Comprehensive Pediatric Spine Care at Gillette Children’s Specialty Healthcare

By Melissa Moore
Wednesday, March 8, 2017

From managing easily corrected conditions using evidence-based treatment to helping patients who have extremely complex deformities in need of extensive supportive services, the team at Gillette Children’s Specialty Healthcare orthopedics program is equipped to handle a full range of spinal health concerns.

With sixteen orthopedic surgeons, five physicians practicing spine surgery and three surgeons dedicated solely to spinal care, Gillette has one of the nation’s largest groups of fellowship-trained pediatric orthopedic surgeons. Gillette also has four pediatric neurosurgeons that provide additional expertise to spine cases that need neurosurgical assessment and surgical intervention.

“Our overall volume lends us a degree of clinical expertise that isn’t seen in other institutions in the region or the state,” says Tenner Guillaume, MD, spine surgeon at Gillette. “We also invest in technology that increases our patients’ overall safety and experience.”

Spine surgeons at Gillette treat a wide range of conditions including spondylolysis, spondylolisthesis and scoliosis. Physicians also work with patients experiencing other causes of back and neck pain.

“One of the most common reasons why children see a physician is for back pain,” says Walter Truong, MD, pediatric orthopedic and spine surgeon with Gillette. “It’s a common complaint for teenagers who are rapidly growing. Depending on the cause, we have different treatment options available, including working with experienced therapists.”

“Gillette has a long history of excellence in clinical care and research. We see a high volume of patients with pediatric scoliosis deformities, and facilities like ours with higher patient volumes experience lower complication rates. Physicians also turn to us to care for complicated patients, many of whom have high-risk issues such as neurological injury or infection, or a problem related to another medical condition. When you take care of the most complicated cases on a regular basis, you become more prepared to handle mild spinal curvatures and the care of children who are otherwise healthy.”
— Walter Truong, MD, pediatric orthopedic and spine surgeon with Gillette Children’s Specialty Healthcare

Ahead of the Curve

Gillette is the regional leader in scoliosis care and its experts manage a large volume of patients experiencing abnormal lateral spine curvature, indicative of scoliosis, including idiopathic, congenital and neuromuscular scoliosis. Idiopathic scoliosis accounts for 80 to 85 percent of all scoliosis cases — as many as four out of every 100 adolescents are affected by it. Congenital scoliosis is defined as curvatures caused by abnormally formed bones in the spine that develop in the womb and are present at birth. Unbalanced growth then causes an increase in the curve sizes during spinal growth. Gillette specialists also manage patients with neuromuscular scoliosis, defined as a curvature of the spine that is secondary to conditions that cause abnormalities in muscles or nerves. Spina bifida, cerebral palsy, muscular dystrophies, spinal muscular atrophy, Friedreich’s ataxia and traumatic paralysis can all lead to neuromuscular scoliosis. Scoliosis typically presents between the ages of 10 and 18. However, it is possible for the condition to present earlier. Infantile scoliosis occurs in children age 3 and younger, and juvenile scoliosis affects children between ages 3 and 10. Although infantile and juvenile scoliosis are less common, they represent some of the most challenging cases. Gillette is fully equipped with the technology and techniques necessary to treat children in these age groups.

Building on Bracing

Bracing is the first treatment option for most children with scoliosis, particularly for skeletally immature children with moderate spinal curves. Though braces rarely correct curvature, they can prevent it from worsening. Gillette offers orthotics in-house from experienced orthotists who have often worked for decades in the field.

For children with idiopathic scoliosis, bracing is a treatment option when the spinal curvature is between 25 and 40 degrees. Gillette specialists fit patients with a modified version of the Boston Brace. Orthotists customize braces to fit patients’ specific anatomy and needs, allowing the brace to affect both translational and rotational forces on the spine. Gillette providers keep a close eye on the latest research and developments in spinal deformity care, ensuring their patients have access to the leading-edge technology and evidence-based care for improved outcomes. This includes altering bracing directions — instructing children to wear their braces for 18 hours a day — a practice that improves compliance without compromising outcomes. Effective bracing allows the majority of patients to avoid surgery. Children with neuromuscular scoliosis often face challenges with bracing, as they may be confined to a wheelchair due to the neuromuscular condition. In these cases, special considerations are taken by Gillette experts to accommodate mobility and comfort while still providing spinal stabilization and treatment.

“It can be difficult to sit up in a wheelchair when curvature is so extreme that patients have difficulty holding their heads straight and their ribs are pressed against their pelvic bones,” Dr. Truong says. “Seating systems have to be adjusted to balance patients in the wheelchair so they can be comfortable without developing pressure sores and skin issues, while also enabling them to sit upright so they can eat, look up and interact with their families. For patients who spend that much time in a wheelchair, it’s so important that the brace fit is correct and comfortable for them.”

