For children with spinal deformities, surgical intervention can lead to life-altering improvements in pain relief, daily functioning, and cosmetic appearance. In fact, statistics show that with proper screening, the majority of children do well after undergoing surgery to correct a spinal deformity. However, for a relatively small percentage of young patients, additional surgery may be required in order to address painful symptoms, a deformity that continues to progress, or to maintain the child’s growth potential.
“During the initial surgery the goal is to preserve as much motion in the spine as possible, explains Oheneba Boachie-Adjei, MD, Chief of the Scoliosis Service at the Hospital for Special Surgery (HSS). “In addition, because these young patients haven’t attained their full growth, the surgeon may leave the growth plates open. Even in carefully screened patients, however, surgical intervention can not ensure that the original deformity will not progress or protect against the emergence of a new deformity.”
A number of factors may contribute to the need for revision surgery, including:
Imaging techniques used to assess patients with these symptoms include:
The nature of revision surgeries vary, depending on the underlying problem. “Achieving a thorough understanding of the patient’s condition prior to surgery, as well as the precise nature of the initial surgery, helps guide the orthopedist’s treatment recommendations,” Dr. Boachie says. “We also need to understand why the initial surgery was unsuccessful.” Among those procedures that may be considered are:
Revision surgeries for pediatric spinal deformities present a complex set of challenges. “However,” notes Dr. Boachie, “with diligent preoperative assessment and diagnosis and proper perioperative technique, as well as the participation of a multidisciplinary team including pediatricians, nutritionists, intensive care, and pulmonary specialists, these patients can do very well.”
In a recent study of fifty pediatric patients, Dr. Boachie and his colleagues at HSS saw good outcomes in the majority of this group, including improvement in function, pain, and body image.
In order to continue improving outcomes in treatment, Dr. Boachie and his colleagues at HSS are also looking at ways to optimize bone healing. Substances called bone morphogenic proteins (BMPs) may actually help build stronger bone and may eventually have a role in spinal fusions. Ensuring that patients are not Vitamin D and/or calcium deficient may also help strengthen the bone and improve the patient’s ability to tolerate the insertion of instrumentation and achieve successful spine fusion.
Also, a procedure involving a complex posterior approach known as vertebral column resection, or VCR, is becoming popular to eliminate complications associated with anterior/posterior procedures. This surgery involves a three-column (posterior, middle, and anterior) resection, or partial removal, of the spinal column around the spinal cord and nerve.
If you would like more information about revision spine surgery at HSS, please visit the Physician Referral Service or call 1(877) 606-1555.
Summary prepared by Nancy Novick. Diagnostic imaging courtesy of the HSS Department of Radiology and Imaging.