Early Onset Scoliosis Center
The Center for Early Onset Scoliosis is led by Michael Vitale, MD, chief of pediatric spine and scoliosis surgery at NewYork-Presbyterian Morgan Stanley Children's Hospital and the Ana Lucia Associate Professor of Clinical Pediatrics and Orthopaedic Surgery at Columbia University College of Physicians and Surgeons. More than 400 patients under the age of five are seen each year in the Center by Dr. Michael Vitale, Dr. David Roye and Dr. Benjamin Roye.
While more than 100,000 children in the U.S. are diagnosed with scoliosis each year, most patients are diagnosed between ages 10 and 15 with Adolescent Idiopathic Scoliosis. Scoliosis identified at birth or up to the age of eight is rare, and is categorized as Infantile Scoliosis, Juvenile Scoliosis or Early Onset Scoliosis. The cause of Infantile Scoliosis is unknown; however considerable medical research has led to the development of hypotheses that include intrauterine molding, postnatal positioning and genetic influences. Click here for more in-depth description. Early Onset Scoliosis is often associated with other diagnoses including congenital chest wall deformities, neuromuscular disorders such as cerebral palsy, myelomeningeocele or muscle disease, or spinal pathologies such as a tumor. Early Onset Scoliosis is a rare occurrence, requiring special knowledge and experience to solve the complex issues surrounding this condition.
ScoliScore™ Predicts Risk of Severe Scoliosis
The ScoliScore test is intended for patients:
If the test shows a patient has a high risk for serious spinal curvature of 50 degrees or more, Dr. Vitale and his colleagues can intervene earlier than they would otherwise, such as by prescribing a back brace. And since less than 10 percent of teens with scoliosis progress to the point where spinal fusion surgery is necessary, the new test can also prevent unnecessary testing. Radiation exposure from diagnostic X-rays is associated with increased risk of problems with bone and breast tissue (girls are more likely than boys to have scoliosis).
An estimated 4 percent of children between the ages of 10 and 16 have AIS, making up 80 percent of all scoliosis cases. The ScoliScore provides doctors with information about the likelihood that an abnormal spine curve will get significantly worse or stay the same, which allows for earlier intervention and helps guide treatment.
ScoliScore is now available to a wider age range of children. Previous indications stated that to be eligible for the test, a patient must be between the ages of nine and 13. New indications now state that there is no age limit to receive the ScoliScore as long as the physician deems the patient “skeletally immature.” This new regulation allows children over the age of 13 who meet the inclusion criteria to benefit from this breakthrough testing.
ScoliScore feedback from patients and their parents has been extremely positive. Read patient testimonials here.
Many children with EOS do not require treatment — close clinical follow is needed, but many do not progress. For those who do demonstrate progressive curves there are a number of options outlined below. For children who experience progression of scoliosis, early intervention is indicated to prevent chest wall deformity and to allow normal lung development.
* Upon meeting, each child will be evaluated and appropriate treatment options will be discussed. Although early results are positive, the new treatments using VEPTR, Growing Rods and Stapling do not have an extensive history. Results may vary for each patient.
Casting for Infantile and Juvenile Scoliosis
Our infantile idiopathic casting program utilizes an Amil casting frame and follows the techniques of Dr. Mehta to utilize growth as a corrective force in the treatment of progressive infantile scoliosis. Further information about casting, including tips for care of the young child in a spinal cast, is available at www.infantilescoliosis.org.
Spinal Fusion is Not Recommended Treatment for Early-Onset Scoliosis in Young Children
"We recently presented evidence that spinal fusion in young children can lead to significant issues in quality of life and pulmonary function over the long term," says Dr. Vitale, who presented the findings at the International Conference on Early Onset Scoliosis in Montreal.
Surgeons at Children’s Hospital and other specialized centers, therefore, attempt to avoid spinal fusion in young children with early-onset scoliosis. Where spinal fusion has been shown to improve quality of life and life expectancy in adolescents who have achieved normal pulmonary capacity before the onset of scoliosis, this treatment has quite a different result in skeletally immature children. Spinal fusion irreversibly limits growth of the patient's spine, thorax and lungs and may result in progressive pulmonary insufficiency.
