Blog Post: The Impact of Lumbar Partial Microdiscectomy in Adolescents on PROMIS Pain, Physical Function, and Mental Health Domains

5-31-2024 The below talk was presented at the European-Pediatric Orthopaedic Society of North America Combined Annual Meeting in Washington, DC on May 10, 2024 The conclusion of this research is Lumbar Partial Microdiscectomy (LPM) for Vertebral Apophyseal Ring Fractures (VARF) has improved Pain Interference and Mobility for patients up to 2 years after surgery, with […]

Isolated Thoracic Fusion for Idiopathic Scoliosis, T2-T12

4-6-2024 Above is a 15-year-old female with a right thoracic idiopathic scoliosis measuring 55 degrees. His Risser stage is 4 and Sanders stage is 7, which means there is some, but not a lot, of vertical spinal growth remaining until she reaches skeletal maturity.From the side there is a lower amount of thoracic kyphosis (25 […]


3-12-2024 This is a 10 year old female with idiopathic scoliosis. Radiographs measured out a 64 degree right thoracic curve. To determine the treatment options some of the additional information is crucial. Specifically, the amount of growth remaining which is best determined by the Sanders classification. This patient is a 3- which means the spine […]

Is Physical Therapy necessary AFTER Posterior Spinal Fusions for Idiopathic Scoliosis?

3-12-2024 [Slide 1] So you or your child just went through a four-hour posterior spinal fusion for scoliosis, a three-day hospital stay, has stopped their postoperative prescription pain meds, is finally sleeping and eating normally and your thoughts are about how to get back “to normal”. What is the next step in recovery? Commonly the […]

Spine Podium Presentations at POSNA Annual Meeting, April 2023

Below is my list of the top 10 Pediatric Spine podium presentations presented at the last POSNA Annual Meeting in Nashville, Tennessee (April 2023). The list is in no particular order. My disclaimer is that I most highly value the presentations, which affect clinical decision-making and patient outcomes from surgery. Topic #1: Anterior Vertebral Body […]

Severe Idiopathic Scoliosis, Treated with Preoperative Halo-Gravity Traction and then Posterior Spinal Fusion

The patient presented with the below scoliosis, no prior treatment. The proximal thoracic curve measured 57 degrees, and the main thoracic 91 degrees in skeletally mature patient. The patient has developed daily back pain, which is interfering with school and sporting activities. Not only does scoliosis cause chest asymmetry and back pain, but it can […]

Recent Publication in Spine Deformity

Post 8-9-2023 Take-away message: Regardless of fixation, whether it be the spine or the ribs, the spine will get stiffer over time with dual magnetically-controlled growing rods.

Development of a Treatment Matrix for Adolescent Idiopathic Scoliosis (IS)

The following post is an abridged version of a PowerPoint talk I recently presented to the Washington University School of Medicine Orthopaedics Residents on 3-21-2023. It is important to understand the purpose of this talk is to present these big treatment topics in a high-level manner, a 30,000 foot view, to provide a framework to […]

Neuromuscular Scoliosis: Use of Magnetically-Controlled Growing Rods

In the second-to-last blog post the concept of using Magnetically-Controlled Growing Rods (MCGR) was presented for treatment of NeuroMuscular Scoliosis (NMS). In that post the different cranial/upper and the caudal/lower foundations were discussed briefly, and the reasons for why we choose one type over another. In this post the use of proximal screws and distal […]

Recent Publication on Anterior Vertebral Body Tethering (AVBT) Compared with Posterior Spinal Fusion for Major Thoracic Curves: A Retrospective Comparison by the Harms Study Group

Study Cohort: Thoracic Idiopathic Scoliosis patients who underwent Anterior Vertebral Body Tethering (AVBT) with minimum 2-year follow-up after surgery and propensity matched to Posterior Spinal Fusion (PSF) patients from Harms Study Group multicenter database. 237 AVBT patients (thoracic curve tethered only) vs. 237 PSF patients Propensity matched using: age, preoperative thoracic curve magnitude, sex, and […]

