September 26, 2017

PHILADELPHIA — According to a presenter at the Scoliosis Research Society Annual Meeting, spinal osteotomy may improve quality of life for patients with ankylosing spondylitis kyphosis.

“From our series of clinical research, we had to know what is the sagittal decision-making for these kinds of patients, the proper osteotomy and osteotomy site, and how to calculate the correct angles,” Yan Wang, MD, said during his presentation.

In a retrospective study, Wang and colleagues reviewed information for 448 patients with ankylosing spondylitis kyphosis who underwent spinal osteotomy. Patients either underwent one-level transpedicular spinal osteotomy or two-level transpedicular osteotomy from T12-L3, based on the apex of kyphosis, deformity type and neurological conditions. Radiological parameters were measured preoperatively and postoperatively. Investigators recorded any complications.

Researchers found patients were able to walk with horizontal vision and lie on their backs postoperatively. In patients who underwent two-level osteotomy, the chin-brow vertical angle improved from 68.3° to 8.2°. This measurement went from 46.2° to 4.2° in patients who underwent one-level osteotomy. Investigators noted that in patients who underwent two-level osteotomy, the mean sagittal balance improved from 29.4 cm to 8 cm. This went from 18 cm to 4.3 cm in those who underwent one-level osteotomy.

At the superior site of the osteotomy, the amount of correction in the two-level group was 27.7° and was 42.1° at the inferior site. In the one-level group, it was 46.2°. There were no major complications in the study. Investigators found 32 patients with one or two complications, which included transient neurological deficit, vascular laceration bleeding, infections, postoperative low back pain, a broken spinal rod, pedicle screw pull out, non-fusion at the osteotomy site and cerebrospinal fluid leaks.

“Two-level spinal osteotomy show[s] risk tendency of higher operation-related complications,” the researchers wrote in their abstract. – by Monica Jaramillo

Reference:

Wang Y, et al. Paper #39. Presented at: Scoliosis Research Society Annual Meeting; Sept. 6-9, 2017; Philadelphia.

Disclosure: Wang reports no relevant financial disclosures.

Fabien D. Bitan, MD, Orthopedist and Spine Surgeon at Manhattan Orthopedic Spine, and affiliated with Lenox Hill Hospital, Mount Sinai Beth Israel, and Saint Barnabas Medical Center, has been named a 2017 Top Doctor in New York City, New York. Top Doctor Awards is dedicated to selecting and honoring those healthcare practitioners who have demonstrated clinical excellence while delivering the highest standards of patient care.

Dr. Fabien D. Bitan is a vastly experienced and highly acclaimed surgeon who has been in practice for over 32 years. His distinguished medical career started in his native France in 1985 when he graduated from the University of Paris. Dr. Bitan later completed a residency in Orthopedic Surgery at the Assistance Publique Hopitaux de Paris, followed by a residency in Pediatric Orthopedics at the Institut Francoise Calot in Berck sur Mer in France. After a fellowship in France, Dr. Bitan relocated to the United States and completed further fellowships at New York’s Hospital for Special Surgery and at the Beth Israel Medical Center.

Dr. Bitan is board certified by the American Board of Orthopaedic Surgery, and has a wealth of experience as an orthopedist gained in both France and America. He is particularly renowned, however, as an expert spine surgeon, and has embraced the latest minimally invasive surgical treatments that can accelerate typical recovery times. Conditions treated by him include spinal deformities such as scoliosis and kyphosis, as well as spinal fractures. He is also renowned internationally for being at the forefront of the use of artificial disc replacement technology that is transforming lives today.

Dr. Bitan was awarded a ‘Certificate Of Appreciation’ by the New York State Chiropractic Association, and he is also a member of many other professional organizations including the North American Spine Society, the American College of Spine Surgery, the Scoliosis Research Society, and the International Society of Endoscopic Spine Surgery. His expertise, and his important research, makes Dr. Fabien D. Bitan a very worthy winner of a 2017 Top Doctor Award.

