Early Onset Scoliosis Center

The Center for Early Onset Scoliosis is led by Michael Vitale, MD, chief of pediatric spine and scoliosis surgery at Morgan Stanley Children's Hospital of NewYork-Presbyterian 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 tens of thousands of 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. 

View our Webcast titled "Avoiding Fusion in Early Onset Scoliosis: Growing Rods and the VEPTR (vertical expanding prosthetic titanium ribs) Treatment option for children suffering from early-onset scoliosis."

Making the Diagnosis
Early Onset Scoliosis includes children with Infantile Scoliosis (age 0 to three years) and Juvenile scoliosis (age 3 to 8 years).  Those with the infantile form will generally fall into two groups:  those whose curvature disappears with growth and those whose curvature becomes progressive. Infantile scoliosis occurs more often in boys than in girls. Juvenile scoliosis is defined as children identified with a ten to fifteen degree curvature up to the age of eight – these children must be closely observed as progression of the curve is common.
There are many different causes of early onset scoliosis therefore it is critical to perform the appropriate examination and tests.  In addition to close observation a careful neurologic exam, a spinal MRI, and a series of x-rays to review if other structural problems exist are needed.  Other associated problems may dictate other examinations or consultations including cardiac, pulmonary or renal function testing.

Scoli Sore
The Morgan Stanley Children's Hospital of New York-Presbyterian is one of twenty sites nationally selected to review a new diagnostic test that is based on a patient’s DNA to predict the risk of a child’s scoliosis progressing into adolescence.  The test called “Scoli Score,” developed by Axial Biotech, is currently being tested for Adolescent Idiopathic Scoliosis using a child’s saliva.  The sample is analyzed for DNA markers associated with the likelihood for scoliosis progression. The scores identify the likelihood of progression, information that can be important to guide treatment including observation, bracing and surgery.

Treatment Options
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.
The pediatric orthopaedic surgeons at MSCHONY are dedicated to advancing treatment options for Early Onset Scoliosis through  research and clinical innovation. 

Casting for Infantile and Juvenile Scoliosis
The very young child with scoliosis is often not a candidate for surgery and in fact may not need surgery.  The EOS Center at MSCHONY has state of the art non invasive treatment techniques available for these children.  The patient has a cast applied to the trunk on a specially designed table that allows us to control and correct the curves.  The cast is changed regularly until the curve is appropriately reduced.

Spinal Fusion NOT Recommended Treatment for Early-Onset Scoliosis.
Ground breaking research in 2007 by the Pediatric Orthopaedic Research Team at Morgan Stanley Children's Hospital of New York-Presbyterian revealed that spinal fusion, once a standard practice when treating Early Onset Scoliosis, prevents growth of the spine and thorax during a critical period of lung development.  The patients with  early fusion had poor pulmonary function and a significantly decreased quality of life. Surgeons at MSCHONY 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. 
View MSCHONY surgeons discussing this on a webcast. (link to webcast)

VEPTR and Growing Rods
Treating Early Onset Scoliosis with growing rods and/or VEPTR permits continued growth in the spine, maximizes space available for lungs and enhances pulmonary function.  VEPTR - Vertical Expandable Prosthetic Titanium Rib- is the most advanced treatment option for children with Thoracic Insufficiency Syndrome (TIS).  While the condition is rare (less than 4,000 children in the US each year), children with TIS have severe deformities of the chest, spine and ribs that prevent normal breathing and lung development.  VEPTR straightens the spine and opens a larger space for the lungs and other internal organs to grow by placing a titanium device between two ribs to push them apart. VEPTR can be expanded as the patient grows through an outpatient surgical procedure.
“Before VEPTR, we had no way of dealing with the entire chest wall,” explains Dr. David P. Roye, Jr.  “Straightening the spine without growing the ribcage was not enough.  Now we can straighten the spine while we increase room in the rib cage for the lung.”
For more details Link to The Titanium Rib.

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. For more details Link to Growing Rods.

By increasing pulmonary capacity as well as straightening the spine, these treatments provide significant quality of life improvements and promote normal respiratory function.
The complex care required by children diagnosed with early-onset scoliosis has tended to limit their treatment to children’s hospitals offering a convergence of strong orthopaedic, pulmonary and ICU facilities.  Morgan Stanley Children’s Hospital of New York-Presbyterian' orthopaedic teams have significant experience in applying these techniques and are continuing to develop and test techniques, and share in research, with the expectation of even better outcomes in the future.

Spinal Stapling
Morgan Stanley Children's Hospital is one of only a few hospitals in the country to offer spinal stapling, a new treatment alternative for scoliosis patients who have progressive scoliosis at a young age. Spinal stapling modulates growth allowing correction of curves without fusion and without the necessity of multiple procedures.
"Stapling not only stops scoliosis from getting worse, but can even correct the curve.  While stapling is very new," says Dr. Michael Vitale "it promises to have a major effect on how we treat young people with scoliosis."

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).

Casting
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 are available at http://www.infantilescoliosis.org/

Early Onset Scoliosis Research
Physician-scientists of the Pediatric Orthopaedic Research Team at the Morgan Stanley Children’s Hospital of New York-Presbyterian 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, they focus on multicenter studies of rare conditions such as Infantile Scoliosis and Early Onset Scoliosis.

Quality of Life
Studies to measure the impact of a child’s health on his life and his families’ life gather in a number of domains as 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 EOS because of their compromised conditions.  One of the major goals of the Pediatric Orthopaedic Research Group at MSCHONY is to develop new methodologies to measure the impact of EOS and the care of EOS on children whose quality of life we have not been able to measure before.

In a recent analysis, the Research Group found that patients with TIS score among the lowest in all pediatric populations in almost all domains in measures of 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 4-6 months as the child grows 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.

Cite Research (to come)

Spinal Fusion
"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. The study followed 27 patients who received spinal fusion, which permanently connects several vertebrae. After 10 years, their pulmonary function, measured by lung volume, and reported quality of life were significantly less than that of a healthy child.

Cite Research (to come)

Case Study

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 and 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.

To see our story and others with Early Onset Scoliosis visit  http://www.vertebralstapling.com/

Lisa, Jason's Mom, 2/4/09