Growing Rod Constructs for Patients with Neuromuscular Scoliosis

This talk was presented at the International Pediatric Orthopaedic Symposium in Orlando, Florida last November 2022. My topic was to talk on patients with neuromuscular scoliosis (NMS) who were less than 8 years of age, presenting the argument to do Growing Rod (GR) surgeries, instead of performing a Posterior Spinal Fusion (PSF). My opponent was […]

Talking Points about Thoracic Vertebral Body Tethering vs. ApiFix

Vertebral Body Tethering (VBT) and the ApiFix device are procedures which have garnered a lot of attention from surgeons, patients and families. Below is a list of talking points which should be known about VBT and ApiFix so there can be informative, educated, transparent discussions about VBT and ApiFix, when compared to the other commonly-performed […]

Use of Magnetically-Controlled (MAGEC) Growing Rods in Neuromuscular Scoliosis

In past blog posts we have presented Magnetically-Controlled (MAGEC) Growing Rods. 1) There was the three-part series on the following dates: 3-9-2017          MAGEC: Part 1 5-3-2017          MAGEC: Part 2 5-18-2017        MAGEC: Part 3   2)   On 11-28-2021 a study on the use of MAGEC vs. Posterior Spinal Fusion vs. Vertebral Body Tethering in 8-11 year […]

Published study in Journal of Bone and Joint Surgery: Trunk Motion of Vertebral Body Tethering vs. Posterior Spinal Fusion

This was a study of trunk (back) motion from the Philadelphia Shriners hospital by a previous spine fellow from Washington University, Dr. Joshua Pahys.  This elegant study used a motion analysis lab to quantify back motion between two groups of patients: 1) 65 patients having undergone Vertebral Body Tethering (VBT), and 2) 47 patients who […]

Thoracic Scheuermann’s Kyphosis

What is thoracic kyphosis? From the side the human spine is wavy, unlike the view from the front in which it should be straight. The only part of the spine with kyphosis is the thoracic spine, the cervical and lumbar spine are in lordosis. How much thoracic kyphosis is normal? In general normal kyphosis is […]

Talking Points for Early-Onset Scoliosis Patients: Magnetically-Controlled Growing Rods vs. Shilla Growth-Guidance

In the surgical treatment of Early-Onset Scoliosis (EOS) the options boil down to two main constructs: Distraction-Based: this encompasses both Traditional Growing Rods (TGR) and Magnetically-Controlled Growing Rods (MCGR)             Growth-Guidance: this is also called the “Shilla Procedure” We will not go into detail about these two spine constructs, but ask you go […]

Blood Management During Spine Deformity Surgery

In 2022, spine deformity surgery usually requires a long incision and temporary retraction of muscles from the spine.  This extensive exposure of the spine helps to loosen up the spine (to get better correction), insert pedicle screws to grip the spine and place the long rods, which moves the spine in space and maintains the […]

The Use of Internal Distraction in Severe Scoliosis

In severe scoliosis, the use of traction has demonstrated an ability to improve the spinal deformity before surgery was actually performed.  There are three main methods: 1.   Preoperative halo-gravity traction 2.    Intraoperative halo-femoral traction 3.   Intraoperative Internal Dis-Traction   This post will focus on #3: Intraoperative Internal Dis-Traction   To demonstrate this treatment we […]

Spinal Deformity in Neurofibromatosis Type 1 – Case #2

Surgical Case #2 The next case is a 14 year old male with NF-1. There are dystrophic changes to the spine around the thoracolumbar junction, specifically penciling of the ribs and scalloping of the vertebral bodies (red arrows).  This has induced a painful kyphoscoliosis. The next pictures demonstrate there is some, but not much flexibility […]

Spinal Deformity in Neurofibromatosis Type 1 – Case #1

Surgical Case The case presented is a 13 year old male with NF-1 who has a severe, progressive, painful kyphoscoliosis. There is some inherent spinal flexibility as the thoracic kyphosis of 91 degrees improves when he lays on his back and hyperextends.  The below selected MRI cuts demonstrates he does not have significant dural ectasias […]