About Top Doctor Awards

Top Doctor Awards specializes in recognizing and commemorating the achievements of today’s most influential and respected doctors in medicine. Our selection process considers education, research contributions, patient reviews, and other quality measures to identify top doctors

Direct link:  https://www.prnewschannel.com/2017/08/29/esteemed-orthopedist-fabien-d-bitan-md-is-to-be-recognized-as-a-2017-top-doctor-in-new-york-new-york/

LONE TREE, Colo. – Dr. Jaren Riley knows his young patients are nervous when he prescribes a back brace for scoliosis, but now he can talk to them about the experience.

The pediatric orthopedic surgeon at Rocky Mountain Hospital for children wore a back brace 18 hours a day for a week.

“I felt like I had good scientific reasons for them to wear the brace, but I didn’t have good answers for them as far as- What does it feel like? What’s it like getting used to it? How do I dress? How do I sleep?   And so I needed more experience to be able to answer those questions,” Dr. Riley said.

While wearing the brace, he says it was not painful, but it was confining.

“What it feels like is that I’m that tube of toothpaste with that last little bit of toothpaste in it, and you are just trying to squeeze me from bottom to top,” Dr. Riley said.

About one in 100 kids have scoliosis of some level.  If the curve in their spine is 25 to 40 degrees, they are a candidate for a brace.  The brace can potentially reduce the need for surgery by 50 percent.  But it can mean some changes for patients.

Aracely Talamantes’s son Andrew has scoliosis.  She says patient families really appreciate Dr. Riley’s efforts.  “It makes them know that he really does care,” she said.

Spinal deformities in children may be the result of many conditions, such as congenital malformation of the spinal column, disorders of the neuromuscular system or trauma. They may be progressive in which case their severity increases with age, leading to restrictions of pulmonary growth, nerve function and heart pumping capacity.

Classification

The classification of pediatric spinal disorders has undergone several metamorphoses, such as that by King and Lenke et al. Their usefulness always depends on how well they are able to recognize the impact of the root condition, as well as the predicted effect on normal growth of the child, the natural history, and the extent of disability that is possible and preventable by appropriate management.

Pathological systems of classification focus upon the reason for the deformity, such as abnormal spine development, neuromuscular disease leading to unbalanced strains on the developing cord, or other disorders of spinal column formation. Other systems classify them by the age of onset, whether infancy, early childhood, or adolescence. The most commonly used systems deal with the structural changes that are present, such as the degree of curvature, the direction and rotation of the spine, as well as other anatomical results of the deformity. These structural systems offer the most help with clinical management and are the most reliable with respect to the response to treatment.

The most common spinal deformities in childhood include scoliosis (curving of the spine to one side), kyphosis (curvature of the spine in the backward direction), spondylolysis (stress fractures in the lower back) and spondylolisthesis (one vertebra slips over another).

Diagnosis and treatment

Pediatric spinal deformities can be diagnosed based on the patient history, family history, and complete physical examination. Clinical findings, such as unequal height of shoulders, tilted head or pelvis, difficulty in breathing, limping or back pain, may be found. Imaging modalities are very useful in diagnosing these conditions, such as X-rays, CT, MRI and DEXA scans. Most spinal deformities require only observation to ensure that they are not progressing.

The management of pediatric spinal deformities depends on the extent to which they have been allowed to interfere with normal growth. Growth spurts soon after birth, as well as during adolescence, can aggravate the malformations. These have to be anticipated when planning corrective surgery to prevent undue shortening of the spine.

Treatment may be non-surgical or surgical. Nonsurgical treatment includes brace application and spinal casts. Surgical correction includes fusing a segment of the spine with screws and rods to arrest or reverse the deformity.  In children who are still growing, growing rods are used, which can be expanded every few months to keep up with the increase in spinal length.  Once growth is complete spinal fusion is performed.

References

1. https://www.ncbi.nlm.nih.gov/pubmed/15766220
2. https://www.ncbi.nlm.nih.gov/pubmed/14713581
3. https://www.emoryhealthcare.org/pediatricorthopedics/spinaldeformity.html
4. http://thejns.org/doi/pdf/10.3171/foc.2003.14.1.4
5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4940247/
6. http://www.chop.edu/conditionsdiseases/spinaldeformities

Reviewed by Jonas Wilson, Ing. Med.

Further Reading

What Causes Pediatric Spinal Deformities?

