Year: 2020

Congenital Scoliosis #1

  Scoliosis can be broadly broken down into one of 4 types: Idiopathic: meaning there is no known etiology Syndromic: connective tissue disorders (Marfan’s, Ehlers-Danlos), trisomy 21, Prader-Willi, Retts syndrome, Beale’s syndrome, muscular dystrophies (e.g. Duchenne’s), osteochondrodystrophy (dwarfism), neurofibromatosis, Noonan syndrome, VATER/VACTERL, Angelman, Osteogenesis Imperfecta, Neuromuscular: such as cerebral palsy, spina bifida, muscular dystrophies (e.g. […]

Vertebral Body Tether of Lumbar Scoliosis Curves 

Over the last 15 years there has been an increasing interest from patients and families in non-fusion solutions for scoliosis.  Vertebral Body Stapling (VBS) was the first non-fusion technique reported for treatment of idiopathic scoliosis, in the 1950s.  Due to the lack of advance implant technology the technique disappeared for 40+ years, but re-appeared in […]

Spine Deformity Surgical Wound Healing

Back in July (7-28-2020) I published two blog post on spine wounds, specifically the concepts and methods used to close the incisions used during spine surgery, mainly posterior spinal fusion incisions in pediatric and adolescent patients. As I explained previously the goal in the end is a nice narrow (or thin) scar which blends into […]

“Internal Dis-traction”

The last 4 posts have been on spine traction, and this is the last one, which details the third type traction we use in pediatric and adolescent spine deformity surgery: Temporary Intra-operative Distraction Rods (TIDR).  This type of traction, like Halo-Gravity and Intraoperative Halo-Femoral Traction, are used for the correction of severe scoliosis.  Each of […]

Intraoperative Halo-femoral Traction Part 2

In nonambulatory neuromuscular scoliosis (i.e. cerebral palsy, spinal muscle atrophy, myelomeningocoele, muscular dystrophy) progressive scoliosis with long, sweeping curves can cause significant tipping of the hips which can create sitting imbalance, pressure sores and pain.              12 year old female with spastic quadriplegic CP   The goal of surgical treatment […]

Intraoperative Halo-femoral Traction

As mentioned in the previous blog post, the use of halo-gravity traction (HGT) before surgery is a safe and very effective technique to improve severe spinal deformity, prior to a corrective surgical procedure.  On one end of the spine, the head, a carbon-fibre frame is placed onto the skull and a vertical force is placed […]

Halo-Gravity Traction

https://www.shrinershospitalsforchildren.org/st-louis/news-and-events/lily-stands-tall-after-spinal-fusion–243   https://www.shrinershospitalsforchildren.org/st-louis/halo-traction Earlier this spring I put up three blog posts on Halo-Gravity Traction.  I will briefly re-present it here as a way to launch into the two other types of traction we utilize: Intraoperative Halo-Femoral Traction and Internal “Dis-traction” Technique. What is halo-gravity traction? As you see from the three young patients above, […]

Spine Traction in Scoliosis

Question: My child’s spine doctor says they want to use “traction” on my child’s spine.  This sounds scary.  What is it?  Is this something new?  I have never heard of it. Answer: Spine traction to correct spinal deformity is not a new concept; in fact, the first applications were reported in ancient Hindu mythological epics […]

Spine Osteotomies                             

So your surgeon want to “cut” your spine….that just doesn’t sound good, does it? Well what are they talking about “cutting” the bone of your spine? To surgeons it is call an “osteotomy” which, if you break the word down to its latin roots, means bone (for “osteo”) and cutting part of the body (for […]

Closure of Spinal Deformity Wounds

The long-term appearance of a planned surgical scar is a common concern before surgery.  Sometimes this question is asked to us, other times it is not, likely because people do not want to appear overly concerned or vain about appearance or aesthetics of their skin.  Either way, the concern exists and is valid. Why would […]

Spine Rotation in Scoliosis, Part 3

How we correct spine malrotation and rib prominence during spine fusions In the last 2 posts I showed how scoliosis is a 3-dimensional problem, with the spine rotating around itself as it bends to the side.  The way to visualize this is to imagine a water slide, as it turns to the side, it also […]

Spine Rotation in Scoliosis, Part 2

In the last post I showed how scoliosis is a 3-dimensional problem, with the spine rotating around itself as it bends to the side.  The way to visualize this is to imagine a water slide, as it turns to the side, it also rotates…just like the spine in scoliosis. What is interesting is that each […]

Spine Rotation in Scoliosis, Part 1

I have scoliosis…. So why do I have a rib hump? Why does my shoulder blade sticks out more on one side? Why are my ribs in the front different? These are common questions I hear from patients with scoliosis and their parents and caregivers. So why do these changes to the chest happen? Well […]

Scoliosis Surgery Frequently-Asked Questions

1. How do I know if I have scoliosis?             Uneven shoulders or hips, or asymmetry of the contour of the back (which is more obvious with forward bending) can be visual tip-offs that scoliosis is present.  Also, individuals with a family history of scoliosis are more likely to have scoliosis.  Assessment by primary care […]

Driving After Adolescent Spine Surgery: FAQs and General Guidelines

When can I return to driving after surgery?   The ability to return to driving after orthopedic spine surgery us dependent on several factors including the type of surgery performed, the type of car (manual vs automatic) and the surgical site.  Studies using driving simulators have been able to estimate when braking function and reaction […]

Halo-Gravity Traction in Spinal Deformity Treatment (Part 3)

Do the kids lie in bed the entire time? Absolutely not. The only time they are in bed is to sleep, take a nap or rest.  Otherwise the patients in traction are kept busy and upright. If patients are in bed they will not get the maximal benefit from the traction, so the more they […]

New Publication to Review

117 patients were analyzed to assess if any of the preoperative labs could identify which patients were at a greater risk for a deep surgical site than other patients. We are constantly striving to minimize, and ideally eliminate, surgical site infections after posterior spinal fusion.  There is a lot more work to be done! To […]

Halo-Gravity Traction in Spinal Deformity Treatment (Part 2)

To provide a more complete answer from the last blog on “when” we use halo-gravity traction, the answer is: Before spine deformity surgery, at which time growing rods, Shilla Growth Guidance System or a definitive spinal fusion is performed.  Case: 5 year old male with 101 degree curve.   Decreases to 72 degrees after 6 weeks […]

Halo-Gravity Traction in Spinal Deformity Treatment (Part 1)

1. What is halo-gravity traction (HGT)? Gravity pulls the body down, and causes the spine to bend and twist more, especially for those individuals with scoliosis or kyphosis or both.  Simply put, gravity makes spinal deformity worse.  Laying down in bed, or on the ground, negates the force of gravity making the spinal deformity better […]

“Doctor, What Would You Do?”

“Doctor, what would you do?”….DWWYD…or more precisely: “What would you do if this was your child?” Fifteen years ago I rarely heard this question from parents and caregivers.  Now this is a commonly asked question.  The media (e.g. Parents Magazine) and advocacy groups have advocated this question as a good one to ask medical providers, […]

The Shilla Growth Guidance Procedure

My first on this surgical technique was in August of 2018, and I posted yesterday how I compare Shilla Growth Guidance against Traditional Growing Rods and MAGEC Growing Rods.  I will continue to discuss the Shilla Growth Guidance System using a Frequently-Asked-Question format, based on questions parents and caregivers have asked me over the last […]