby, was just 12 when she was diagnosed with scoliosis – a severe curve in her spine, which she feared would ruin her chances.

However, after just four weeks undertaking a daily programme of muscle-strengthening exercises from Scoliosis SOS she now has hope for the future.

Scoliosis is a progressive condition which causes the spine to excessively curve sideways

It affects more than four per cent of the population and if left untreated can lead to fatal heart and lung problems.

Current treatment in the UK is an incredibly risky procedure which involves metal rods being inserted in the spine and fusing it solid.

Having always led an active lifestyle, people first noticed something was wrong when Rebecca was becoming tired more quickly and complaining of aches and pains in her back.

In a state of panic, Rebecca's mum immediately booked to see the family GP who gave them the devastating diagnosis.

Rebecca was told her spine was so twisted and contorted that she would never be able to stand up straight again, let alone play her beloved hockey.

The condition also left her in excruciating pain and her GP, believing her condition to be severe, referred her to an orthopaedic surgeon.

It was there she was told her ONLY OPTION was to have an eight-and-a- half-hour operation to fuse her spine from top to bottom, which would mean having to give up her beloved hockey and any other contact sports.

Rebecca said: "Scoliosis rocked my world. I have always been passionate about keeping fit and playing sports but when I started feeling tired and getting pain down my back, it was really hard to stay motivated.

"I struggled to keep up with all my practices and I lost loads of confidence.

"Everyone around me was really worried and it was hard because I felt like certain things were being kept from me.

"I felt like crying all the time and none of my friends could understand how I was feeling as they were all completely healthy!"

In a desperate attempt, Rebecca and her family searched the internet for alternative treatments and discovered Scoliosis SOS.

Founded by Erika Maude, who has Scoliosis herself, the clinic opened nine years ago and has since brought relief to hundreds of sufferers.

Rebecca and her family decided the treatment could not do any harm and if it meant she could play hockey again it could be life-changing.

Rebecca booked onto a four-week treatment course and the results were overwhelming.

Rebecca said: "I feel like myself again. After my diagnosis I really felt like my world had fallen apart.

"I just wanted to be able to run around like my friends.

"I felt like a liability, I would start a match and then have to give up after 10 minutes because of the pain.

"The thought of being normal again was enough to push myself and get some amazing results

"For me, having surgery was just not an option and it really wasn't something I ever wanted to consider, that's why I knew that I needed to find something else!"

For more information visit www.scoliosisSOS.com

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REBECCA is not the first Grimsby youngster to bounce back from the brink of needing major surgery.

As reported, last year Laura Allen, 14, of Marklew Avenue, Grimsby, had feared she would never be able to take part in ttrampolining, after being diagnosed with severe scoliosis.

She said: "I'm not comfortable with doctors and I have a massive phobia of hospitals, so when I was told that I had a massive curve in my spine and that I would need to have surgery I was so scared I didn't know what to do with myself.

"It was awful, I wasn't sleeping and I was crying all the time."

Another blow came when Laura was told she would have to give up trampolining.

After travelling to London for the four-week treatment programme, Laura – who is now pain free – has not looked back.

She said: "It was the best thing we could have ever found. It felt like a massive weight had been lifted from my shoulder.

Source: Grimsbytelegraph , 30th March 2015 

First-year Harry Paul presents work on scoliosis at White House

First-year Harry Paul worked on his invention, a spinal implant to help people with congenital scoliosis, throughout high school. He is currently working to get it patented.



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Tufts first-year Harry Paul presented his invention, intended to ease the lives of children living with congenital scoliosis, to President Barack Obama and other White House officials earlier this month. Paul has been working on the device for three years and recently submitted it for a patent. The Daily spoke with Paul about his invention, its inspiration and the process he went through to create the device.

The following is an abridged version of the interview.

Tufts Daily: What inspired you to build this device?

Harry Paul: I was born with congenital scoliosis, a curvature of the spinal column, which, because it happens so early in development, gets much worse over time and really affects the development of the thoracic cavity, which is all of the space where the heart and lungs and other vital organs develop. So when you have congenital scoliosis, it restricts the amount of growth that can happen, which compresses those organs and hinders them from developing, which as you can imagine is very, very dangerous. So most people who have congenital scoliosis will die before the age of 4 if he or she doesn’t have treatment.

What current treatment does is surgeons put rods in, and the rods keep the spine straight, but they have to be lengthened with another surgery every three to six months. So I went through all that and it wasn’t that fun. I decided that I wanted to try to learn about the different treatments out there and see if there had been anything that had been developed to make it easier, and there really wasn’t anything.

TD: Can you explain, in simple terms, how the device works?

