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Common Spine Conditions We Treat
Children’s Orthopaedics utilizes the most advanced technology available to treat kyphosis, including minimally invasive surgical techniques and computerized intraoperative navigation. Our practice is affiliated with Johns Hopkins All Children's Hospital and has repeatedly been recognized as Top Ranked Pediatric Orthopedic Care in Tampa Bay. Our two fellowship–trained spine specialists, Dr. Jeffrey Neustadt, Dr. Gregory Hahn and Dr. T. Cooper Wilson, perform over 120 kyphosis procedures each year. Combined, they have over 30 years experience performing kyphosis surgery.
Additionally, our orthopaedic support team consists of knowledgeable professionals who assist our specialists in each step of the procedure, including pediatric nurses and patient care technicians with orthopaedic training, neuro–technologists, fellowship–trained pediatric radiologists, and pediatric anesthesiologists. Kyphosis treatment is often an ongoing process, and our goal is to provide the support and care that your child needs every step of the way.
What is Kyphosis?
The human spine features several natural curvatures which help our bodies move and remain balanced. The thoracic spine has some degree of a rounded curvature. Kyphosis is an abnormally rounded back. It is a condition that may affect children, teenagers and adults.
The doctor will ask your child to bend forward, to reveal any spinal deformities. This is called the “Adam's forward bend test.”
- The cause for Scheuermann’s Kyphosis is unknown. It may be caused by abnormal growth of the vertebra in which the front part stops growing before the back part does. This growth abnormality causes wedge–shaped vertebral bodies, which create an abnormally rounded thoracic spine. It typically progresses during puberty.
- Kyphosis may also be caused by vertebral compression fractures (due to tumors or weak bone) or degenerative bone conditions, such as arthritis.
Understanding your spine and how it works can help you understand kyphosis.
The spine is made up of small bones, called vertebrae, which are stacked on top of one another. Muscles, ligaments, nerves, and intervetrebal disks are additional parts of the spine.
- These bones connect to create a canal that protects the spinal cord. The spinal column is made up of three sections that create three natural curves in the back: the curves of the neck area (cervical), chest area (thoracic), and lower back (lumbar). The lower section of the spine (sacrum and coccyx) is made up of vertebrae that are fused together.
- Five lumbar vertebrae connect the twelve thoracic vertebra to the pelvis.
Types of Kyphosis
Congenital Kyphosis occurs when the spinal column does not develop properly while the fetus is still in the womb. The vertebrae do not properly form as they should, or some vertebrae may be fused together. The spinal cord may be at risk of injury with congenital kyphosis. Surgery is frequently necessary.
Postural Kyphosis is the most common type of kyphosis. It becomes noticeable during adolescence, is more common among females than males, and rarely causes pain. It is a non-surgical problem.
Scheuermann’s Kyphosis is the most common type of kyphosis often requiring surgery. Boys are affected more often than are girls. The upper back gradually appears more rounded, and there may be accompanying back pain that worsens during the day and is relieved with rest. Pain, if present, is typically felt at the most curved point of the spine and can be aggravated by activity or prolonged periods of sitting or standing. Low back pain also frequently develops.
The distinguishing factor between postural kyphosis and Scheuermann’s kyphosis on physical examination is rigidity of the spine.
Do you have Kyphosis?
If your child has kyphosis, it is important to seek treatment. Without treatment, kyphosis can progress, causing functional issues and lower quality of life over time. There are different treatment options available, depending on the severity of your child's kyphosis. Your physician will suggest the best treatment option for your child. Treatment options can include the following:
Continually observing a small curve to check for progression as the child or adolescent grows.
Bracing may be recommended to prevent the curve from getting worse. Advances in orthotics and prosthetics have led to much more comfortable and lighter weight polypropylene plastic. Unfortunately, to date, no brace has been shown to actually improve kyphosis. That desired outcome is only available via surgical treatment.
The surgical treatment for Scheuermann’s Kyphosis is usually reserved for curves that have progressed beyond 65 degrees. If left untreated, continued progression of these curves may lead to chronic, severe, pain, deformity, psychosocial disability and pulmonary dysfunction.
Congenital kyphosis also often requires operative treatment, usually to protect the spinal cord from injury or relieve it from pressure created by the congenital spinal deformity.
Surgical Procedures for Kyphosis
When surgery is indicated, our fellowship–trained pediatric orthopaedic surgeons offer the most advanced and proven techniques in reconstructive spinal surgery.
The surgical procedure used to correct kyphosis is called a spinal fusion. During this procedure, the surgeon will realign the bones in the spine and fuse them together using a bone graft so that they heal together into a solid piece of bone. Bone grafts may be taken from the patient's hip, or an allograft may be taken from cadaver bone.
Our surgeons use different devices and technologies during the procedure, including pedicle screws, growing rods, and intra–operative image guidance.
Pedicle screws are used to anchor the correcting rods to the spine to prevent further movement while the spine is being fused with bone grafts. The screws are used to correct rotation as well as to treat deformity in the coronal and sagittal planes. The pedicle screws can be placed at multiple levels throughout the spine depending on the severity of the curve. The rods are then connected to the pedicle screws.
Growing rods are used to stabilize the spine in very young children with severe kyphosis, sometimes called Early Onset Kyphosis. The rods are placed through the muscles around spine spanning the curve and are usually attached with screws. Growing rods allow for continued, controlled growth of the spine in juvenile patients with kyphosis. The rods are then lengthened on a regular basis, approximately every 6 to 12 months.
Cutting Edge Technology
Our operating room has been specially–outfitted with advanced imaging technology and specialized instrumentation to accommodate all of our orthopaedic surgical procedures.
CT–based, intra-operative image guidance allows the surgeon to navigate the spine using “smart tools.” The data from a CT scan of the spine taken before the operation is used to plan the procedure, including selecting the correct screw size and placement. These images are merged with real–time images of the spine during the procedure so that the surgeon has accurate reference points on where to place fixation devices.
This technology facilitates rapid and accurate placement of pedicle screws—there is virtually no chance of inaccurate placement. It also allows for more precise sizing of the screws within the pedicles and the vertebral body by allowing your surgeon to measure the pedicle and select the correct size. This reduces the chances of loosening or having the screws stick out from the bone.
Dr. Neustadt and Dr. Hahn use this technology very often in kyphosis surgery. Surgeons from around the world visit them at Johns Hopkins All Children's Hospital to learn about these cutting-edge techniques.
Monitoring Nerve Function in Surgery
Intra–operative neurophysiological monitoring helps protect your child from neurologic damage like paralysis. The goal of such monitoring is to identify changes in brain, spinal cord, and peripheral nerve function before irreversible changes occur. Motor and sensory monitoring of the spinal cord is conducted with every kyphosis procedure our surgeons perform in order to complete the case safely and efficiently.
Recovering from Kyphosis Surgery
After surgery, your child will need to stay in the hospital for about a week. Following discharge from the hospital, your child will need to recover at home for about 3 weeks, on average. If school is in session, you may want to arrange for about 3–6 weeks of homeschooling with your child's school.
During the recovery period, your child will need to avoid running, bending, and twisting at the waist. Your child must also avoid lifting anything heavier than 5 pounds. Full recovery can take from 6 months to 1 year, as the bones must achieve a solid fusion. After full recovery, your child can resume all normal activities, except for contact sports.
After kyphosis surgery, most patients will be able to function normally at the level they were prior to surgery. In most cases, additional procedures are not needed.