Last updated on February 14, 2019
Here, with our Chief of Staff, Dr. Dan Sucato, in honor of Scoliosis Awareness Month, aboutadolescent idiopathic scoliosis. So, welcome back! – Thanks, it’s good to be back. – It’s a week later. – It’s a week later, this is our third week in a row. Kind of fun – We’re excited. Okay, so you can’t get it, it’s worth it. . . Let’s break it down. Adolescent, because you’re older than ten.
That’s the definition. Idiopathic, you’re afraid of scoliosis. And then, scoliosis. So, adolescent idiopathic scoliosis. If you’re looking for it, it affects the healthy, normal, adolescents. And it ‘ they typically go through their growth spurt. So what does he really wants to take off? And so we monitor that. It gets viewed by schools. It can’t be treated appropriately. – So, you know, last week we talked about early onset.
So, does that. . . do patients start with the EOS and then it goes into AIS, or. . . – Yes, so great question. It would be a little bit better to make it a bit harder normal, whether they are less than ten or older than ten, that’s idiopathic scoliosis. Early onset of the scoliosis. They can be congenital, they can be neuromuscular, they can be idiopathic, if everything else is normal. So, it’s a diagnosis of exclusion. If you can exclude everything else, idiopathic. The challenge with the early onset, it is so much growth left. If you’re older than ten years old, you’re getting So, what’s more with their time limit? So that’s the difference. – Okay. So then in terms of treatments, you know, we talked about bracing and surgery.
So, how does it play in this condition? If you’re thinking about it, you’ll not be happy. common. And so, we want to know that. It is a bit of a bit of a painful back pain because it can be a painful back pain. They wake up with back pain. That ‘ It is different from you. So as an example, those are really important questions, and there are several others. Then we do a good physical exam. Adam’s Forward Bend Test; From behind, we look at the rotational aspect. And we’re going to show a couple of pictures here. And then you get an X-ray. Some of those things on X-ray. It is based on their curve of magnitude. So, we often watch them. If you have a 20 degree curve of growth, you can’t need anything. A 20 degree curve is to go through the rest of their life.
Won’t cause any issues. If they have a 20 degree curve and then ten, then 11, then they have to watch them closely. We can even start a brace at that point. So bracing is that it is important to take it about 25 degrees, sometimes we’ll wait until it’s about 40 degrees, or 45 degrees, then we’ll brace those patients. The goal is to get the curve from the bottom. – Right. – So, I can show you. – Yeah! – You’re about to see a typical. . . So, here ‘ sa young lady that presented to usat ten years of age. I hope you can see this X-ray. It is a curve that we’ve seen a curve. So when we look at the X-ray, the bones themselves, the vertebra, are all normal. Their shape is normal. But the contour of the spine is curved to the right. The most common type of scoliosis. Now, this young girl is ten, almost ten and a half.
There’s a lot of growth. Typically, girls at ten are growing very fast. And so you can see this curve on her. We did an exam. You can see it. The X-rays clearly show a 35 or 36 degree curve. So that the curve is going to get better. And so, all the braces are custom-made braces. So we are very, very fortunate here. So everything is done in-house. Our orthotists are in the clinic. If you are a young woman, you’ll be able to make sure that you’re a young lady. What are the types of brace? And what are they? – Yes. So, basically there were two main types of braces. There’s the all-day and nighttime brace. And then, for certain curve patterns, the night time brace. – Okay. – And that’s a specific indication that it’s been developed over the yearsthrough lots of study and research.
Don Katz clearly showed that thoracal lumbar, lumbar curve, It is clear that it can be treated with a night time brace. And then we have the night time, all the day and night time. And so we shoot for 18 hours a day, which is challenging. It’s time for your parents to take 20 hours a day. On this day, you’re not going to wear it. 12 hours a day. Once in a while, that’s okay. That works out fine. We don’t want to – Well, because, you know, they’re young, and so they want to be active, and be playing around. So, with that, I know that we’ve done a lot of research with monitors inside of the brace. And so it doesn’t help. . . Yes, absolutely! Loli Karol, and his team, some really nice work done. If you put on a temperature sensor and don Katz started this work several years ago. If you put the temperature on the skin in the brace, it’ll take it for you. And so, we have shown that this is what you want to watch out for your brace. And so, we monitor all of our children. We give them a report card. And we say, here’s what you’re doing. You either doing really well, or you can for improvement. If you are not wearing it. We can improve on that.
And it was so effective. So, this is a typical brace. As you can see, it’s low profile. It goes under the clothes. This one was made for a young lady. You can see that it is red, white and blue. – Very patriotic! – Very patrioticin this time of year. So, she got the red, white, and blue. And it’s low profile. We provide the t-shirts. We measure them for the brace. It takes you to make up your brace. And they get a separate department to fit the brace. They’re used to the brace. It is a little bit of time. And so, that works out really well.
“Great question.” “Great question. So every time they come on, he sees it on. Sometimes, they get a little red hair in certain spots. There are no bits, and contour the brace. So every time they come in, it can be reassess the brace. So, that’s a typical brace. It goes under the clothes, very well tolerated. Usually, if they get used to wearing it right away, then they do very well. So, this young lady came in. If you’re after you’ve been given the brace, you’ll have to get the brace. They get an appointment with the orthotist, then they come back a month after that. So, you can get a correction in the brace. So you wear it, If you want to grow, you can’t get any bigger. So, we want to see a good brace? So here, it is a good brace. We’ve gone from 36 down to 16 degrees.