Spinal Deformity in Neurofibromatosis Type 1

For details on Neurofibromatosis Type 1 (NF-1), I will refer you to Wikipedia: As this blog focuses on spinal deformity in children and adolescents following is a brief summary as it relates to the musculoskeletal system (spine and extremities): 1.     NF-1 causes tumors along nervous system which can grow anywhere on the body. […]

Congenital Spine Dislocation with 8 Years of Postoperative Follow-up

Congenital dislocation of the spine (CDS) is a rare congenital malformation due to failure of the spine and the spinal cord to develop at a single spinal level. The patient may be completely neurologically intact or, in severe cases, may not have any muscle function or sensation below the level of the dislocation. It is […]

Disc herniation/Bulges in adolescents and how to treat

So, the symptoms of lumbar disc problems and the cause symptoms (pressure against nerve roots) are similar between adults and adolescents.  What is different? In adults the pressure is created by a dehydrated (lack of water) or a bad disc herniates through the posterior ligament in adults In adolescents the growth plate on the vertebral […]

Disc herniation/Bulges in adolescents, and how they differ than those in adults

When talking about a new topic, I have tended to go into significant detail about the basics of the problem to be discussed.  However, after review of the below webpage from the American Academy of Orthopaedic Surgeons (AAOS) I don’t think I can do a better, more thorough explanation of the anatomy, pathology, diagnosis and […]

Bone Grafting in Spine Surgery

In the previous blog post, we presented “what is a spine fusion”? In most pediatric spine surgeries metal implants correct and stabilize the spine in a new position (see below), then a spine fusion is performed. What I tell families/patients: “The metal allows us to attain and maintain the spine in a new position while […]

Latest Publication on Intraoperative Halo-Femoral Traction

  Appointments: 314-514-3500                      Appointments: 314-432-3600    This study was just published in the Journal of Spine Deformity For those interested to read more please use this hyperlink supplied by the publisher:

What is a “Spine Fusion”

In the average, normal spine there are 7 cervical, 12 thoracic, and 5 lumbar vertebra, a sacrum and coccyx.  From the skull to the sacrum, each vertebra is separated by a mobile disc, which is a highly complex structure which provides stability and motion at the same time. In spinal deformity, such as scoliosis, the […]

What is ApiFix?

In previous posts the Anterior Vertebral Body Tethering (VBT) has been presented.  This implant utilizes the flexibility of the growing thoracic spine, and its growth, to straighten the spine and then modulates its growth through the remainder of spinal growth.  There has been a lot of social media interest and publications about this procedure over […]

Gustavus Health Professions Podcast

This fall I had the wonderful opportunity to be interviewed by Heather Banks and Heidi Selzler-Bahr for the Gustavus Health Professions Podcast.  This was impactful for me as Gustavus Adolphus College in St. Peter, Minnesota is my alma mater.  This small, Lutheran, liberal arts college (about 90 minutes from Minneapolis) and provided me the opportunity […]

New publication comparing MAGEC Growing Rods, Posterior Spinal Fusion and Vertebral Body Tether in 8-11 year old scoliosis patients

  Spine (Phila Pa 1976). 2021 Oct 1.  doi: 10.1097/BRS.0000000000004245. Online ahead of print. Magnetically Controlled Growing Rods (MCGR) Versus Single Posterior Spinal Fusion (PSF) Versus Vertebral Body Tether (VBT) in Older Early Onset Scoliosis (EOS) Patients: How Do Early Outcomes Compare? Catherine Mackey 1, Regina Hanstein, Yungtai Lo, Majella Vaughan, Tricia St Hilaire, Scott J Luhmann, Michael G Vitale, Michael P Glotzbecker, Amer Samdani, Stefan Parent, Jaime […]

Talking Points between Surgeon and Patient/Family about Thoracic Vertebral Body Tethering vs. Thoracic Posterior Spinal Fusion

