Early Onset Scoliosis Center

Specialized Spine Care for the Youngest Patients

The Center for Early Onset Scoliosis at NewYork-Presbyterian/Morgan Stanley Children's Hospital is one of North America's leading centers for diagnosing and treating scoliosis in young children. Early onset scoliosis (EOS) affects children up through age 8.

  • A Team of Experts for Your Child: Our doctors thoroughly evaluate your child and customize a personalized plan of care. Children with EOS also often have other medical disorders that require attention. As a full-service children's hospital featuring specialists from every area of medicine, we provide all of the care your child may need — such as heart, lung, and kidney function tests and treatment of related disorders — all in one center.
  • Nonoperative and Surgical Treatments: We offer the full range of nonsurgical and surgical treatments for your child, including Mehta casting, bracing, spinal stapling, conventional growing rods, Vertical Expandable Prosthetic Titanium Rib (VEPTR), and now MAGEC® (MAGnetic Expansion Control) — the first remotely controlled growing rod approved in the U.S. which can be lengthened in the office with a magnet, sparing the need for repeated surgeries. We have the largest casting program in the northeast for children with EOS. Our goal is to straighten your child's spine while increasing lung function and promoting normal lung development.
  • Leading the Way in Research: Our physician-scientists conduct research to advance the care of children with musculoskeletal concerns, and are also among an elite group of spine surgeons selected to participate in national research groups. They're studying new ways to treat severe spine and rib cage deformities and assessing outcomes of children treated with VEPTR and growing rods. Our team also created the classification system for EOS and is developing ways to reduce the risk of complications such as surgical site infections. Through our research and clinical work, we'll continue to deliver high-quality care to our patients and advance the overall quality of care delivered by pediatric orthopedic surgeons across the country.

Contact

Division of Pediatric Orthopaedics

3959 Broadway, 8th Floor
New York City 10032
Phone: 212 305-5475
Fax: 212-305-8271

 

The pediatric orthopaedic surgeons at NewYork-Presbyterian Morgan Stanley Children's Hospital are dedicated to advancing treatment options for Early Onset Scoliosis through research and clinical innovation. Many children with EOS do not require treatment -- close clinical follow-up is needed, but many do not progress. For those who do demonstrate progressive curves, there are a number of options outlined below. For children who experience progression of scoliosis early intervention is indicated to prevent chest wall deformity and to allow normal lung development.

The pediatric orthopaedic surgeons at Morgan Stanley Children's Hospital are dedicated to advancing treatment options for Early Onset Scoliosis through research and clinical innovation.

Upon meeting, each child will be evaluated and appropriate treatment options will be discussed. Although early results are positive, the new treatments using VEPTR, Growing Rods, and Stapling do not have an extensive history. Results may vary for each patient.

Casting for Infantile and Juvenile Scoliosis

The very young child with scoliosis is often not a candidate for surgery and in fact may not need surgery. The Early Onset Scoliosis Center has state-of-the-art noninvasive treatment techniques available for these children. The patient has a cast applied to the trunk on a specially designed table that allows us to control and correct the curves. The cast is changed regularly until the curve is appropriately reduced.

Spinal Fusion is Not Recommended Treatment for EOS

Ground breaking research in 2007 by the Pediatric Orthopaedic Research Team at Morgan Stanley Children's Hospital revealed that spinal fusion, once a standard practice when treating early onset scoliosis, prevents growth of the spine and thorax during a critical period of lung development. The patients with early fusion had poor pulmonary function and a significantly decreased quality of life. Surgeons at Morgan Stanley Children's Hospital and other specialized centers, therefore, attempt to avoid spinal fusion in young children with early onset scoliosis. Where spinal fusion has been shown to improve quality of life and life expectancy in adolescents who have achieved normal pulmonary capacity before the onset of scoliosis, this treatment has quite a different result in skeletally immature children. Spinal fusion irreversibly limits growth of the patient's spine, thorax and lungs and may result in progressive pulmonary insufficiency.

In the webcast, "Avoiding Fusion in Early Onset Scoliosis: Growing Rods and the VEPTR (Vertical Expanding Prosthetic Titanium Ribs) Treatment Option for Children Suffering from Early Onset Scoliosis," Morgan Stanley Children's Hospital surgeons discuss why spinal fusion should be avoided and the new techniques that are available to treat young children with early onset scoliosis. These new options offer hope and significantly improve patients' outcomes and quality of life.

Avoiding spinal fusion is the goal, however, there may be times when it is the only treatment option. As mentioned, all options will be discussed when determining the most effective treatment plan specific to each patient.

Vertical Expandable Prosthetics Titanium Rib (VEPTR) and Growing Rods

Treating Early Onset Scoliosis with growing rods and/or VEPTR permits continued growth in the spine, maximizes space available for lungs and enhances pulmonary function. VEPTR -- Vertical Expandable Prosthetic Titanium Rib -- is the most advanced treatment option for children with Thoracic Insufficiency Syndrome (TIS). While the condition is rare (less than 4,000 children in the U.S. each year), children with TIS have severe deformities of the chest, spine and ribs that prevent normal breathing and lung development. VEPTR straightens the spine and opens a larger space for the lungs and other internal organs to grow by placing a titanium device between two ribs to push them apart. VEPTR can be expanded through an outpatient surgical procedure as the patient grows.