“Treating a child’s spine is different from treating an adult spine. On a basic level, these patients are at very different stages in life. A child treated in a children’s hospital has access to staff and physicians trained to deal with the specific medical needs of pediatric patients. I can speak with parents about what their child’s experience will be like, connect patients with each other and refer patients to local organizations that provide support for these families.”
— Tenner Guillaume, MD, staff spine surgeon at Gillette Children’s Specialty Healthcare

An Individualized Approach to Surgery

For severe idiopathic scoliosis, the primary surgical treatment option is spinal fusion.

According to Dr. Guillaume, outcomes for selective fusions at Gillette are routinely positive, and the program goal is to take patients through the procedure and get them back to their previous level of activity and functionality.

“When we do a fusion, we have to be selective about which portions of the spine we fuse,” Dr. Guillaume says. “We want to fix problematic curves and not compensatory curves. One of our driving objectives is to fuse as little as necessary to achieve the outcomes we want.”

Also, a variety of innovative treatment solutions are available at Gillette for patients with an immature skeleton who have large magnitude, progressive scoliosis for whom bracing is not effective. Rods can be implanted to serve as an internal brace to control the spinal curve while still leaving room for the child to grow. Gillette is a national leader in the utilization of magnetically driven growing rods, a system which can be adjusted in an outpatient clinical setting to account for growth. The group’s physicians also have experience with vertical expandable prosthetic titanium rib surgery for rare cases of scoliosis that cause thoracic insufficiency syndrome. For patients with neuromuscular scoliosis, spinal fusion can provide a drastic change in quality of life.

“I recently had a patient who could not sit upright in a wheelchair for more than 20 minutes because it became too painful,” Dr. Truong says. “It was difficult for the patient to eat, be interactive and maintain lung function. After the surgery, the patient was able to sit up all day and use the wheelchair normally. The pain from the rib pushing on the pelvis was gone. When you can relieve pain so that someone can sit up and be more independent, it can make a huge difference for the family.”

When to Seek Specialty Care

“Physicians direct children to us whose spinal curves have progressed past a certain point and are at risk of affecting their lives negatively,” Dr. Truong says. “There are times when physicians feel comfortable managing scoliosis themselves, but if not, they send a child to us once the curve gets larger than 10 degrees. We typically step in to assist orthopedic and spine surgeons with their more complex cases, such as those secondary to neuromuscular conditions or neurologic problems. Managing these more complicated patients is where we excel, and we are happy to work with referring physicians to ensure patient cases are managed in the best manner possible.”

The more complex and severe a spinal issue is, the higher the potential risk of complications. By providing readily available access to specialty care, Gillette helps ensure patients receive the care they need as soon as possible.

“Our care model makes collaboration simple,” says Dr. Guillaume. “If I’m concerned about a patient’s pulmonary function, I can bring a pulmonologist in to look at the patient. If I have a patient with restrictive lung disease or shortness of breath, I can call in a respiratory therapist for a consultation. We also work frequently with neurosurgeons and neurologists to manage patient care.”

In addition to neurologists, managing patients with spinal conditions often requires collaboration with other specialists, assistive technology, pediatric intensive care, radiology, physiatrists and physical therapy—all services that are available at Gillette. Coordination of care is one of the reasons why Gillette is able to provide a high level of spinal surgery service and maintain a high level of success.

“Many places that offer scoliosis surgery are reluctant to accept cases of children with complicated problems because they don’t have the resources on-site to respond to a crisis or don’t have a pediatric intensive care unit that can take care of anything that comes through the door,” Dr. Truong says. “Here, we not only have all the subspecialties we need to support the surgical procedure, but if there is an unforeseen problem or specific surgical consideration related to the patient’s case, we have access to that care through our team as well.”

A Tradition of Innovation

Although the program at Gillette is set apart by new technology and treatments, this high level of care comes from a long line of innovative approaches to spine and scoliosis care. John Moe, MD, was the first president of the Scoliosis Research Society, the most influential and prestigious society for spinal deformity care. He cared for his patients at Gillette, and the hospital has been home to three different presidents of the society in its 50-year history.

“Since our founding 120 years ago, Gillette has had a reputation for being a spine center of excellence,” Dr. Guillaume says. “We not only have the technology and ability necessary to manage complex spine cases, but we have institutional knowledge collected over decades that positively influences the outcomes of our patients.”

Gillette continues its tradition of improving patient safety and care by providing unique approaches to spine and scoliosis care. This includes an EOS X-ray imaging system that uses lower doses of radiation—children receive 15 times less radiation than with a traditional X-ray. Advanced printing technology is used to create 3-D models of spines that allow surgeons to plan the surgical approach and anticipate any potential concerns.

“Pediatric spine care is part of our history and the foundation of the hospital,” Dr. Truong says. “The more complex the spinal problem, the more you need expertise in that area. Complex spine care for children is not just a minor goal for us at Gillette — it’s a major mission. That’s why we treat the most cases in the region, and why we’ll continue to do so.”

To refer a patient to Gillette for pediatric spine care, call 651-325-2200.