New scoliosis surgery 'could be revolutionary,' but Halifax surgeon says questions remain

The ApiFix device, held by Dr. Ron El-Hawary, includes movable joints that will help patients maintain their flexibility after scoliosis surgery, allowing them to participate in sports. (Carolyn Ray/CBC)

A teenager from southern Ontario says her quality of life has changed dramatically after travelling to Halifax for a new spinal surgery that one surgeon says has the possibility to dramatically change the way children with scoliosis are treated.

Just six patients have had the surgery so far, including 14-year-old Jessica Robb of Westover, Ont., who said that within a week of the surgery, she felt a difference.

"I felt a little straighter. I was still in pain a little bit after, but I felt a lot better than I did before," said the teen about the surgery nine months ago that is now allowing her to participate in more sports.

The IWK Hospital in Halifax is the only place in North America to offer the ApiFix procedure, and surgeons across North America are watching the results closely.



Ontario resident Jessica Robb, 14, had 50 per cent curvature of her spine before the surgery in Halifax.(Submitted by the Robb family)



Jessica was diagnosed with scoliosis — a curvature of the spine that most often occurs during the growth spurt just ahead of puberty — when she was seven years old. She spent nearly seven years wearing a brace 20 hours a day as part of her treatment. Last year, the curve of her spine reached 50 per cent.

"Her lungs were being restricted by her rib cage twisting," said her mother, Tracy Robb, who said her daughter was limited in her physical activities. "All the things she loved doing, she wasn't able to do. She was also experiencing pain."

Her physicians at McMaster Children's Hospital in Hamilton told her family it was time to consider fusion therapy, an invasive procedure that uses between 15 and 20 screws to fuse rods to the spine.

Instead, Jessica's mother started searching for alternatives, something that led the family to go to Nova Scotia.

'A really intriguing concept'

At the IWK, Dr. Ron El-Hawary, an orthopedic surgeon, is the first to admit that he was skeptical when he learned of the ApiFix procedure three years ago.

The ApiFix device was developed in Israel. Instead of two rods, it's one with several joints that are flexible. It attaches to the spine with two to four screws.

El-Hawary spent months researching the device and procedure before he became convinced of its potential.

X-rays of a patient who received an ApiFix device show the change in the curvature of the spine months after the surgery. (Submitted by the IWK Hospital)

"I think it could be revolutionary, I think it's a really intriguing concept," said El-Hawary.

He said there are many benefits to the new device, including that it allows the patient to continue to have flexibility, instead of being limited by fusion rods.

The surgery for the ApiFix device also takes half the time — less than two hours — making it safer and less invasive for patients, as well as freeing up time in operating rooms.

Unknown future

While it might sound like a glowing endorsement, El-Hawary emphasizes the fact it's a new procedure that needs further review.

Just over 100 patients in the world have reached two years or more since their surgery, a number that is considered a benchmark.

He said the surgery can be approved for certain cases in Canada and there's an ApiFix study underway.  

El-Hawary spends a lot of time warning his patients there's no long-term knowledge of how the device will hold up.

"I tell them I don't know what's going to happen in 10 or 20 years. There's lots of questions that are still unanswered and we're doing lots of research to try to figure that out."

He emphasizes that fusion surgeries will continue to be the standard until more studies are complete.

Dr. Ron El-Hawary and Jessica Robb say goodbye after Jessica was approved to return to Ontario and finish her recovery. (Submitted by the Robb family)

The surgeon's efforts are being watched by other physicians across North America as the device hasn't yet been approved in the United States.

El-Hawary is also hearing from patients as far away as South America and Australia who are interested in the ApiFix approach.

He has performed the surgery six times in Halifax, and more are planned in the coming weeks.

"First and foremost, I would like to be able to offer this to the patients in the Maritime provinces. The only time we're doing extra patients from elsewhere, we're doing our best not to displace local patients," said El-Hawary.

Tears of joy

In Ontario, Jessica's mother said she did her homework before opting for something so new. She believes it was a risk worth taking.

"With the ApiFix, you haven't burned any bridges," she said. "If for some reason the device no longer works, you can always have it removed and go back to fusion. You just can't go from fusion to something else."

Tracy Robb said it was shocking to see the before and after X-rays of Jessica's spine after her Nov. 2, 2017, surgery.

"We were all in tears," her mom said. "We could not believe that it could correct it that much. We were not expecting that because hers was so rigid because she had it so long."

An X-ray of Jessica Robb after her ApiFix surgery shows the new rod in place with just four screws. The alternative was to have fusion rods, which require upwards of 20 screws to stay in place. (Submitted by the Robb family)

Jessica says she also no longer relies on puffers to help her breathing. Best of all, she never has to wear her brace again.

"I have no more pain anymore, which is really nice."

SOURCE : CBC NEWS , 25th JULY 2018