That’s really good correction. You can see it here. There’s also the temperature sensor that’s in this particular young lady. So this young lady was fantastic with the brace. And she wore the brace. She participated in athletics. She was a volleyball player. – [Interviewer] Love that sport. – Love that sport, right? I knew you would. And so on, then she was ten and a half. She wore it until she was about 13. And then, here she is at 16 years of age. So, she ‘ s been off the brace for three years. She has the same curve we measured, actually, at 34. So, it’s 36 Here she is in the X-ray, in the brace. And then she’s done growing. Her spine isn’t going to change. She’s left with a 34 degree curve.
She looks very good. It doesn’t bother her. It will never be a bother – So it would be normal for the curve bounce back. – The curve will always go back. – Always. – Yeah. The curve will be back. Okay? – Okay. – When they are in the brace, they are corrected. The curve doesn’t get any bigger. Soon as they come out of the brace, that’s where they are. It is really, really well, The answer is yes. That’s not very typical though. But this, you wouldn’t be able to tell you this. You wouldn’t see this young lady. It’s not a functional issue. She does everything she wants to do. She has no back pain. It is a long-term study of all issues at all. – It is a good thing to do it, – take the brace off. So, they take it out. You wear it in bed. You can not wear it to shower, swim. We certainly want to do kids activities. – That’s awesome.
So then, another treatment is surgery. So, maybe get into that. – So, surgery is typically for two scenarios. If you’ve been growing. So scoliosis gets bigger in two ways. Scoliosis progression happens in two ways. One, is if you’re growing fast. Or, if they’re growing up, they’re And so in general terms, that curve magnitude is 50 degrees. And remember we measure scoliosis in degrees. A straight spine is zero degrees, anything above ten degrees is true scoliosis. Above 50 degrees, curves, So, a 16 year old, one year per one year. If you have a degree, have a degree, have a degree, still very young. So, that’s the indication for surgery.
And. . . So it’s possible to avoid surgery with early detection. So what happens in schools, what happens in schools, what happens in the pediatrician’s office. So, those are really important. But, there are many times where surgery is appropriate. So, we’ve come a long, long way from surgery. We’ve come a long, long way with surgery over the years. The goals of surgery are twofold. It is a certain amount. And we’re very successful in obtaining reallygood correction today. Safely. And that’s the most important part. Safety, safety, safety. We do a lot of things here at this institutionthat have made surgery safe. We continue to study how to make surgery safe. Aspects are avoiding issues like infection. And we have a performance improvement committee. If you’re losing a bit, you’ll have to make it a bit more difficult. And so, they’ve made huge strides in doing that. It’s antibiotics before it’s in the operating room, all sorts. There was a three-tier program that was really challenging.
So, that’s important. The most important thing is neurologic issues. Spinal cord issues, neurologic issues can happen. It is a state of the peace of mind of the monitoring system, it has been a spinal cord monitoring system, normal throughout surgery. And those are all in-house people. We don’t outsource that to anybody. Very few institutions do that. And so we have the same team in the operating room. Some of us surgeons actually look at the data also. And that makes it very safe. So for idiopathic scoliosis, we’ve just completed a year of study. re looking at the roomis two percent. So two out of 100. No one, no woke up with any permanent neurologic problems. So it’s a great track record. It’s been very safe. Correlation is very effective, which I can show you. – Yeah, definitely. – So, here’s a young boy.
This is a very typical curve. Double curve, again, right thoracic curve. His curve magnitude measured 57. This curve measured 58. He has a right curve and a left lumbar curve. This actually was done 15 years ago, this surgery. And so, we got a nice correction. You can see the screws. So you can see the screws. This is the X-ray looking from the side. This is the X-ray looking from the back, so it s same X-ray here, that is there. Spine and hold up the spine and hold it up. And that’s the downside of surgery, is fusion. Become one, one bone. It was a nice thing to do. So this is a very typical sort of surgery. And sometimes we see young folks. 115 degree curve. That’s a lot bigger curve than is typical. But fortunately, here, we’re able to take care of very straightforward to the very complex. Had this same type of surgery, and you can see the difference here in here. Her spine looks very good. And, in terms of the long-term health of your spine, is this.
We like to see thoracic kyphosis and lumbar lordosis. Overall, it looks really good. This young lady looks like. Here she is before surgery. And here she is after surgery. And she did very, very well. So that gives you a little glimpseof what surgery’s all about. – Wow, okay. So, I’m thinking of some of our followersthat. One says, “My daughter is 15, and has a 48 degree curve.” Yeah, that’s a great question. So, that’s what the question is in the gray zone. So, she’s 48. I told you that above. . . 50 or above, we generally see curves get bigger adulthood. So, each patient really needs to be evaluated. If she’s been happy, she has a nicely balanced coronal plane – It’s not a problem. It is not true that the progress has been rapidly. And you can get an X-ray every five to ten years. So the short answer. . . that was a long answer.
The short answer is that she should be great. So, as she gets older, child-bearing, having a family, no issues. If you have a little scoliosis, you shouldn’t have to do it. – Very good. Okay, I think we have time for one more question. And this parent asks, “Can a child, that had a spinal fusion, have an MRI?” – The answer is yes. So, and we do that all the time. They’re made of cobalt chrome, which are definitely magnetic, but they’re securely fixed to the spine. MRI is very, very safe. No issues. We do it all the time. Because there is metal there, sometimes it is somewhat challenging. But the radiology teams are getting much more MRIs that they can see. So yeah, it’s not a problem. – Very good. Well, you’ll appreciate it. – Well thanks, it’s been fun. – So, please continue to watch. Leave a comment and you’re not sure. So we will see you next week.