Avoiding spinal fusion is the goal, however, there may be times when it is the only treatment option. As mentioned, all options will be discussed when determining the most effective treatment plan specific to each patient.
VEPTR™ and Growing Rods
In the post operative period, there is no casting or bracing necessary and regular activities are not limited.
VEPTR expands to allow for rib cage and lung growth as the patient grows. Children receive expansions, an outpatient surgical procedure, every four to six months.
Learn more about VEPTR here.
Growing Rods are used in a similar fashion to VEPTR. Rods are attached to the spine and affixed to vertebrae at the top and the bottom. Growing rods are expanded over time using a mechanism that allows the lengthening to be performed in a simple outpatient surgery. The approach minimizes spinal deformity, allows spine growth and most importantly allows lung development to occur to preserve a normal life span for the patient.
Learn more about Growing Rods here.
By increasing pulmonary capacity as well as straightening the spine, these treatments provide significant quality of life improvements and promote normal respiratory function.
Spinal stapling is a two-hour minimally invasive surgery that involves implanting inch-long metallic staples across the growth plates of the spine. Made of a high-tech temperature-sensitive metal alloy, the staples are implanted using a camera called a thoracoscope with a very limited incision and minimal scar. The procedure is available to children with progressive moderate scoliosis (less than 30 degrees) who are still growing (girls up to age 14 and boys up to age 16).
Spinal Stapling and VEPTR or Growing Rods
Physician-scientists of the Pediatric Orthopaedic Research Team at the Children’s Hospital conduct their own research to advance the care of children with musculoskeletal concerns, and are among an elite group of spine surgeons selected to participate in national research groups. The Chest Wall and Spinal Deformity Study Group is comprised of 20 members from across the country who are interested in defining new ways to treat severe deformities that affect both the spine an the rib cage. This group is collecting data on the outcomes of patients treated with VEPTR.
Also, members of the Spinal Deformity Study Group, a research committee of 50 surgeons from across North America, focus on multicenter studies of rare conditions such as Infantile Scoliosis and Early Onset Scoliosis.
Studies to measure the impact of a child’s health on his life and his families’ life gather data in a number of domains including physical functioning, mental health and the impact of the child’s condition on the caregiver’s time and outlook. However, many of these studies are unable to accurately measure quality of life in Early Onset Scoliosis because of their compromised conditions. One of the major goals of the Pediatric Orthopaedic Research Group at Children’s Hospital is to develop new methodologies to measure the impact of Early Onset Scoliosis and the care of Early Onset Scoliosis with children whose quality of life we have not been able to measure before.
In a recent analysis, the Research Group found that patients with Thoracic Insufficiency Score (TIS) among the lowest in all pediatric populations in almost all domains when measuring quality of life. This is a significant benchmark that will allow effective measurement of the impact of the VEPTR treatment. Patients receiving VEPTR treatments return for adjustments every four to six months as they grow so that the device can be lengthened or replaced, until the chest cavity is large enough to support adult sized lung capacity. The Research Group will continue to collect data to understand the impact of this life-saving treatment.
Below is a list of current and research conducted by the Pediatric Orthopaedic Research Group relating to Early Onset Scoliosis. Led by Dr. Michael Vitale, this group is engaged in multiple research projects each year and present their findings at national and international medical sympoisia. In addition to leading his own research team, Dr. Michael Vitale is a member of the Board of Directors for the Chest Wall and Spine Deformity Study Group, a research group dedicated to improving the quality of care and the outcome of treatment for patients and families dealing with chest wall and spine deformities. Dr. Vitale guides the Group's research direction and is an active participant in both retrospective and prospective studies. To see the 2010 annual report of the Chest Wall and Deformity Study Group, click here
My 12-year-old son Jason was born 14 weeks premature. He had several complications due to his prematurity including scoliosis.
After a huge misstep with an orthopedic doctor when Jay was a baby, we luckily found Dr. Vitale. He has been Jay's doctor/surgeon for most of his life. I can't say enough about the level of care that Jay receives from Dr. Vitale and his staff. Read our story and others about families dealing with Early Onset Scoliosis at www.vertebralstapling.com.
Lisa, Jason's Mom, 2/4/09