Transcription:
Treatment Options for Early-Onset Scoliosis

Melanie Cole (Host):  If you suspect that your child might have a curvature of the spine, what options are available for patients with early onset scoliosis. My guest today is Dr. Anuj Singla. He is a fellowship trained orthopedic spine surgeon whose specialties include caring for patients with scoliosis at UVA. Welcome to the show, Dr. Singla. What is early onset scoliosis and what are the symptoms that parents might recognize in their children that would even send them to the doctor to begin with.

Dr. Anuj Singla (Guest):  Good morning, Melanie. Thanks for having me. Scoliosis is a lateral or sideways curve of the spine. Normally, a spine is straight upright, but when the spine starts growing sideways in the shape of a C of S, it is what we call scoliosis and early onset scoliosis is when the scoliosis starts early on, say, less than 10 years of age. That is early onset scoliosis. The most important remarkable symptom of a scoliosis is asymmetry or unevenness. Normally, our spine—and for that matter, the whole of our body—is very symmetrical, very even on both sides, the right side and the left side of the body. But if you notice that there is some unevenness in the kid’s body with regard to spine or adjacent to the spine, like tilted or uneven shoulder, one shoulder blade protruding more than the other or prominence of ribs on one side or uneven baseline or uneven pelvis, one hip higher than the other, or overall, kid leaning onto one side, these are the things that should give you the early clue that the kid might have scoliosis and you should see a specialist.

Melanie:  Is this something in a pediatrician’s office during their well visit that might be caught by the pediatrician when they are just doing their normal well visit? 

Dr. Singla:  Yeah. Actually, most of the time, parents has features of unevenness like I just mentioned, but sometimes, the findings are so subtle, it is so minor difference between the right side and the left side overall asymmetry, that the parents do not notice that and the pediatricians are very good at finding that out and we get a lot of referred patients from the pediatricians all over the region where the pediatrician or the primary care doctor find out about the scoliosis and the patients get referred over to us.

Melanie:  Are there certain groups of patients, Dr. Singla, that are at higher risk than others? 

Dr. Singla:  Yeah, there are certain groups of patients. Early onset scoliosis, we broadly say there’s a neuromuscular type of early onset scoliosis, which is imbalance of the nerve and the muscle function, like in cerebral palsy, CP, spinal muscular atrophy, muscular dystrophies, or paraplegia or a traumatic spinal cord. If the nerve and the muscle band go haywire, then they can get scoliosis. Some kids who have some syndromes in the body like Marfan syndrome or neurofibromatosis or dwarfism, they also have higher chances of getting scoliosis. Some kids who have abnormal bone in the spine, which is present since the birth, what you call as congenital scoliosis, they can also have a big scoliosis deformity early on in their life. At the same time, the biggest chunk of our patient is a group of patients who are otherwise completely normal, no problem with any other system in the body. They just have scoliosis. There is no reason for them to have scoliosis, but they end up having scoliosis.

Melanie:  What a scary diagnosis, I would assume, for parents. What treatment options are available and what can they look toward for the future of this child? Are they going to be standing upright after these treatments? What are the options out there and what are the outcomes? 

Dr. Singla:  Melanie, this is a very interesting question. Because treatment options for scoliosis and especially early onset scoliosis has to be customized for every child’s need, there is no one single answer for all the patients. The treatment has to be individualized. There are broadly three categories of treatment, three steps of treatment. First is observation, where we just look at the child and see if it is progressing, if the curve is getting worse over time or not. We take images of the spine. We take MRI or a CT scan to make sure we understand the problem and we take the consultation with some of the other specialists to make sure there is no other problem in any other part of the body. That is observation. The second step is doing a non-surgical treatment. Non-surgical treatment, we use bracing and casting for that. That is really very effective. That is one of the mainstream treatments for scoliosis especially early on. The third category of treatment is doing a surgery. For the surgery, I would like to mention that there have been some tremendous advances in the treatment of scoliosis and early onset scoliosis in last five to ten years. Earlier, the treatment option for early onset scoliosis and scoliosis used to be only fusing the spine. We used to fuse the spine so the spine does not grow any more crooked or any more curved than it is now. Or we used to correct the spine and then fuse it. That was the problem, especially for early onset, because if you fuse the spine, that also fuses the chest cavity or the thorax. If the chest does not grow, say in a five or six-year-old, the space available for the lungs for breathing gets very compromised or very jeopardized and that has a far-reaching effect and the lungs cannot actually grow to the normal extent for the rest of their lives. But with the newer advances of non-fusing technologies, we can really overcome. It is still early on for the non-fusing technologies for spine, but I guess we have made some groundbreaking achievements in the last five to 10 years. Now we have the groin rods, we have the dissection B system; we have the magic rod system. We don’t have to fuse the spine with the tethering and stapling. So there are a couple of options, which we can customize as per the kid’s age, kid’s growing potential, the flexibility of the curve, and the severity of the curve.

Melanie:  Dr. Singla, when you speak about bracing and casting and traction, back in the day, we would see people, young kids walking around in those really severe braces with their heads up. It was something that really restricted that child’s movement, and in school kind of set them aside from the other children. What is it like now if a child has to go through bracing or casting or traction?

Dr. Singla:  The principle behind the bracing is we have to push on certain segment of the spine on the convexity or the rounding side so that the spine grows straight. The brace, obviously, has to be worn for quite a significant amount of time, we say, about 16 to 18 hours a day. But that bracing material has changed a lot in the last five to ten years, and people do not notice. If you are wearing a brace underneath your clothing, people do not notice. Kids do not have any major restriction with the brace on. For the kids’ playtime and activity time, we encourage them to take the brace off, say after the school period. We encourage them to take the brace a couple of hours so the kids have time to do all the fun activities as well. 

Melanie:  That is really great information that gives hope to parents. Dr. Singla. Why should patients come to UVA for their care? 

Dr. Singla:  That’s an interesting question. I am fellowship trained and I have the training in the latest and cutting-edge technologies like the non-fusing methods I was just mentioning. If you combine that with the extensive experience of my mentor, Dr. Abel, over here, it makes up a great pediatric spine surgical team. Spine and scoliosis treatment is not just pediatric spine surgeon; it is a big team effort. It involves pediatric surgeons, team of intensive care intensivists, ICU nurses, anesthetists, therapists, orthotists who work with the braces, neurologists. I feel we have a great team taking care of kids with scoliosis over here at UVA. We also have low-dose imaging modalities. Because, like I mentioned, these kids need frequent and repeated imaging of the spine, and over a long period, the radiation amount in the body can have impact on the overall growth potential on all the glands and on the reproductive function later on. If we can cut down on the radiation dose, it can significantly impact the overall growth of the kid. We also have a one-stop solution to the problem over here. We have the imaging, our clinic, and our bracing shop all under one roof in our clinic setup. 

Melanie:  Thank you so much. You are listening to UVA Health Systems Radio. For more information, you can go to uvahealth.com. That’s uvahealth.com. This is Melanie Cole. Thanks so much for listening.