Surgical options for 12 year old boy

[JeanZ]

My son has been wearing a Boston Brace since he was eight years old. He is now almost 13, and his curve is 41 degrees. His doctor recommended one more try at the brace, and also talked about surgery from T2 - T12 as soon as possible, even though he is only Risser 0 and probably has quite a bit of growing to do even though he is 5' 9" but his brother is 6' 5". There is a chance of crankshaft phenomenon also, I was told. When I asked about growth rods, I was told that they are generally used for children much younger than 13. I have also heard about stapling, but I think that is only for younger children also.
1) Are there other types of surgery other than posterior fusion for this age?
2) I was told that about 50% of his growth after fusion would be stopped, and the other 50% would come from the growth in his legs. Does anyone know if that is true, or does it depend on how much of the spine is fused and where it is fused?

Thank you. I appreciate any comments and information.

Jean (Mom to Robert, an almost 13 year old who has been braced for almost five years with a Boston Brace and an idiopathic S curve which seems to be curving more around T2 now than before)

[tonibunny]

Hi Jeanz,

I was fused from T1-T12 when I was ten. It was a long time ago, but hopefully I can help answer your questions

Crankshaft phenomenon can be prevented by doing an anterior procedure as well as a posterior one. This halts growth in the front of the spine. If your doctor is not comfortable with doing an anterior release/fusion then I'd seek a second opinion (I'm in the UK so don't know any names, but I'm sure the other chaps here can recommend someone). I had an anterior release done and have had absolutely no problems with crankshafting.

Fusion from T1-T12 at the age of ten hasn't made any noticeable cosmetic difference to how I look now. Even though I still have significant curves (45 and 35 degrees) which also make me shorter than I should be, it's not noticeable to other people.

Hope that helps! Good luck

Toni xx

[scoliboymom]

My son's surgery was done when he turned 15, posterior only and he has crankshafting. His curve was beyond 80. I may not know the reasons why your surgeon wants to do the surgery sooner then later but if I were in your position I would first seek several other opinions and knowing now what happened to my son I would wait as long as possible for the surgery though at 80 degrees and rapidly growing our options were closing in on us. When Patricks curve was about 65 (can't remember exactly without looking at my records) the surgeon still said it was okay to hold off on surgery in order to let him grow more.
Talking to the surgeon recently he said he could have done the anterior but it would have ment loosing some respiratory function.
I think you still have time to wait. Many, many kids have very successful surgeries at curves much higher then 41 and getting as much vertical growth as possible before surgery will help

[mamandcrm]

Your son may not be too old for stapling. I know of 12-13 year old girls who have had it done, and they may do it to a slightly older age in boys. His curve probably would require a hybrid rod as well though. Look for mariaf here on the forum--she has the info for the shriners hospital in philly in her signature. The assistant at shriners can talk to you by phone about whether your son might be a candidate.

[LindaRacine]

Jean...

Not to apply any pressure, but Dr. Diab is doing stapling.

--Linda

[mariaf]

My son has been wearing a Boston Brace since he was eight years old. He is now almost 13, and his curve is 41 degrees. His doctor recommended one more try at the brace, and also talked about surgery from T2 - T12 as soon as possible, even though he is only Risser 0 and probably has quite a bit of growing to do even though he is 5' 9" but his brother is 6' 5". There is a chance of crankshaft phenomenon also, I was told. When I asked about growth rods, I was told that they are generally used for children much younger than 13. I have also heard about stapling, but I think that is only for younger children also.
1) Are there other types of surgery other than posterior fusion for this age?
2) I was told that about 50% of his growth after fusion would be stopped, and the other 50% would come from the growth in his legs. Does anyone know if that is true, or does it depend on how much of the spine is fused and where it is fused?

Thank you. I appreciate any comments and information.

Jean (Mom to Robert, an almost 13 year old who has been braced for almost five years with a Boston Brace and an idiopathic S curve which seems to be curving more around T2 now than before)

Hi Jean,

I would strongly suggest that you contact Shriners Hospital, Philadelphia, as soon as possible for a consult. This is where the technique was pioneered and they have done the vast majority of VBS surgeries (although other doctors are now performing it at certain locations around the country).

In addition, and perhaps more importantly, at Shriners they offer other non-fusion procedures for those who are not candidates for VBS (I'm not saying, necessarily, that your son is or isn't a candidate). One such option is a hybrid growing rod that is different from traditional growing rods and is often used now in conjunction with the staples in certain patients (often those kids who mature for VBS alone or with curves over 35 or so degrees).

But there are no cookie-cutter treatements here - they give each child a thorough and individual evaluation and will tell you what your options are.

The contact info Janet Cerrone is in my signature - she is the Physician's Assistant to the Spine Team at Shriners in Philly, and is extremely knowledgeable and very nice.

Good luck!

[JeanZ]

Thank you everyone for all of the information. I will look into the different options that are available and talk to some other doctors as well. Thanks again.
Jean

[jillw]

Jean, to add a little to what Maria said - don't hesitate to contact Janet Cerrone at Philly Shriners. She is very knowledgable and even if you don't decide to officially visit Shriners Philly, you will likely learn valuable information.

The setup at shriners is different than other typical ortho practices where you won't find out any background information unless you physically visit. Janet is very open and willing to provide background info on the phone even if an individual isn't a patient yet (although of course she couldn't provide an opinion specific to your son since he hasn't visited - however you could mention your son's background info and your concerns and how you were wondering if VBS were an option and hear what she says). Just leave a message and she will call you back within a couple/few days. You have nothing to lose by making the phone call - theres no expectation or committment to become their patient.

Good luck