New scoliosis fixes may bypass back braces

Trials with staples and ‘growable rods’ straighten kids’ crooked spines

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updated 6:24 p.m. ET March 5, 2007

WASHINGTON - New technologies to straighten crooked spines while letting them grow may one day help children bypass those hated back braces.

Scoliosis specialists are trying staples to force a curving spine to grow right — and for worse cases, implanting “growable” rods in place of standard spine surgery called fusion that stunts youngsters’ growth.

The technologies aren’t yet widely available. Initial recipients of growing rods are just getting old enough to be sure that lengthening the implants twice a year really worked. And researchers hope later this year to begin the first major study comparing staples with braces.

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But they’re at the forefront of what could be a long-needed revolution in scoliosis care. The key question is how to tell which child needs radical treatment before his or her back becomes badly misshapen — and who’s destined to have only a mild curve. Trials are under way comparing patients’ genes and outcomes, in hopes of creating a test to predict just that.

“We are really seeing the light at the end of the tunnel about making that diagnosis,” says Dr. Behrooz Akbarnia of the San Diego Center for Spinal Disorders, who reported the latest data on growing rods at a recent meeting of the American Academy of Orthopaedic Surgeons. “There are a lot of patients that may not be treated unnecessarily in the future.”

6 million affected in the U.S.
Viewed from behind, a normal spine looks like a straight line. With scoliosis, the spine curves into an “S” or “C” shape. It affects between 2 percent and 3 percent of the population, roughly 6 million people in the U.S., according to the National Scoliosis Foundation.

The curve usually arises in early adolescence, between ages 10 and 15. Fortunately, most cases are mild and don’t need treatment.

But a badly curved spine can limit activity, cause pain, and affect appearance and self-esteem. Worse, in severe cases, scoliosis shrinks the chest cavity — there’s not enough room for the lungs and heart to develop normally, leading to potentially life-threatening respiratory problems. And the earlier scoliosis hits, especially before age 5, the more severe it tends to be.

The scoliosis foundation estimates that each year, 30,000 children are told to wear a brace to slow worsening curves — and 38,000 patients undergo spinal fusion surgery, permanently bonding vertebrae together to keep the spine straighter.

Treatment depends on the degree of the curve. “Some children walk in our doors with curves in excess of 90 degrees,” laments Dr. Linda D’Andrea of the Shriners Hospital for Children in Philadelphia. “You always want to operate before it gets to that point.”

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It can be a battle to get children to wear uncomfortable, often unsightly braces in hopes of staving off surgery. Fusion significantly shortens a younger child’s spine, Akbarnia says, but after growth stops in the late teens, it can be used without affecting growth.

CONTINUED : New techniques

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