"Before VEPTR, we had no way of dealing with the entire chest wall," explains Dr. David P. Roye, Jr. "Straightening the spine without growing the ribcage was not enough. Now we can straighten the spine while we increase room in the rib cage for the lung.

Growing Rods are used in a similar fashion to VEPTR. Rods are attached to the spine and affixed to vertebrae at the top and the bottom. Growing rods are expanded over time using a mechanism that allows the lengthening to be performed in a simple outpatient surgery. The approach minimizes spinal deformity, allows spine growth and most importantly allows lung development to occur to preserve a normal life span for the patient.

By increasing pulmonary capacity as well as straightening the spine, these treatments provide significant quality of life improvements and promote normal respiratory function. The complex care required by children diagnosed with early-onset scoliosis has tended to limit their treatment to children's hospitals offering a convergence of strong orthopaedic, pulmonary and ICU facilities. Morgan Stanley Children's Hospital's orthopaedic teams have significant experience in applying these techniques and are continuing to develop and test techniques, and share in research, with the expectation of even better outcomes in the future.

Spinal Stapling

Morgan Stanley Children's Hospital is one of only a few hospitals in the country to offer spinal stapling, a new treatment alternative for scoliosis patients who have progressive scoliosis at a young age. Spinal stapling modulates growth allowing correction of curves without fusion and without the necessity of multiple procedures. "Stapling not only stops scoliosis from getting worse, but can even correct the curve. While stapling is very new," says Dr. Michael Vitale, "it promises to have a major effect on how we treat young people with scoliosis."

Spinal stapling is a two-hour minimally invasive surgery that involves implanting inch-long metallic staples across the growth plates of the spine. Made of a high-tech temperature-sensitive metal alloy, the staples are implanted using a camera called a thoracoscope with a very limited incision and minimal scar. The procedure is available to children with progressive moderate scoliosis (less than 30 degrees) who are still growing (girls up to age 14 and boys up to age 16).

Spinal Stapling and VEPTR or Growing Rods

For children with larger curves, the benefits of growing instrumentation -- Growing Rods or VEPTR -- can be combined with spinal stapling. This new hybrid technique is being applied for curves greater than 35 degrees and patients are showing tremendous outcomes. Children return to active vibrant lives just months after surgery. Adjustments are made every six to nine months during their growth periods and usually completed on an outpatient basis.

Casting

Our infantile idiopathic casting program utilizes an Amil casting frame and follows the techniques of Dr. Min Mehta to utilize growth as a corrective force in the treatment of progressive infantile scoliosis. Further information about casting including tips for care of the young child in a spinal cast are available at http://www.infantilescoliosis.org/

Contact

Division of Pediatric Orthopaedics

3959 Broadway, 8th Floor
New York City 10032
Phone: 212 305-5475
Fax: 212-305-8271

 

ScoliScore™, a groundbreaking molecular test that helps predict the risk of spinal curve progression, uses a DNA sample from the patient's saliva. Within about two weeks, a report is sent to the physician with a score indicating the child's likelihood of having scoliosis that will progress. The scores are grouped into low, moderate, and severe categories.

The ScoliScore test is intended for patients:

  • With a primary diagnosis of adolescent idiopathic scoliosis (AIS), the most common type of scoliosis
  • Over the age of 9 who are deemed "skeletally immature"
  • With a mild scoliotic curve (defined as <25°), or
  • With a moderate scoliotic curve (defined as >25°, but less than 40°)

If the test shows a patient has a high risk for serious spinal curvature of 50 degrees or more, Dr. Vitale and his colleagues can intervene earlier than they would otherwise, such as by prescribing a back brace. And since less than 10 percent of teens with scoliosis progress to the point where spinal fusion surgery is necessary, the new test can also prevent unnecessary testing. Radiation exposure from diagnostic X-rays is associated with increased risk of problems with bone and breast tissue (girls are more likely than boys to have scoliosis).

An estimated 4 percent of children between the ages of 10 and 16 have AIS, making up 80 percent of all scoliosis cases. The ScoliScore provides doctors with information about the likelihood that an abnormal spine curve will get significantly worse or stay the same, which allows for earlier intervention and helps guide treatment.

ScoliScore is now available to a wider age range of children. Previous indications stated that to be eligible for the test, a patient must be between the ages of nine and 13. New indications now state that there is no age limit to receive the ScoliScore as long as the physician deems the patient "skeletally immature." This new regulation allows children over the age of 13 who meet the inclusion criteria to benefit from this breakthrough testing.

ScoliScore feedback from patients and their parents has been extremely positive.

Contact

Division of Pediatric Orthopaedics

3959 Broadway, 8th Floor
New York City 10032
Phone: 212 305-5475
Fax: 212-305-8271

 

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