Testing and Diagnosing Pediatric Spinal Deformities
Last Updated: Aug 22, 2017

By Stephan Lehman

Community members have rallied behind Marais Steyn Park resident, Leigh Stephens, in her quest to raise funds for a life-changing spinal surgery.

Today, August 23, Leigh will undergo a 10-hour life-altering operation at a local hospital.

27-year-old Leigh said when she was a teenager she was diagnosed with Scoliosis and, until two months ago, had lived a normal life.

One Saturday morning in June this all changed, however.

The Edenvale mother of two said her legs just collapsed and she couldn’t get back up.

After going to the hospital where she underwent MRI scans and X-rays, Leigh was told her lower back was degenerating and was diagnosed with Kyphoscoliosis.

“I couldn’t understand it because for most of my life I had lived with Scoliosis. When in pain, I would take painkillers,” said Leigh.

Leigh explained that a spine is meant to be straight but hers is skewed.

She described the pain as having a constantly knotted back.

“It’s as if you have a pulled muscle – permanently.”

Leigh said her spinal disks are degenerating and her nerves are being compressed because of Scoliosis.

The intense pain requires Leigh to do simple tasks – which people take for granted – in short bursts.

Unfortunately, nothing can be done to assist Leigh besides intrusive surgery.

Leigh explained that in order to straighten her spine two metal rods, 22 screws and a base plate will be attached to her spine.

She said in order to attach the base plate, the surgeon will have to go through the front of her abdomen.

All in all the surgery will take 10 hours.

Although Leigh does have medical aid, the shortfall for the operation is R70 000.

If she doesn’t get the surgery Leigh could be paralysed by the age of 30 or 40.

For the mother of two this is not an option.

“To a parent children are the most important people in his or her life. I’m not doing the surgery for myself but for my two boys,” said Leigh.

She explained that although she can spend time playing with her sons, the Scoliosis limits the amount of time she spends with them.

She can only stay in one position for about 20 minutes before she has to change it.

In order to get funds to cover the shortfall on her medical costs, Leigh’s mother began a fund-raising initiative on Go Get Funding.

Leigh said the community of Edenvale has come to her assistance.

One of her sons attends Elma Park Pre-Primary School which has also stepped up its support by arranging fund-raising drives.

“People from the school are concerned and make an effort to treat me like a family member,” said Leigh.

Principal of the school, Elizabeth Human who is also known as Teacher Lizzie, said the school hosted a week-long fundraiser till August 18 for Leigh’s surgery.

“When there is a family member of the school in crisis, we help,” said Teacher Lizzie.

She said although the donation drive has ended, any further donations would go towards Leigh’s medical costs.

Elizabeth explained that the school always comes to the assistance of its family because supporting the family enhances a child’s ability to learn.

Leigh said she is excited about her surgery as it will give her the opportunity to spend more time with her children.

The surgery will be done on August 23.

To get in touch with Leigh, send her an email on: leighspineoperation@gmail.com

POSTED 11:32 PM, AUGUST 22, 2017, BY LINDA WAGAR

LONE JACK, Mo. — Madison Bruce is an active 14-year-old. She’d like to stay that way.

“It’s hard to run and sometimes I can’t sleep,” said Madison, who is in constant battle with her body.

Two years ago, she was diagnosed with scoliosis. Her spine is curving abnormally. You can clearly see it an X-ray of her spine and the curve can even be visible through clothing. Left untreated, her condition could eventually compress her lungs, making it difficult for her to breathe.

To help relieve the pain and pressure, Madison works with a chiropractor and straps herself into a vibrating machine every day to keep her spine flexible. But the only permanent solution is surgery. The typical surgery involves fusing a steel rod to the spine. That can leave patients with limited movement, which is hard to accept when you are only 14 years old.

That’s why University of Missouri Orthopedic Surgeon Dan Hoerschemeyer told Madison about a much newer procedure – vertebral body tethering – which uses ropes and pulleys to train the spine back into normal alignment.

Dr. Hoerschemeyer shared before and after photos of young patients who had the surgery. To the untrained eye, their backs looked normal afterwards. But Dr. Hoerschemeyer said the best part is that the young patients feel normal because they can move freely.