HP: So what I did is I invented an implant that grows with the spinal column to keep the spine straight as growth is happening, minimizing the number of surgeries the child would have to have and lengthening the time between surgeries so they can have less complications, less time out of school, less of all the bad things.

Then as I was doing that, I realized that in order to test it, I would need to put it in either a human or an animal and I wasn’t really into that, nor could I because I was a high school student. So what I did is I built my own mechanical model of the spinal column. I used computers and an engineering lab and 3D printers and screws and bolts and mills and all that good stuff to build [it]. It was just made out of plastic and metal but it simulates the natural growth of the spinal column. So we could not only put my implant on the trial spine … but any other implant that might be developed in the future to see whether it’s going to work or not. I hope this will stimulate more and more people to not only get involved in science and STEM [Science, Technology, Engineering and Math education] as a whole but to focus on this problem, because it is a field that has been sort of stagnant lately, and that’s not a good thing.

TD: Were there any technical difficulties in your process?

HP: For most of it I would do things, find out how much it would cost to do what I needed to do, find out it was way too expensive, and because of that have to make something myself. So part of it was, I didn’t have the money to put it in an animal trial, or to pay a surgeon to test it out, so I had to do something else.

I have incredible parents; I am lucky that they have supported me, not just emotionally, but financially as much as they can. So when I said that I wanted a computer that could handle this ridiculously powerful engineering program, they rolled their eyes and then found a way to do it.

Also in the high school I went to, I was in a science research program, so I had a very limited amount of funding through that, but I used all of what I could and tried to weasel more money out of them. So that was great, and then eventually, as I started to really get into this and to really develop this, I partnered with an engineering firm in Virginia called K2M, and they were just an amazing company and really supported me, not just by letting me use all their facilities to do these things but to talk to some of the best people out there.

It took many months, and the whole thing took me three years to do.

TD: How did your device get recognized?

HP: I certainly didn’t start at the White House. I first started contacting people to ask them questions about their articles. So this was years ago, before I had even started to make something myself. I was just reading about my disease and I had questions about the articles and the books so I emailed the authors and I eventually started talking about what they were doing, and I learned about it through that.

And then, through the science research program at my high school, we had to apply to science competitions and I did and I ended up winning, and then people took note. And since I went to the biggest science fair [last May], which is the Intel International Science and Engineering Fair … and since I won there, the press has sort of gotten wind of it…

The White House found out about me through Society for Science and the Public, which is the organization that runs and administers the Intel fair. Two weeks ago I got a call. I screamed.

TD: What was the presentation like?

HP: I presented to way more people than I can ever remember … When I saw [Obama] walking towards me with his amazing smile on his face, I didn’t think real life was happening. But when he asked me about my device, he was just another person to talk to about the science, which I am so passionate about.

TD: How has your research continued at Tufts?

HP: Freshman year, I knew I wanted to take a break. Mostly because I had to. Right now, we are submitting a patent, and so I’m not allowed to work on it or put it in clinical trials until the patent gets approved … The process can take up to 5 years. Right now, I am in the process of looking at all the amazing labs [at] Tufts. I love research in general, so I am figuring out what lab I want to apply to.

TD: Will your device be available for widespread medical use?

HP: Yes but no. After the patent is approved, we can start manufacturing and we can start doing more intensive tests or put more funding into it. After we do that, we would need to do clinical trials to develop the implant and test it in an animal to make sure there are no adverse reactions. And then there is the whole FDA (Food and Drug Administration) regulatory process.

TD: Do you have any advice for young engineers?

HP: Anyone who is really passionate about something should have a chance to keep talking about and working on it. It doesn’t matter who you are to be interested in science, and if you are interested in it, you can go as far as you want. Don’t give up. I could have given up a trillion times. My device failed again and again and again. I could have just said, I failed, I didn’t win, and given up. You will keep having failures until you don’t fail, and then it’s amazing

Source: Tufts Daily , 1st April 2015 

Giuliana Rancic: 'I Was Called Ugly My Entire Life'

Giuliana Rancic finally speaks out about her Fashion Police controversy, the health problems she’s kept secret, and why she’s become shockingly thin.

She's revealed personal heartache and private pain on her reality show, Giuliana & Bill, but Giuliana Rancic has kept one very painful part of her past a secret – until now. 

The E! personality, 40, reveals in her new book, Going Off Script that for over a decade she suffered from scoliosis, a curvature of the spine that if untreated can lead to permanent deformity. 

"The thing about scoliosis is it's a different kind of ugly for a young girl," says Rancic, who was diagnosed at 13. "It's one thing to hate your hair or to have bad skin, but those are things you can hopefully treat. [Scoliosis] is very hard to camouflage and it's all you think about all day, every minute of the day." 

