Correcting Pediatric Scoliosis & Spondylolisthesis
Spinal deformities can be painful or even devastating—especially for your child or teen who is just trying to fit in and enjoy life.
In recognition of this, Dr. Jason Lowenstein recently delivered a course to other pediatricians entitled “Hottest Topics in Pediatric Orthopedics for the Pediatric Practitioner.” Part of the seminar included a primer on using pedicle screws to correct scoliosis and spondylolisthesis. (Click the “using pedicle screws” link above to watch a live demonstration of Dr. Lowenstein attaching pedicle screws to a pediatric spine model!)
Treating children with spinal issues is different from working with adults. After all, a child’s bones are still developing. However, since younger patients naturally have a more efficient healing capacity, they recover faster once treatment begins. Sometimes simply resting the area, physical therapy, and bracing can stop the progress of mild spinal deformities.
More severe cases, however, may require the intervention of an orthopedic surgeon who specializes in spinal deformities. Needless to say, early intervention can prevent a lifetime of spinal problems.
Before we talk more about pedicle screws as an intervention, let’s take a closer look at spinal deformities that commonly affect children and adolescents.
Understanding the Spine
Your spine runs from the base of your skull to your tailbone. The bones of the spine (i.e. the vertebrae) play an important role in supporting the body, absorbing the shock of everyday activities, and protecting the spinal cord.
Of course, the spinal column relies on a vast network of soft tissues like muscles, ligaments, and tendons to maintain stability. In addition, in between most vertebrae resides a rubbery disc that assists in absorbing the shock of everyday movements.
As we age, our personal habits, health, activities, and genetics can cause issues to develop in the spine. The wear and tear of our everyday actions can put the spine at risk for serious, and often, debilitating conditions.
But what about children?
A child’s bones aren’t fully formed and hardened. As such, their vertebrae may be more vulnerable to fractures or other issues, especially for children and adolescents who participate in sports. In addition, some children are born with congenital spine conditions or a predisposition to developing spinal deformities.
Common spinal issues for children include:
Some may think the spine is a straight, rigid structure. After all, how many times have we heard someone telling us to sit or stand up straight? The spine, in fact, contains natural curves that are designed to support our bodies. When viewed from the side, the spine resembles an upside-down “S” curve. For example, the neck (cervical spine) and lower back (lumbar spine) curves inward while the middle back (thoracic spine) curves outward. However, when viewed from the posterior, the spine should appear perfectly straight.
Scoliosis is a condition in which the spine rotates sideways to the left and/or right. When viewed from the back of the body, the spine resembles a “C” or even “S” curve instead of a straight line. Scoliotic curves generally occur in the middle or upper back. Sometimes scoliosis is also present in the lower back, but this is comparatively rare.
Most children suffering from this spinal abnormality have idiopathic scoliosis. This means that the exact cause of their scoliosis is unknown. Others may have congenital spinal defects or develop this condition because of other health issues like cerebral palsy, spina bifida, or Marfan’s syndrome.
Mild curves may not require any intervention aside from routine monitoring. Additionally, children with spinal curves between 25 and 45 degrees may benefit from a scoliosis brace.
More severe curves, however—such as those over 45 degrees while your child is still growing—may require surgical intervention to stop the curving and stabilize the spine.
Spondylolisthesis is a condition in which one vertebra slips over another. It often starts with a fracture toward the back of a vertebra—known as spondylolysis. As this crack forms on both sides of the vertebra, the slippage occurs.
But, wait. This seems like a pretty serious spine condition. Does it really occur that often in kids?
It’s more common than you think. In fact, almost 1 out of every 10 kids may have a form of this condition. Most don’t even know it. This is especially true for kids involved in sports who must regularly hyperextend their backs. If the core muscles are not strong enough to absorb the extra strain on the spine, this is a particular risk.
Therefore, if your kids are complaining about back pain after sports or other strenuous activities, take it seriously. They could very well have spondylolisthesis.
Why this condition?
When we think of adults suffering from back pain, one tends to imagine issues with muscle strain or slipped discs. In children, the discs are actually harder than the developing vertebrae. After all, the vertebrae aren’t fully ossified (or turned into hard, bony tissue). A fracture can occur, then heal, but may be more likely to fracture again.
What sports put kids at risk for spondylolisthesis? Those that involve a lot of lower back stretching like football, wrestling, gymnastics, ballet, and weightlifting.
Like scoliosis, treating spondylolisthesis generally involves conservative treatments such as strength training, physical therapy, and, in some cases, bracing.
More severe cases, especially with concurrent neurological symptoms, may require surgical intervention.
Correcting Spinal Deformities with Surgery
Every child’s case is unique. Accurate diagnosing, imaging tests, and individualized treatment plans are essential for achieving successful outcomes.
As mentioned earlier, surgery may not always be necessary. When conservative treatments don’t seem to help or the spinal deformity is so pronounced that it is painful and limiting, surgery may be an option.
Using Pedicle Screws to Correct Scoliosis and Spondylolisthesis
When surgical intervention is necessary, pedicle screws—along with other hardware—can be an effective, relatively safe way to correct spinal deformities. In many cases, pedicle screws are used during spinal fusion surgery.
Spinal fusion surgery involves making cuts to the bone to realign the spine into a straighter position. Subsequently, your surgeon inserts pieces of bone (aka, bone grafts) into the open areas so that they can fuse with the vertebrae.
To facilitate this process, pedicle screws are inserted into consecutive spine segments. Your doctor then uses a short rod to connect the screws. How does this help? It delivers added stability to the spine, thus increasing the success rate of spinal fusion surgery.
Moreover, inserting pedicle screws is a minimally invasive procedure. The surgeon uses a tiny camera and surgical tools to accurately place the screws. He or she then inserts metal tubes through small incisions directly over the pedicles—small stubs of bone connecting the lamina to the vertebral body.
Puncture holes are made through the tubes and into the pedicles. Your doctor then places titanium screws into these holes. These screws serve as an anchor point into which your doctor inserts a rod. He or she then packs small bone grafts into the area. The structure of this hardware allows the spine to remain stable as the bone grafts fuse to the spine.
After about six months, usually with some physical therapy involved, your child will enjoy a full recovery. The spine will remain stable and your child can return to the activities that he or she loves.
Choosing an Expert for Your Child’s Spinal Deformity
There’s no doubt: You want the best for your child. And, when it comes to correcting spinal deformities, you want to make sure that you have a trusted doctor who specializes in these complicated conditions.
Dr. Jason E. Lowenstein, MD, is a board-certified orthopedic surgeon who specializes in adult and pediatric spine and scoliosis surgery. He is a partner at The Advanced Spine Center and the Director of Scoliosis and Spinal Deformity at Morristown Medical Center in Morristown, NJ.
Dr. Jason Lowenstein is an award-winning expert in the treatment of spinal deformities—including scoliosis and spondylolisthesis—using minimally invasive techniques. In fact, he received awards from both New Jersey Monthly Magazine and New Jersey Family Magazine for his work with children who have serious spinal deformities.
Are you ready to schedule a consultation or perhaps obtain a second opinion for your child’s treatment? Dr. Lowenstein is currently accepting new patients. Simply fill out this form and we can get the process started. If you prefer to talk to someone, give The Advanced Spine Center a call at (973) 538-0900.
Remember: Contacting a professional whom you can trust is a great way to start improving your child’s future today!