“I think the huge benefit is the preservation of motion,” the doctor said.

Madison and her mother Lori Bruce were thrilled to learn about the procedure and felt confident their insurance would cover the $150,000 price tag.

“The procedure is considered experimental for scoliosis, but Blue Cross Blue Shield in other states had paid for it,” Bruce said.

But a week before Madison’s surgery, Blue Cross Blue Shield denied her coverage.

“It was like hitting a brick wall,” Madison’s mom said.

Plus, Madison was running out of time. Surgery candidates must be young enough to still have growth and flexibility left in their spine, Dr. Hoerschemeyer said.

Madison’s mom refused to give up.

“I told somebody I would live in my car and eat Ramen noodles every day if I thought I could get her a straight spine,” Lori Bruce said with tears welling in her eyes. “If you knew how much I hate Ramen noodles you’d know how much that means. “

The mother of three, tracked down a doctor in Germany who would do the surgery for about $44,000. That’s less than a third of what it would have cost in the United States.

But it still hasn’t been easy to come up with the money. The family has maxed out their credit cards and cleaned out a retirement account. Even that wasn’t enough, which is why they contacted FOX 4 Problem Solvers. The hope is that with the public’s help, Madison can have the surgery that she needs. They’ve set up you caring account, but time is running out.

“We live in America the greatest country in the world,” Lori Bruce said. “How do I have to take my daughter to Germany for surgery? It’s hard.”

But if there is anything she has learned from watching her daughter, it is not to give up.

westfaironline.com /92226/cutting-edge-treatment-for-scoliosis-brings-a-surgeon-and-his-patients-magneticresults/

A pediatric orthopedic surgeon at Maria Fareri Children’s Hospital in Valhalla is using a new technology-aided surgical procedure to spare young patients the pain, physiological risks and social setbacks of traditional treatment for scoliosis, a curvature of the spine that affects an estimated 6 million to 9 million people in the U.S., most of them children.

Dr. Damon DelBello, an attending orthopedic surgeon at Westchester Medical Center and the children’s hospital on the WMC campus, has introduced a less invasive procedure to correct the spinal condition that requires fewer surgeries and less exposure to anesthesia for children, minimizes the risk of infection and reduces anxiety in his patients.

In traditional treatment for pre-adolescents with early-onset scoliosis, surgeons insert “growing rods” in the patient that are attached to the spine with adjustable screws above and below the spinal curve. As the child grows, surgeries are needed every six months to lengthen the rods.

At Maria Fareri, DelBello has made use of a medical device, Magnetic Expansion Control Rods, part of a magnetictechnology treatment system that spares growing children multiple follow-up invasive surgeries once the MAGEC rods are implanted. Instead, the magnetically controlled rods are lengthened every three months by the surgeon using an external remote controller.

“The end result of the two procedures is the same from a mechanical point of view, but from the patients’ point of view, they don’t suffer the same physiological risks,” DelBello said. “I had several kids who were very upset and anxious about their traditional growth rods and when we changed them to the MAGEC rods the negative physiological effects ended.”

Reaching adolescence and skeletal maturity, patients receiving either the traditional or magnetic rod procedure typically undergo a spinal fusion surgery to permanently correct the spine with a titanium rod.

The MAGEC spinal bracing system was approved three years ago by the U.S. Food and Drug Administration for use in pre-adolescents with severe progressive spinal deformities. Newburgh resident Grace Ramos, whose 12-year-old son, Miguel, is a patient of DelBello’s, said her family is “very blessed” that the new technology was approved for use and adopted by Miguel’s pediatric surgeon.

Ramos was in her 23rd week of pregnancy with Miguel when a sonogram led to a diagnosis of infantile scoliosis in her unborn child. Miguel in infancy wore a brace 23 hours a day to stop or slow the progression of the spinal curve, but it had little effect. “The brace works for some kids with minor scoliosis, but when you have 40, 50 or 60 degrees of curvature, you need more than a brace to correct it,” his mother said.

“Miguel is very blessed that these new rods were available at the time that they were or else he would have been one of the children using the painful old procedure,” Ramos said. Dr. Delbello, she said, had his eye on the new procedure that had not yet been approved by the FDA and suggested the Ramos family wait until it became available.

