Beyond The Brace: New Advancements in Non-Invasive Scoliosis Treatments Offered at RWJUH

Dominick Tuason, MD, pediatric orthopedic surgeon at The Bristol-Myers Squibb Children’s Hospital at Robert Wood Johnson University Hospital

An estimated 7 million people in the United States are affected by scoliosis, a common yet potentially serious curvature of spine according to the National Scoliosis Foundation. During a period of rapid growth, typically just before puberty, children are susceptible to spinal deformity which may manifest as a simple “C” shaped curvature or double curved “S”. While the cause of scoliosis is still unknown, most cases are mild and only require monitoring throughout adolescence to ensure the curvature does not impede mobility or health. Other cases, however, require the use of external braces or rods applied via surgery to redirect the growth of the spine. Because scoliosis often does not exhibit visible symptoms or cause pain, Robert Wood Johnson University Hospital (RWJUH) New Brunswick offers services to help identify and treat scoliosis in children and adolescents, including the new non-invasive MAGEC® System technology.

Symptoms

Since scoliosis develops gradually throughout childhood, screenings are often conducted between the ages of 10 and 14 using the Adam’s Forward Bend Test. During this test, which requires your child to simply bend over at the waist, the doctor or nurse will analyze your child’s back for:

• Uneven shoulders
• Uneven waist
• Prominent or uneven shoulder blades
• Hips that are higher than the other
• Protruding ribs

If any of these characteristics are detected, your doctor may order an x-ray of your child’s spine to diagnose the condition and severity.

Risks and Complications

While scoliosis may not cause pain for your child, it is still extremely important to seek medical attention for any spinal deformity or curvature. If scoliosis is not addressed while the child is still growing, the spine can continue to curve and lead to:

• Organ damage. When scoliosis is allowed to progress and become severe, internal organs such as the lungs and heart may become compressed. This can lead to difficulty breathing and heart problems since the organs do not have enough room to function properly.
• Back problems. Scoliosis developed in childhood may lead to increased back pain in adulthood.
• Appearance. As the spine continues to curve, the body can begin to shift and cause unlevel shoulders, ribs or hips. An irregular appearance may cause individuals to feel self-conscious.

Treatment Options

The evaluation and treatment of scoliosis is varied and dependent upon the type of scoliosis a child has, the skeletal maturity of the patient, the degree of the curvature and the past medical history of the patient. Depending on the severity of the curve and rate of progression, there are a variety of options available for children diagnosed with scoliosis including:

• Bracing. Children may be prescribed to wear an external, custom-made brace to control scoliosis until their growth has stopped. While the brace cannot correct deformities, it can guide the growth of the spine to prevent scoliosis from progressing.
• Casting. Unlike bracing, casting can slow and correct a spinal curve by enclosing the child’s abdomen in plaster casts. Each cast is typically replaced every eight to 16 weeks to account for growth and changes in the curve.
• Surgery. In severe cases of scoliosis, surgery may be necessary to control spine curvature. In most procedures, including growing rods, guided growth and MAGEC® procedures, rods are implanted along the spine to correct curvature and guide growth. Some procedures require multiple follow-up surgeries to account for a child’s growth, requiring the child to miss school for recovery.

Benefits of MAGEC® for severe scoliosis:

If it is determined that your child will need surgery to correct their early onset scoliosis (EOS), one of the most complex forms of scoliosis that is often most difficult to treat, RWJUH has a program designed specifically for individuals with this severe form of scoliosis. As part of this program, RWJUH offers the MAGEC® System, providing patients the same benefits of traditional surgical options without the need for multiple follow-up operations associated with growing rods and guided growth procedures. After implanting foundations through two small incisions, a MAGEC® magnetically-controlled growing rod is cut and bent to guide the growth of the spine. The rod acts an internal brace to minimize the progression of scoliosis while still allowing for continued growth. Unlike other surgical options, the rod does not require follow-up operations and can be manipulated using a non-invasive, external remote controller. With fewer procedures, patients are at a decreased risk of suffering from complications and can remain in school and out of the hospital. Interested individuals should note that the MAGEC® System is intended for skeletally immature patients less than 10 years of age with severe progressive spinal abnormalities.

The Center for Orthopedics at RWJUH New Brunswick provides care for patients of all ages requiring care for injuries, deformities and diseases of the bones, muscles and joints. Supported by a Level 1 Trauma Center, RWJUH New Brunswick prides itself in its long history of orthopedic care utilizing leading technology. Each patient at RWJUH receives personalized care from a staff of dedicated specialists, nurses and physical therapists. Over the last five years, the Scoliosis Program at RWJUH alone has treated and/or evaluated over 500 children for scoliosis, and approximately 364 children have undergone corrective surgery for scoliosis at The Bristol Myers Squibb Children's Hospital at RWJUH.

For more information or to make an appointment at the Center for Orthopedics at RWJUH New Brunswick, call 1-888-MD-RWJUH or visit http://www.rwjuh.edu/rwjuh/center-for-orthopaedics-at-new-brunswick-campus.aspx.