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Correcting the curve
New developments and technology aid in the treatment of scoliosis

By JOANN PETASCHNICK

 

Children’s Hospital of Wisconsin is one of two pediatric hospitals in the nation to offer the EOS scanner for scoliosis patients.


In the past, some children with scoliosis faced a difficult surgery with up to a year of inactivity, but today that time has been reduced thanks to advancement in surgery and other treatments.

The rigid back brace to try and correct the spinal curvature is still used in some circumstances, but a new treatment involving stretching and breathing has been shown to be quite effective.

Scoliosis is a medical condition that causes an abnormal "S" or "C" curvature of the spine. People of all ages can be affected by scoliosis, but the most common type is idiopathic scoliosis, occurring in children age 10 to 12 and the early teens. Girls are more likely than boys to have this type and there is no known cause for it. Two other common causes of scoliosis are: Congenital — present at birth; and Neuromuscular — due to diseases such as cerebral palsy, muscular dystrophy or spina bifida.

The National Institutes of Health reports that about 2 percent of people have some form of scoliosis. Depending on the seriousness of the spinal curve, scoliosis may not be noticeable at all or it may cause pain and discomfort and require treatment or even surgery.

"When scoliosis is mild we usually just observe it. When there is a moderate curve, we can treat it with a brace — a plastic shell that squeezes the back and forces the spine to grow straighter. This works 80 percent of the time," according to Dr. Brian Black, a children’s orthopedic surgeon with Midwest Orthopedic Specialty Hospital in Franklin. "The brace won’t resolve the scoliosis, but it will prevent it from getting worse," he explains.

If there is a severe curve, however, surgery is often warranted, and current surgical techniques have improved. "Surgery involves a spinal fusion with placement of a rod that straightens the spine. It used to mean up to a year of inactivity, but now most kids return to full activity within three to four months," Black says. He also believes that surgery can be avoided in some children via a program of aggressive physical therapy known as the Schroth method. This involves stretching and breathing exercises repeated every day for an extended period of time.

Some of Black’s patients have achieved good results with the Schroth method. "It is somewhat controversial here, but it is used extensively in Europe and it enhances bracing and helps stop the curve. I have seen patients do very well with it. In fact, some of my patients have gone on to become excellent athletes," he says. Black often works with a physical therapy center called Spinal Dynamics.

When a child has scoliosis, physicians like to follow their growth and development carefully, which means having spine X-rays at least every six months until they have reached their full height. "This exposes children to a lot of radiation," says Dr. John Thometz, director of orthopedic surgery for Children’s Hospital of Wisconsin. CHW is one of just two pediatric hospitals in the nation that invested in an EOS low-dose radiation scanner that is used primarily on children with scoliosis.

"One of the major benefits of using the EOS scanner is the significant decrease in radiation dose. It is 10 times less than a regular X-ray and up to 89 percent less than a CT scan of the spine," says Thometz. A second benefit is the 3-D view it offers. "Scoliosis is a three dimensional deformity and X-rays only give us a two-dimensional view. The EOS is like a large box that takes a three dimensional image of the patient from top to bottom, giving us the full picture," he says.

Researchers are looking for the causes of idiopathic scoliosis by studying genetics, growth and changes in the spine. Currently, studies are under way to determine how different treatments can help to straighten the spine or keep curves from getting worse. "If we can identify scoliosis earlier and force the spine to grow straight, it may prevent surgery down the road," Thometz says.