“It pains me that there are children that have to endure painful extending procedures,” Miguel’s mother said.
“Children under the old procedure have to go to the emergency room and go under anesthesia to extend the rods.
The child is heavily medicated and has to stay over in the hospital one to two nights after each surgery. There is no attending school during this time and their lives are put on hold. Just as these children are feeling better again, they go back for another one.”

“Miguel sees Dr. DelBello every three months to extend the rods,” said Ramos. “The beauty of these rods is that we schedule an office visit instead of a hospital visit, he is not under anesthesia and it’s noninvasive.”

DelBello said his checkups for patients using the MAGEC rods “are six minutes, compared to an hour and a half procedure followed by an overnight stay with the traditional growth rods.”

The doctor and his just-turned-12 patient have formed a strong bond during those checkups and rod adjustments.  “Miguel talks with Dr. DelBello about basketball, sailing and baseball as he turns on a magnetic device that takes 30 seconds to extend each side,” Grace Ramos said.

“I talk to children in a straightforward manner and in an adult way,” said DelBello. “I don’t baby them in any way.
They get the same information their parents get. They understand more than we give them credit for.”

Miguel Ramos understands: “I am the luckiest scoliosis patient thanks to Dr. DelBello,” he said.

“We feel that although Miguel was born with scoliosis, our family is very blessed,” said Grace Ramos. “As a mother, I want it to be my mission to show every child with scoliosis these MAGEC rods.”

DUBAI: Scoliosis—the condition wherein the spine curves due to genetic and environmental factors that may be diagnosed from early childhood to adolescence—must be immediately addressed, according to a paediatric orthopaedic surgeon in the past 18 years.

Interviewed, Dr. Zaid Al Aubaidi added: “I also believe that all congenital deformities like all spinal problems and issues and not only scoliosis must be included in health insurance policies. Idiopathic scoliosis appears after the age of 13.

“It is unethical not to because these are life-threatening to any individual, especially to the young who undergo and experience and will continually experience physical, psychological, emotional and social problems.”

He said global, regional and UAE records show that scoliosis is determined in three per cent of the population while there are other spinal deformities such as kyphosis (hunchback) and generally it is the girls or women who suffer the most.

Twenty-five years in the medical field, Al Aubaidi decided to become a paediatric orthopaedic surgeon because he saw the need.

He explained that orthopaedic surgery is all about helping the young,  analysed with spinal abnormalities, to become the “Straight Child” in order that their skeletal and muscular systems function well.

Saying “the head must be balanced with the pelvis,” Al Aubaidi reasoned that any spinal mis-alignment impacts on the vital organs.

“It is difficult when they get older,” he said, pointing out that with aging come stiffness and the inability to flex that consequently leads to muscle and skeletal strains that will affect the “ability to see.”

Al Aubaidi attends to between two and three young to teen-age scoliotic patients every week at his clinic in Burjeel Hospital for Advanced Surgery in Dubai, coming from across the UAE, Oman, Kuwait and Jordan.

The youngest on record is aged three while the eldest is 17 years old.

For these patients, he uses the Magec Rods or the Magnetic Expansion Control Technology, a 2012 invention and which he introduced in the country in 2014 after it got the clearance from the European Medicine Agency.

US hospitals started using the technology in 2015 after it was approved by the Food and Drug Administration.

Al Aubaidi said that with the technology, rods are embedded on the deformed spine through surgery.

The aim is to ease the burden of periodic surgeries on young scoliotic patients.

Once embedded, the rods are lengthened from time to time which may last for several minutes only per session.

