Spine Center’s Mission: Completing the Circle

from The Children's Hospital (TCH) News, March 2004

Like all programs at The Children’s Hospital, the Spine Center has a mission. But the Spine Center’s mission — to complete the circle — is a little bit different.

The circle began in May of 1998, when the Center was formerly established as part of the Department of Orthopedic Surgery.

"We saw spinal deformities and pediatric spinal issues and wanted to focus on improving the care of our patients," said Elise Benefield, RN, BSN, orthopedic spine nurse coordinator for the Center. The Center has a small staff: Benefield, Medical Director Mark Erickson, MD, and staff assistant Heather Ramey.

The Center treats newborns to high-schoolers with diseases such as cerebral palsy, spina bifida, muscular dystrophy, congenital spine deformities, neuromuscular scoliosis and idiopathic scoliosis, the most common form of scoliosis among adolescents.

The 10 surgeons associated with the Spine Center perform 180 spine operations a year, which is more than 80 percent of all pediatric spine surgeries in the Denver metro area. And the number of patients seen for non-surgical treatment is 10 times that number.

Another part of completing the circle is offering the newest and most advanced surgical techniques, said Erickson, who’s been a surgeon at TCH for eight years.

"We’re trying to minimize the levels of the spine we have to fuse and leave more of the spine mobile," he said. "What we’re basically doing is taking a segment of the spine that is deformed and manipulating it into a straight position."

The human spine always fascinated him, Erickson said. He thought for a long time about going into adult spinal surgery, but always loved taking care of kids.

"That made the decision easier," he said. "Working at Children’s was a natural for me."

Robert Eilert, MD, chairman of Orthopedic Surgery, couldn’t agree more.

"Dr. Erickson’s energy and leadership have been key in making the concept of a spine center a success," he said.

Most spine surgeries are done to correct severe scoliosis that bracing, casting and therapy can’t correct. But if the curve of the child’s spine becomes severe, surgery can be the only option.

"A severe curve will twist a child’s spine, making it difficult for him to sit up," Erickson said.

Erickson performs two kinds of spinal surgery — half-day and full-day — depending on the magnitude of the curve in the patient’s spine and the size of the child.

Afterward, a healthy child will spend about four days in the hospital, and a special-needs child will spend seven to 14 days as an inpatient.

Years ago, Benefield said, patients would spend 10 to 22 days in the hospital after surgery and then nine months to a year in a body cast.

"Now, they are up and out of bed the next day and they’re home in four to five days" with no brace, she said.

Those advances are part of the Spine Center’s mission to complete the circle of care — providing the best care and the best technology to their patients.

Another part of the circle is the Center’s Pre-Op Spine Class for healthy idiopathic scoliosis patients, held once or twice a month. The program, which began in June of 2001 to help patients and families prepare for surgery, is attended by three to six families and is followed by a tour of the hospital. A team of Benefield, a physical therapist, a respiratory therapist, an OR nurse, a pain service nurse and a child life specialist prepares patients and families for surgery. Feedback from families regarding the class has been extremely positive. One of the highlights of the class is having a former patient return and share his or her experience.

Another program, The High Risk Pathway, began in June of 2000 and is for kids with cerebral palsy, muscular dystrophy or other disabilities. A different team works with these patients, including Benefield, a respiratory therapist, a physical therapist, a dietitian and a social worker.

The program offers a consistent contact person for families and patients: Benefield. Patients visit with several specialists before their surgeries. Benefield pulls all the information together for the families and answers their questions.

"Elise Benefield has been the glue that has bound the center together," Eilert said.

"Elise keeps in touch with families during their preoperative program and during their stay," Erickson said. "It’s a three-ring circus to get all those specialists together. It’s continuity of care. It’s the No. 1 thing in the Spine Center — or close to it. Families repeatedly comment on this."

Letting these patients and families know what to do before the surgery, what to expect during the surgery and what to expect after discharge has had a big payoff. In four years, the high-risk program has decreased lengths of stay by 40 percent for these complex patients.

"The program decreases costs and increases efficiency," Erickson said.

The next part of the circle — the part that will complete it — is research, Erickson said.

"We need research to improve patient care," he said.

TCH has been asked to participate in several research projects, including an international multi-center pediatric spinal deformity study group.

"We have the clinical arm well-organized," Erickson said, "and the research helps guide our future treatment. We want to make sure what we’re doing is working. If it’s not, we need to change it. That’s what I am talking about with completing the circle."

Although it’s difficult to do research and take care of so many patients, the rewards are well worth it.

"We have a long-term relationship with most of our patients," Erickson said. "We see them and follow them for multiple years. We see them go off to college."