Yesterday we shared a Q-and-A on the history of scoliosis treatment at HSS with Dr. David B. Levine. Dr. Levine was chief of Scoliosis Surgery at HSS from 1967 to 1994 and is director of alumni affairs and chair of the HSS Archives Committee. Today we look ahead toward emerging research in the prevention and treatment of this debilitating condition.
Since the first Harrington rod surgery was performed at HSS in 1963, rod materials and technologies have advanced to allow patients to recover from surgery faster and without post-operative casts. While scoliosis surgeons embrace innovations that help patients resume their lives with minimal interruption, “we are cautious about new technologies and techniques until they have a track record for success,” says HSS spine surgeon and basic scientist Dr. Matthew Cunningham.
Future Surgical Trends
As technology continues to develop, advances in minimally invasive surgeries may ultimately make spinal fusions more tolerable, and surgical methods that do not require fusions at all may emerge. In addition, improved bracing and promising developments in physical therapy may prevent the need for surgery in some cases. These new surgical techniques are currently being evaluated.
The Promise of Genetics
One of the most significant recent advances in scoliosis is the development of genetic testing. There has been dramatic development in identifying gene mutations that correlate with scoliosis. Despite the fact that the exact cause of the type of scoliosis seen in 70 percent of children with scoliosis (“idiopathic scoliosis”) remains unknown, there is now a first-generation commercial genetic test that allows physicians to identify children at low, intermediate and severe risk for curve progression. This information helps physicians to provide appropriate preventive care. As these genetic tests improve, the ability to intervene with non-operative treatments early on will improve as well. Ultimately, early detection may help prevent the relentless scoliosis curve progression that makes surgery necessary. “It would be great value to have the ability to intervene early and prevent the problems that lead to the need for surgery,” says Dr. Cunningham.
Emerging Research at HSS
HSS physician-scientists are developing new technologies that may ultimately reduce the need for surgery in people with scoliosis and other spine conditions. Surgeons and scientists are using gene therapy to develop a new non-surgical spinal fusion technique that may replace spinal fusion surgery with an injection of genes to the spinal disc, causing the disc tissue to turn into bone. In certain situations this might be able to eliminate surgery altogether. Early diagnosis and treatment of scoliosis is important because severe scoliosis may lead to heart and lung failure if left untreated. Even more moderate cases can lead to physical restriction following surgical treatment, fueling the desire to prevent progression and avoid surgery. HSS physicians continue to use both surgical and non-surgical techniques to treat scoliosis.
Matthew E. Cunningham, M.D., Ph.D, is an orthopedic surgeon at the Spine Care Institute at Hospital for Special Surgery. Dr. Cunningham has clinical interest in thoracic and lumbar spine care, including spinal deformity (scoliosis, flatback, kyphosis, and spondylolisthesis) for adult and pediatric patients, and degenerative problems (stenosis, herniated discs, arthritis, instability) in adults. In consideration of each and every patient, he focuses on the discovery and refinement of less-invasive, less-painful, and less-disruptive ways to correct spinal pathology.