Straightening crooked spines while also letting them grow
By Lauran Neergaard
AP Medical Writer
WASHINGTON — New technologies to straighten crooked spines while letting them grow may one day help children bypass those hated back braces.
Scoliosis specialists are trying staples to force a curving spine to grow right — and for worse cases, implanting "growable" rods in place of standard spine surgery called fusion that stunts youngsters' growth.
The technologies aren't yet widely available. Initial recipients of growing rods are just getting old enough to be sure that lengthening the implants twice a year really worked. And researchers hope later this year to begin the first major study comparing staples with braces.
But they're at the forefront of what could be a long-needed revolution in scoliosis care. The key question is how to tell which child needs radical treatment before his or her back becomes badly misshapen — and who's destined to have only a mild curve.
Treatment depends on the degree of the curve. "Some children walk in our doors with curves in excess of 90 degrees," laments Dr. Linda D'Andrea of the Shriners Hospital for Children in Philadelphia. "You always want to operate before it gets to that point."
It can be a battle to get children to wear uncomfortable, often unsightly braces in hopes of staving off surgery. Fusion significantly shortens a younger child's spine, Akbarnia says, but after growth stops in the late teens, it can be used without affecting growth.
Enter the new techniques:
n Like small drapery rods that lengthen with the turn of a screw, growing rods are placed on either side of a young child's spine to force the curve to straighten. Twice a year, doctors make a small incision in the child's back to turn screws holding them in place, allowing for spinal growth.
Studies tracking 275 children for two years or longer suggest the rods straighten as well as fusion but allow the spine and rib cage to grow.
Now the quest is to lengthen the rods noninvasively. In one closely watched attempt, Arkansas doctors are testing self-lengthening screws to hold the rods in place.
n For children who need braces, staples may offer an alternative. Inserted through small incisions into the outer side of the spine's curve, the staples exert pressure to make the concave side grow faster. That flattens the curve and prevents worsening, explains D'Andrea.
"It's a godsend for the children who otherwise would be wearing a brace for 10 years of their life," says D'Andrea, who has put staples into patients as young as 3.
Earlier attempts failed because staples made of inflexible stainless steel snapped with movement. Today's staples are made of nitinol, a metal flexible at body temperature; small studies suggest they're safe and stay put.
But the real test — randomly assigning patients to braces or staples to prove which works best — hasn't yet been done, so insurance seldom covers the staples. D'Andrea hopes to begin such a study later this year.
Parents should know "you've got to be dedicated," says Jilliene Crawford of Las Vegas, whose son Colin at 21/2 was among the growing rods' early recipients in 2001. "It is a lifelong process."
Now 8, Colin is growing well, his once-severe curve is no longer visible through his shirt, and while rough play is out, he happily runs around the playground.
Still, "there's a lot of commitment to it," Crawford says. Colin fears the twice-yearly trek to San Diego for rod-lengthening, even though physically he's fine the next day.
"I hope to do it for as long as possible to get the most growth out of his back ... so he can have as much normalcy as possible," his mother says.
EDITOR'S NOTE — Lauran Neergaard covers health and medical issues for The Associated Press in Washington.
Copyright 2005 Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.
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