The Children’s Hospital Spine Center
from Practice Update, Spring 2006
The Children’s Hospital Spine Center was created in 1998 to enhance care for pediatric patients with spinal deformities. The Spine Center currently treats over 1,500 non-surgical patients and performs over 150 spine operations each year. The Center treats newborns to high school age patients. Conditions range from idiopathic scoliosis and kyphosis to complex cases including congenital spine deformities and spine trauma. The Spine Center also treats patients with neuromuscular scoliosis including cerebral palsy, spina bifida, muscular dystrophy and spinal cord injuries.
The Medical Director of the Spine Center is Mark Erickson, MD, Chairman of Orthopedic Surgery. Physicians from the orthopedics department at Children’s, as well as orthopedic surgeons from the community, utilize the services provided by the Spine Center and often team together in caring for this challenging and complex patient population. Elise Benefield, RN, and Jennifer Hawley, RN, are the spine nurse clinicians. Physician Assistant, Ryan Ballard works with Dr. Erickson in following and treating his patients. The program collaborates with Rehabilitation Medicine to provide a complete continuum of care.
Non-Surgical Treatment
Non-surgical procedures are the most often prescribed intervention for patients treated in the Spine Center . Infantile forms of scoliosis are treated by a series of casts. If caught early enough (less than two years old) many can be cured with casting alone, eliminating the need for surgery. In the school-age and adolescent population, bracing is used in an effort to slow the progression of scoliosis, hopefully diminishing the need for surgical intervention.
In 2003, a Children’s Hospital parent initiated a support program for younger children who wear braces to treat their scoliosis. The program meets regularly to share field trips and activities, bringing together young patients and their families. A dozen kids and family members actively participate.
Surgical Treatment
The surgical procedures performed at Children’s are based on the most current research and utilize the most advanced technology. The type of surgery performed is based on the child’s age, type and severity of their deformity and any underlying medical conditions.
The most common procedures performed are anterior and posterior spine fusions. Growing rod implants may be used in younger patients delaying definitive fusion until more of their growth is completed.
We anticipate beginning to perform the VEPTR (Vertical Expandable Prosthetic Titanium Rib) procedure in July, 2006. This is used for patients with Thoracic Insufficiency Syndrome.
Preoperative Spine Class
The preoperative spine class enhances the continuum of care through work with patients and families, better preparing them for surgery and the recovery period. The classes are designed for healthy, school-age and adolescent patients scheduled for surgery in the next several weeks.
The class is taught by a multidisciplinary team who is involved in the postoperative care of the patient. The highlight of the class is a former patient coming back and sharing their experience. “The preoperative spine class has increased patient and parent knowledge resulting in improved outcomes and decreased length of stay,” Erickson said.
High-Risk Spine Pathway
About 20 percent of the surgeries performed by the Spine Center are high-risk cases. These patients’ conditions are complicated by diseases such as cerebral palsy, spina bifida and muscle disease. To address the needs of these medically fragile children, the high-risk pathway was implemented. Since implementation, the length of stay for these high-risk kids has decreased by 49 percent. Time in intensive care has also been substantially reduced. A multidisciplinary team, including the orthopedic surgeon, spine nurse, respiratory therapist, dietician, physical therapist, social worker and consults from pediatric specialists at The Children’s Hospital, provide for enhanced coordination of care throughout the patient’s treatment and family satisfaction.
Outcomes
The orthopedic attending physicians meet weekly to present pre and postoperative cases. This type of review and collaboration, along with the dedicated team of nurses and mid-level providers, has provided the continuity necessary to provide quality care to our patients.
Research
The Children’s Hospital and the Department of orthopedics has recognized the importance of our expanding research program and formed the Musculoskeletal Research Center (MRC). The MRC will be dedicated to helping improve clinical outcomes, find new cures and test new technologies. Currently, Dr. Erickson represents Children’s on the Spinal Deformity Study Group (SDSG), an international coalition of 50 centers focused on the development of multi-center studies which will advance surgical technique, education and patient care. The Children’s Hospital is participating in two prospective studies with the SDSG and is actively involved in the development of a third protocol. The current prospective studies are on idiopathic scoliosis and kyphosis. The third protocol is on early onset scoliosis.
Contact the Spine Center
Referrals can be made through orthopedic scheduling at (720) 777-6600.
