For the pediatric orthopedics team at UW Health, caring for children with spinal deformities is a two-step process. Diagnosis is critical, because approximately 10 percent of spinal deformities are associated with underlying neuromuscular or genetic disorders.
Calling on a broad array of resources our team endeavors to pinpoint the root cause of a spinal disorder. Diagnostic work-up may consist of advanced imaging and referral to genetic specialists, neurologists and neurosurgeons.
Treatment is then determined on a case-by-case basis, and may include nonsurgical management as well as the full range of fusion and fusionless surgery.
- scoliosis not associated with an underlying disease - depends on the type and severity of the deformity, and the age and skeletal maturity of the child. For example:
- Mild curves (less than 25 degrees) are carefully followed with regular observation and x-rays
- Moderate curves (25–40 degrees) may be treated with bracing to prevent further progression of the curve until they are finished growing
- Severe curves (more than 45 to 50 degrees) usually require surgery
Definitive scoliosis correction consists of posterior or anterior fusion with standard instrumentation, such as rods, wires and screws. Our surgeons frequently use pedicle screws for spinal derotation, a technique that offers excellent three-dimensional deformity correction, improved lung function and a quicker return to activity.
Management of Scoliosis in the Growing Spine
For young children with
, UW Health pediatric orthopedic surgeons offer several fusionless techniques to correct the deformity while preserving spinal growth, function and motion.
- Growth rods. Surgeons implant an internal expandable metal rod that hooks to the top and bottom of the spine. Every six months, in an outpatient procedure, the growth rod is lengthened slightly, helping to correct the deformity as the child grows.
- VEPTR. Our surgeons were the first in Wisconsin to implant the Vertical Titanium Prosthetic Titanium Rib (VEPTR), for a child with severe scoliosis and thoracic insufficiency syndrome. In addition to straightening the spine, the VEPTR also separates the ribs, so the child's lungs can function correctly.
- Guided growth. Our surgeons are researching guided-growth techniques to correct spinal deformity. In these techniques, the surgeon places implants near different areas of the curve, which guide the direction the spine takes as it grows naturally.
In children, kyphosis, a spine curvature that results in a hunchback, can be congenital or the result of an underlying disorder, trauma or infection. In adolescents, kyphosis may also be the result of Scheuermann's disease, a developmental disorder in which several vertebrae are wedged together, causing the spine to bow forward.
Many children and adolescents with kyphosis can be treated with braces and physical therapy. However, when the deformity is severe enough to interfere with neurological function, causes persistent pain, or is caused by infection or tumor, corrective surgery is usually required.
Surgical procedures include:
- Posterior spine fusions with standard instrumentation, such as rods, wires and screws
- Anterior-posterior spine fusion with standard instrumentation (for severe cases)
- Posterior osteotomy (also for severe cases)
This x-ray shows an implant used to align the vertebrae in a patient with spondylolisthesis
A disorder sometimes found in adolescent athletes,
results from a defect or stress fracture in one of the lumbar vertebra. If the defect widens and becomes unstable, the vertebra can slip forward, causing pain and worsening instability.
Often, the preferred surgical treatment for severe spondylolisthesis is to fuse the two bones surrounding the defect. However, for select patients, our surgeons also offer a novel technique to repair the defect instead of fusing it.
In this technique, surgeons remove the scar tissue around the defect, place a bone graft in the gap, and use a special implant to align the defect as it heals. This effectively heals the defect, eliminates pain, and preserves more lumbar mobility than spinal fusion.