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Surgery Has Improved for Scoliosis Treatment

July 30, 2001|SOLANA PYNE | NEWSDAY

Liken many mothers, Nancy Weiss is full of praise for her 16-year-old daughter, Kimberly. The Port Washington, N.Y., mother commends Kimberly's writing ability and her quick wit, but she really raves about Kimberly's long, flat back.

Thirty-nine years ago, at Kimberly's age, Nancy spent a year in bed recovering from surgery with a cast that stretched from chest to hips. Nancy had scoliosis, a condition in which the spine curves sideways and twists, rotating the rib cage so that the flat part, which normally makes up the back, shifts to the side and a curved side shifts toward the back, creating a hump in more severe cases.

The surgery straightened her spine--it no longer curved like a C across her back--but the hump remained, along with a long thick scar down the center of her back.

Kimberly also had scoliosis. About 20% of children of those with scoliosis will develop it, although in most cases no one knows what causes scoliosis or how it might be inherited.

Just three months ago, Kimberly's spine was curved, her back humped and she was in constant pain. The pain became so intense she had to stop running track, her favorite sport. "When I ran," she said, "I could feel my ribs going into my lungs." On May 21, she underwent an 11-hour surgery to correct the condition.

Kimberly has no cast, and her only scars are 1 inch long and hidden under her arm. She wears a brace when in the car or in other places where her back might get jostled, but she'll no longer need the brace by the time she goes back to Roslyn High School.

The difference between Nancy's experience and Kimberly's is a striking demonstration of progress in medicine. Nancy was diagnosed with scoliosis in 1962. She went into surgery soon after.

Surgeons cut into her back, making a long incision down the middle. They straightened her spine and scraped between the vertebrae to encourage the bone to grow and fuse the vertebrae, immobilizing the spine. A bone from a cadaver was attached to her spine, a standard procedure at the time, to keep it straight while her own bone grew.

Her cast prevented movement while the vertebrae fused, a process that took about a year. Although it straightened her spine, the surgery left her rib cage twisted and her back humped.

"I got a good medical result but not a good cosmetic result," Nancy said. "It was a terribly horrible surgery to just have a medical result."

Kimberly was diagnosed with scoliosis in the sixth grade, during mandatory school testing for scoliosis. She wore a brace for 12 hours each night for the next four years to try to prevent her spine from curving more.

After the trauma of her own surgery, Nancy prayed her daughter wouldn't suffer the same fate. "I felt terribly guilty," she said. "Surgery is really the scariest thing you think about for your child. You pray the brace will work and think, God forbid my child should have to have surgery." But the brace failed, and doctors determined Kimberly's spine had curved far enough for surgery.

The severity of a spinal curve is measured in degrees. In most circumstances, surgeons won't operate until the curve passes 40 degrees. Kimberly's curve was 16 degrees when she was diagnosed and 51 degrees when they operated.

Modern surgeries use metal rods to straighten both the sideways curve of the spine and the twisting of the rib cage, but many are still done through a long incision in the patient's back. Some very severe cases require the surgeons to get at the spine through the front of the body, which is more difficult but gets the best results.

Kimberly and her mother went to Dr. Baron Lonner of Scoliosis Associates in the Bronx. He proposed a new surgery. Rather than cutting in through her back, Lonner entered Kimberly's chest through several small incisions beneath her arm. He deflated a lung to get a better view of the spine and inserted a camera and various surgical tools through the incisions. Lonner removed disks, tire-shaped cushions between vertebrae, along the curve.

He grafted bone chipped from Kimberly's ribs into the gaps between the vertebrae, and then attached screws to each vertebra along the curve. He slipped in a long rod that he attached to the screws. Finally, Lonner compressed and straightened the spine. The rod now holds Kimberly's spine straight while the grafts grow to fuse the vertebrae, eventually locking the straight spine into place.

Kimberly's surgery, called thoracoscopic surgery, gets cosmetically better results, with less scarring than surgeries that enter through the front or back. In the surgery, doctors work on the front of the spine, which allows them more maneuverability and allows a better correction than a surgery through the back.

"The more I see our results, the more I like the operation," Lonner said. Patients lose less blood and often don't need a transfusion. The recovery just after surgery is faster, patients are off pain medication sooner, and they regain mobility more quickly.

Thoracoscopic surgery works only for younger patients with still-flexible spines; of those, only about half have curves that can be straightened with the surgery.

In a year, after Kimberly's spine has completely fused, she will be able to start running, and her doctor says her back will be as flexible and strong as any other teenager's.

Waiting for the surgery to finish was tough, Nancy said, but when she saw her daughter try to sit up, it was all worth it. "When she put her legs on the side of the bed to get up, and I saw her back was perfectly straight," Nancy shakes her head and smiles. "That was totally miraculous."

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