 Giuliana on Fertility Struggle: We Lost Our Last Embryo

Because of the severity of her curve, one of Rancic's hips was inches higher than the other. "I always wore baggy clothes," she says. "And I trained myself so I always looked like I was leaning on something." 

The memories are still difficult to recall for the mom of Duke, 2, (with husband Bill. "[As a teen] I tried to enter pageants and audition for movies and model, because I think I was hoping someday someone would tell me I was pretty. I just wasn't. I was crooked." 

Corrective surgery at 21 straightened Rancic's spine, but left her with a permanent scar and markedly "bony" shoulder blades, which were the focus of a heated weight debate when she wore a strapless dress at the Golden Globes in January. 

"That was very hurtful to me because it was the first huge backlash about my weight," Rancic explains. "And the thing is I've lived with my back and the way it looks since I was a little girl. My shoulder blades protrude as a result of scoliosis. Even if I gained 20 pounds, my bones would still look the way they do." 

But despite all the criticism, Rancic sees a positive outcome from her years of heartache. "I was called ugly my entire life but it made me who I am," she says. "I always tell girls, whatever struggles you go through as a young woman, those are the things that become your power later. Even though it's painful to think back on, I wouldn't change a thing. Because everything I went through as a child got me to where I am today." 

Guiliana: I Know I'm Too Thin

Source: People, 1st April 2015 

Scoliosis not slowing down Hamilton

Living with scoliosis

Elliana Hamilton refuses to let scoliosis slow her down. While there are concessions to the lateral curve in her spine that may one day require spinal fusion surgery, the Shelbyville Middle School eighth-grader remains a three-sport athlete. 

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Four days before the end of sixth grade, Elliana Hamilton fought her way into a completely rigid back brace.

There are zero ways for an 11-year-old girl to sufficiently accessorize that kind of apparatus. The brace, designed to slow the onset of scoliosis in her spine, was to be worn 23 hours a day. Only a dip in the pool or a few minutes in the shower provided a break.

"You can't bend over," said Hamilton, now an eighth-grader at Shelbyville Middle School. "To pick something up, I had to squat."

If scoliosis, the lateral curvature of the spine, has slowed her down any since she was first diagnosed, it's tough to tell.

Two months away from middle school graduation, Hamilton has completed successful athletic seasons as a tennis player and swimmer. Now she is preparing for the upcoming softball season.

All with a broken back. Well, not exactly broken.

Bent? Definitely.

Broken? No.

Rather than growing in a straight line, Hamilton's spine is curved enough that spinal fusion surgery is under consideration.

"It was a tough adjustment," said Hamilton, who was diagnosed after going to the doctor with pneumonia. "After awhile I got used to it and I became confident. I was not going to stop being who I am."

The examination for scoliosis is no longer part of an athlete's preseason physical evaluation, according to Elliana's father, David. The happenstance visit to the doctor gave the first inclination of a growing problem with her spine.

"It's up to you as an individual to go to your family doctor and get screened," said David Hamilton. "Our surgeon is telling us if you see any curve, get it looked at because they can brace it early and prevent it from getting worse."

Elliana's spine was curved 17 percent at the initial diagnosis. Eight months later it was over 40 percent. That prompted the back brace.

"Maybe we could have stopped it at 25 percent instead of 37 percent where we're at (now) and not be on the borderline of what to do," said David.

Elliana's tennis career is likely over. The high school seasons for girls tennis and softball overlap. She expects to swim and play softball at the varsity level sooner rather than later.

Spinal fusion surgery would make that a tough proposition because of the long rehabilitation process. And her chances of returning to the pool to be a competitive swimmer would be slim.

"They don't like to do surgery until (the curve) is 50 percent," said David. "(Elliana) is close to borderline. Our surgeon is pushing us away from surgery since she is an athlete. Doing a flip turn (in the pool) with a spinal fusion would be difficult. That's why we're in a wait-and-see game.

"If her spine doesn't get any worse, she will be fine."

Elliana is currently in a six-month stretch out of the back brace to see how her spine reacts. Until then, she will keep training and competing.

The only real concession she has made to scoliosis is becoming a left-handed hitter to counteract the curve in her spine.

"While batting I was dropping my (right) shoulder," demonstrated Elliana. "My curve was causing me to drop my shoulder. So my batting coach had me try left-handed. So I am now officially a left-handed batter."

She will find it tough to break into Shelbyville's 2016 varsity softball lineup due to the wealth of talent currently in a program that has just one senior. But there is no doubt she will be on the starting blocks as a freshman later this year during the first swim meet of the season.

Despite not yet seriously devoting herself to the sport — she has never competed for an offseason swim club — Hamilton finished runner-up in two events, the 50-yard freestyle and the 100 breaststroke, at the Hoosier Heritage Conference's middle school meet on Feb. 21.

