Recent advances in technology and surgical techniques have dramatically improved pediatric surgery, which has become more accurate, more predictable, and often less invasive. At HSS, surgeons conduct more than 3,100 surgeries for children and adolescents each year. We interviewed Roger Widmann, MD, chief of Pediatric Orthopedic Surgery at HSS, about recent advances that have transformed the field.
Guided growth procedures allow surgeons to achieve major changes in limb alignment through minimally invasive surgery for children with limb length discrepancy, bowlegs, knock knees, and even some spine curvatures. In these procedures, surgeons insert small plates and screws that guide growth plates to grow in the desired alignment, essentially tricking growth plates to grow straighter. HSS pediatric orthopedic surgeon Daniel Green, MD, helped invent a guided device that is used around the country to correct bowlegs in children.
In the recent past, surgeons needed to cut the bone in a major surgical procedure called an osteotomy, in which large plates and screws were used to correct and maintain alignment. Today, pediatric surgeons routinely correct alignment with less than a one-inch incision, resulting in a much faster and less painful recovery.
“We want kids to get back to their normal lives as soon as possible. Kids are back to full activity within weeks of a guided growth procedure, whereas recovery from an open osteotomy usually takes months,” says Dr. Widmann.
Guided growth procedures have also transformed care for children with spinal curvatures. Surgeons now insert internal lengthening devices – a “growing rod” in the spine or a VEPTR in the ribs – that allow a child’s spine to continue to grow as it is straightened. Every six months, the surgeon lengthens the rod in a minimally invasive outpatient visit to match the child’s growth.
Fifteen to twenty years ago, children’s spines were surgically straightened before they were fully grown, which led to pulmonary complications. Today, children are generally managed with guided growth tools until they are fully grown, at which time spinal fusion surgery may or may not be necessary. In development are internal magnetically controlled lengthening devices that may soon allow surgeons to lengthen the rods without any surgery whatsoever. The surgeon will insert an electromagnetic device in a patient’s back, and the rod will lengthen with a press of a button. “There is good evidence to support this technology, both basic science and clinical evidence, so this is something that’s just around the corner,” says Dr. Widmann. “Then another procedure will become noninvasive.”
A new technology called “computer-guided surgical correction” has dramatically improved the precision of limb deformity surgery over the past ten years. Surgeons now precisely program the desired correction into a computer following surgery, and then gradually achieve that correction using external fixators that are adjusted during follow-up outpatient visits.
“This technology allows us to correct all aspects of complex deformities – including length, angulation, and rotation – simultaneously, whereas ten years ago we would have corrected each one of those things separately and sequentially and with less accuracy,” says Dr. Widmann. “We are now very confident that we can achieve correction in all three planes.”
At HSS, the entire pediatric team is focused on patient safety, and exposing children to as little radiation as possible is a high priority. Pediatric imaging experts increasingly use MRI and ultrasound to minimize children’s exposure to X-rays. For situations in which X-rays are necessary, HSS is one of the first centers to acquire an EOS imaging system – a low dose X-ray imaging system for spine and limbs – which gives a 3D image with only ten percent of the radiation of a standard X-ray machine.
“While the surgical principles remain the same, there are very few procedures that from a technical standpoint we do the same way as we did ten to 15 years ago,” says Dr. Widmann. “In many cases, children can get back to their lives faster following surgery, since new techniques have shortened the recovery time and improved expected outcomes.”
Read the full Discovery to Recovery Fall 2013 issue.