Vertebral Body Tethering (VBT) is a procedure which has garnered a lot of attention from surgeons, patients and families.  Below is a list of talking points which should be known about VBT so there can be informative, educated, transparent discussions about VBT, when compared to the other commonly-performed procedure Posterior Spinal Fusions.  Discussions on these […]

Pain Control and Muscle Spasm Management after Idiopathic Scoliosis Surgery

    1. Preoperatively At  At the last outpatient clinic visit before surgery, all patients will also have a visit with the Pediatric Anesthesia service on the same day.  This group of physicians and Advanced Practice Providers (AAPs) will provide the general anesthesia (means the patient will be asleep) for the entire surgical procedure AND […]

“How much correction of the scoliosis did you get during surgery?” Part 2

In the last blog post I presented the position that 100% correction of the three-dimensional spinal deformity is NOT needed for optimal painless, long-term function. However, to create the ideal aesthetic or cosmetic appearance of the body, from shoulders to the hips, achieving >90% correction is probably what is needed to completely normalize the body […]

“How much correction of the scoliosis did you get during surgery ?”

6 months ago in the April 5th, 2021 blog post I addressed the question I sometimes get asked after surgery by parents, families and caregivers: “How much correction of the scoliosis did you get during surgery?” This blog post I will try to explain why we don’t always want 100%, or even 90% or 80% […]

Another new study on Vertebral Body Tethering (VBT)

This study comes from the San Diego group, who have a long, cautious experience with VBT. 23 patients whose mean age at surgery was 12.2 +/- 1.6 years Preoperatively: Mean curve 53 +/- 8 degrees All were Risser 0-1, Sanders 2-3 at surgery Minimum follow-up after surgery of 2 years, with mean follow-up of 3.4 […]

 A nice piece on Shriners Hospital in St. Louis

Bertolotti’s Syndrome

What is Bertolotti’s Syndrome? Bertolotti’s Syndrome involves the lowest vertebra in the back; the one just above the sacrum, called the L5 vertebra.  Basically, Bertolotti’s Syndrome is an abnormal development of the L5 vertebra, which occurred in utero. Normally the L5 vertebra is completely mobile (with a normal disc) and whose transverse processes do NOT […]

Blog Post on the latest, hot-off-the-presses publication on Vertebral Body Tethering

  Some important points of this paper: 1.     1.  Surgeries done 2011-2015, prior to FDA approval 2.     2.  FDA primarily interested in device safety, secondarily on efficacy 3.    3.   Inclusion criteria: a. Only include Type 1A and 1B curve patterns, which means only main thoracic curves. b. There were NO curve patterns with structural […]

High-Grade Spondylolisthesis (Part 5)

This is Part 5 on Spondylolistheses and we have gone from the mild deformities and progressing to the severe grades. In this post we will present a Type 5 High Grade deformity.  This means the patient is compensating for the spondylolisthesis slippage, by rolling the pelvis backwards.  In the Type 5 deformities it means the […]

High-Grade Spondylolisthesis (Part 4)

The several posts were on Low-Grade Slip/Spondylolisthesis Fusion Surgery, which are done for Grade 1 and 2 severity slips. We will now move onto High-Grade Slip/Spondylolisthesis Fusion Surgery…..which if you recall are for Grade 3-5 severity slips One of the best publications on the treatment of High-Grade Spondylolistheses is shown in the below two figures: […]

Low-Grade Spondylolisthesis (Part 3)

The case in the last post is a Low-Grade Slip/Spondylolisthesis Fusion Surgery. The cage which is placed in the front add to the strength of the repair, by minimizing deflection due to cantilever forces. The below link explain this: However, sometimes a cage isn’t needed or simply cannot be placed into the front of […]

Low-Grade Spondylolisthesis (Part 2)

To restate, a Low-Grade Spondylolisthesis is one which is a Meyerding Grade 1 or 2. This means the vertebra has slipped forward up to 50% of the vertebral body. To use a football analogy it hasn’t crossed the 50-yard line. Below is a Grade 2. We typically call spondylolistheses “slips”.   What is the most […]