"She was swimming against girls that swim year round," said David. "And she was competing and doing well. It shows if she focuses on swimming just what she can do."

The results surprised even Elliana.

"I knew I was an OK swimmer and could do good but this year I was swimming harder and going against better teams and I was going faster," she said. "So I started thinking I'm a better swimmer than I thought I was."

In the pool, reaching the wall and inverting into a turn and pushing off is the one time she really notices her abnormality.

"I can feel it during flip turns," she said. "Flip turns are harder to do with scoliosis. I have worked really hard to perfect it. I don't know if I have completely perfected it yet, but I'm trying."

The way she competes — on a tennis court where she played No. 1 doubles last Fall, in the pool or on the softball diamond — the scoliosis is only evident to her family.

"I can see when she runs the bases or is on the track running there is a little bit different gallop because one hip may be just a little higher than the other," said her father. "But the average person wouldn't know what's going on."

And that's a victory for Elliana.

"She's going to be fine," he continued. "When she was first diagnosed and the word 'surgery' was flying around, the initial reaction was like any kid's would be. Why me? But now she has embraced it."

A strong student in the classroom and an athlete driven to succeed, Elliana proudly talks about her affliction because it is not defeating her.

"At first, I thought I couldn't do any sports," she said, "but I can still do as many as I want to. I don't worry about my back anymore."

Jeff Brown is the Sports editor of The Shelbyville News.

Source: The Shelby News, 1st April 2015 

Smaller patients may lose more blood during posterior spinal arthrodesis

Researchers found patients with smaller size and adolescent idiopathic scoliosis, cerebral palsy or Scheuermann kyphosis were at risk for greater blood volume loss during deformity-correction surgery.

The researchers reviewed a large, multicenter database to identify patients who had undergone posterior spinal arthrodesis for spinal deformity; 1,832 patients with adolescent idiopathic scoliosis (AIS), 106 patients with Scheuermann kyphosis and 196 patients with cerebral palsy were identified. The researchers used the patients’ body weight to estimate blood volume as a measure of patient size and analyzed the proportion of total circulating blood volume lost during the procedure as the study’s primary outcome.

Study results demonstrated a negative relationship between intraoperative blood loss/blood volume and blood volume in patients with AIS (coefficient, −5.8; P < .001) and in patients with cerebral palsy (coefficient, −20.3; P < .001); however, there was no significant relationship for patients with Scheuermann kyphosis (coefficient, −2.5; P < .001), according to the researchers.

Despite adjustment for several factors, the researchers concluded that these findings indicated that smaller patients lost a greater proportion of their blood volume during the procedure.

Additionally, in patients with these three conditions, males and those procedures in which a higher number of levels were fused had a greater proportion blood volume loss, according to the researchers.

The researchers concluded smaller patients have a smaller reservoir of blood volume and should be monitored closely during periods of blood loss and targeted for blood-conservation strategies. – by Robert Linnehan

Source: Healio, 3rd April 2015 

Citing scoliosis, TSU hopeful wants limits on bookbags

As the number of schoolchildren diagnosed with scoliosis has more than doubled in recent years, Taiwan Solidarity Union (TSU) legislative candidate Liu Kuo-lung (劉國隆) on Friday said that a law that limits the weight of school bags to less than 10 percent of students’ average body weight should be put into place.

At a news conference in Taichung, a first-grader named Lin Meng-hsueh (林孟學) said that in addition to textbooks, homework and test papers, every day he carries extracurricular books assigned by his teachers, a water bottle and a lunchbox, which altogether weigh from 5kg to 6kg.

“I feel like my muscles are burning,” he said.

Lin’s mother said even though her son sometimes leaves some textbooks at school, the books that he must carry on a daily basis are still heavy, causing him to slouch slightly.

Liu said that people diagnosed with abnormal curving of the spine typically have slanted shoulders, which hamper heart and lung functions.

Citing statistics produced by the Taichung Education Bureau, he said that the number of schoolchildren with scoliosis rose from 627 in 2011 to 1,473 in 2013, with the percentage of students developing scoliosis growing in direct proportion to their age.

The problem is more serious than it appears, considering the nation’s sliding birth rates, Liu said, adding that poor posture can also contribute to scoliosis.

He said the TSU caucus last year submitted a draft bill to the legislature to raise awareness about the threat of scoliosis impeding children’s growth, while calling on the Taichung City Government to implement a weight reduction policy for school bags to protect students’ health.

The bureau said that it has continuously promoted the policy among elementary and junior-high schools by asking faculties to come up with measures to cut the weight of students’ bags.

In addition, Taichung schools procure and maintain lockers regularly, as well as weigh students’ bags from time to time, to prevent schoolchildren from developing scoliosis, it said.

Source: Taipeitimes, 5th April 2015