The ApiFix system represents a breakthrough treatment for Adolescent Idiopathic Scoliosis (AIS) as it is a minimally invasive, non-fusion spinal implant system which dramatically improves the quality of life of patients who undergo scoliosis surgery.  Additionally, it saves hospitalization and OR time, and is considerably more cost-effective than current scoliosis surgery.
“Incorporating the ApiFix system into our portfolio of products fits our mission to bring exceptional, unique, state-of the-art orthopedic products into the Australasian market. The ApiFix system provides game-changing technology for AIS patients and surgeons alike and we’re proud to include them in our suite of products,” commented Sam Scott-Young , Managing Director of Orthotech.
Standard scoliosis surgical correction is a highly invasive, lengthy procedure involving a long recovery period, and resulting in a rigid spine due to fusion of the vertebrae. The ApiFix approach brings an ingenious solution with its minimally invasive, non-fusion spinal implant system, inserted in a short procedure, followed by a brief recovery period, and maintains spine flexibility.
ApiFix CEO Eran Feldhay, M.D. remarked: “The certification for the ApiFix product by the TGA through our distribution partnership with Orthotech allows us to expand our reach and provide treatment for AIS patients in Australia too. We look forward to working with a company like Orthotech who are committed to innovative orthopaedic solutions for their customers.”

About ApiFix
ApiFix is an innovation-driven medical device company focused on providing less invasive solutions for scoliosis patients. ApiFix’s leading product for non-fusion treatment of adolescent idiopathic scoliosis (AIS) is used today in Europe. ApiFix is led by a team of highly-regarded spine surgeons and veteran spine specialists. The company has CE clearance and is marketed in Germany, Italy, Greece, The Netherlands, Spain and Israel.
ApiFix principals will attend the annual meeting of the Scoliosis Research Society, (SRS) in Philadelphia, USA on September 5-8 to present the ApiFix system, clinical cases and their follow-up to potential users from all over the world.

Although surgical techniques continually improve over the years, conservative approaches are gaining steam.
“In looking at how the field has evolved over the last decade or two, it’s obvious that the opportunity for conservative management of scoliosis has evolved dramatically, more dramatically than opportunities for surgical management,” says Michael Vitale, MD, chief of the pediatric spine and scoliosis service at NewYork-Presbyterian Morgan Stanley Children’s Hospital.
Treating adolescent idiopathic scoliosis requires a unified approach, demanding a multidisciplinary, cross-functional team.
Despite significant opportunity for conservative scoliosis management, dissemination of the technique’s benefits has fallen behind that of surgical techniques. Dr. Vitale and other leaders in the field are, therefore, focusing their efforts on establishing best practices in scoliosis
conservative management and funneling the information into the mainstream discussion.
Actively involved on the board of the Pediatric Orthopaedic Society of North America, Dr. Vitale says the organization and others are dedicated to improving non-operative management of children with scoliosis.
The first step is early recognition of spinal deformity through screening. If spinal deformity is identified early, adolescents should first try scoliosis-specific physical therapy, says Dr. Vitale.
A specialized method for scoliosis, the Schroth method focuses on postural correction and breathing. The therapy puts patients in touch with their curve, so they understand how to alter their posture and stand in a braced position.
“In a growing child, the straighter you are when you’re growing, the straighter [your spine] will be,” explains Dr. Vitale. He and his colleagues investigated patient compliance’s impact on Schroth therapy. The subset of patients with high compliance had much lower rates of curve
progression, explains Dr. Vitale, a finding recently presented at a large international scoliosis meeting.
“Just like taking blood pressure medicine, compliance is key to success for bracing and scoliosis-specific physical therapy. Bracing doesn’t work if you don’t do it,” says Dr. Vitale.
Since compliance is so critical to scoliosis conservative treatment, Dr. Vitale is helping develop an app “to get into the kids’ heads.” The app allows children to share their physical therapy progress via a fun platform — online.
“We are also developing a seven-minute Schroth app, using the natural proclivity for electronics to get [the children] to do stuff,” he explains.
Dr. Vitale also serves as CMO for Wellinks, a wearable health technology company, unveiling Cinch — smart straps for scoliosis — this year. Cinch is connected to a compliance app that tracks information on how tightly and long a child wears the brace.
“Now it’s not just we’re prescribing a brace, but we have tools to track brace wear with a parental version, a patient version and a physical therapy version,” Dr. Vitale says. “The smart brace is a really interesting opportunity to use technology for patients in a way that is productive for their
health and in their best interest.”
Dr. Vitale urges the population to get on board to prevent progression toward surgery for adolescent idiopathic scoliosis. He actively tweets about non-operative resources available for AIS using the hashtag #cureAIS.
“Our aspiration is that, by working together and employing the full array of treatment options, together we can #cureAIS,” says Dr. Vitale.