From adolescent idiopathic scoliosis to more complex early onset cases, Gillette Children’s Specialty Healthcare is equipped to meet the spine care needs of children and as they age into adulthood.
Gillette has been a pioneer of pediatric spine care for decades. Since the creation of its first scoliosis program in 1947, Gillette continues to be dedicated to finding new treatments for spine conditions and using evidence-based procedures to improve the lives of patients and families.
“Gillette was one of the first scoliosis centers in the country,” says Tenner Guillaume, MD, spine surgeon and Chief of Staff at Gillette. “The hospital has a remarkable history of treating complex spine conditions, which lends us a better understanding of the pathologies we treat when compared to some newer centers.”
Gillette covers the full spectrum of pediatric spine conditions, including congenital spine deformities, Scheuermann’s kyphosis, spondylolysis, spondylolisthesis, and the many forms of scoliosis, including early onset, idiopathic and neuromuscular cases.
“From a medical and spine deformity standpoint, we take care of children with very complicated conditions,” says Walter Truong, MD, pediatric orthopedic surgeon at Gillette. “These children may have neuromuscular spine issues, disabilities from genetic conditions or severe spinal curves.”
Pediatric orthopedic surgeons at Gillette are well equipped to handle complex spine cases from infancy to old age. This is due in large part to their differing backgrounds and training, which complement each other in patient care.
“Three of our six spine surgeons are fellowship-trained in spine surgery, and the other three have subspecialty training in pediatric orthopedics,” Dr. Guillaume says. “This expertise allows us to take the best of what we’ve learned from each other’s training and incorporate it into our own practices.”
Room to Grow
In cases in which surgical intervention is necessary, new technologies and techniques make treatment safer and more convenient for patients.
Some of the more novel treatment methods available at Gillette include MAGnetic Expansion Control (MAGEC) rod surgery and growth modulation of the spine.
“What generally separates pediatrics from adult care is that children are still growing and developing,” Dr. Truong says. “We can make a curved spine very straight, but if we stunt the child’s growth, it can have disastrous effects, such as prohibiting the proper development of the lungs, chest, thorax and heart.”
Growing-rod procedures allow surgeons to correct spine curves without interfering with a child’s growth.
“When children are younger than 10 years old, our concern becomes focused on how their spine curvature will affect their lung development and function,” Dr. Guillaume says. “Technology allows us to connect rods to the areas of the spine above and below the curve and straighten it as much as we can.”
Traditionally, growing-rod procedures required follow-up surgery every six months to adjust the extension and placement of the rods, thus allowing the spine to grow.
Today, MAGEC rods allow physicians at Gillette to adjust growing rods every three months without surgery. Instead, a remote control is used to lengthen rods while maintaining growth and supporting pulmonary development, with no incisions required. This lowers the risks associated with frequent surgery, such as infection and the unknown effects of general anesthesia on children.
In some cases, children may require spinal fusion surgery, which fuses two or more vertebrae. After the surgery is completed, the vertebrae meld into a single, solid bone while healing. This is indicated for children older than 10 years of age with adequate lung development.
The surgical team’s expertise, combined with the knowledge of other specialists throughout Gillette, gives patients access to an array of services not typically found in a single location.
“We have the support services we need to cover a wide spectrum of conditions,” Dr. Guillaume says. “From neurosurgical assistance to rehabilitation to physical therapy to custom orthotics and bracing, we can offer both complex surgical treatments and nonoperative conservative care.”
Conservative care is normally the first option for patients, and surgery is usually not required to treat most scoliosis cases at Gillette.
“Patients may only require observation, counseling and nutrition-related services,” says Daniel Miller, MD, pediatric orthopedic surgeon at Gillette.
Other conservative options for spine conditions include bracing and physical therapy. The specialists responsible for these types of care work in close proximity to surgeons such as Dr. Guillaume, which allows for quick collaboration and communication among the spine care team.
“I always have access to the specialists I need,” Dr. Guillaume says. “Certified orthotics and prosthetics practitioners are in the same clinic with me, and physical therapists are right down the hall.”
Schroth-Based Physical Therapy
Michelle Engberg, DPT, physical therapist II at Gillette, specializes in providing therapy for patients with scoliosis and is one of two physical therapists at Gillette who are trained in the Schroth method of physical therapy. These therapists are certified by the Schroth-Barcelona Institute, which signifies completion of a rigorous nine-day course that includes both written and practical exams.
“Schroth therapy is a method specific to patients with scoliosis. It addresses asymmetry, muscular imbalance, posture and pain,” Engberg says. “Therapists have specialty training in the theories of pathoanatomy and biomechanics, as well as techniques to optimize the position of the spine and mitigate progression factors through breathing techniques, postural reeducation and the integration of optimal posture into daily living activities.”
Whether used on its own or in conjunction with other treatments, physical therapy is a vital component of the spine program at Gillette and can serve multiple purposes.
“The goal of physical therapy is to slow or stop the progression of the curve, whether to prevent the need for braces in smaller curves or surgery in larger curves,” Engberg says. “For patients who are recommended bracing due to growth potential and curve magnitude, therapy can be an excellent complement to the brace intervention but should not replace the recommendation for a brace.”
Patients who are being weaned from their braces are also good candidates for physical therapy, which can help strengthen muscles that have received brace support for years.
Additional physical therapy services offered at Gillette include aquatic therapy, robotic-assisted locomotor training, and inpatient and outpatient rehabilitation for traumatic injuries.
“With the addition of physical therapy to our spine program, we’re able to offer one more tool that can be used to empower patients to be active participants in their health management,” Engberg says.
Custom Orthoses and Bracing
In addition to surgery and physical therapy, Gillette offers a wide range of custom and prefabricated orthoses for spine conditions.
“Scoliosis is the most common spine condition we treat,” says Kristin Smith, CO, LO, certified licensed orthotist at Gillette. “All of our scoliosis braces are customized and fabricated for each patient.”
The design specifications of each orthosis are customized by the orthotist and depend on the form of scoliosis being treated, the type of curve as determined by imaging and physical examination, the age and skeletal maturity of the patient, and the goals of the patient, family and referring physician.
“A typical orthotist practice may see only a handful of patients with scoliosis per year,” Smith says. “By contrast, our department has a dedicated spinal team consisting of seven highly trained orthotists whose practice is made up entirely of spine cases.”
The spine team sees hundreds of these cases every year, further expanding its knowledge and understanding of spine deformities and the complexities that can accompany them.
“The level of spinal bracing expertise at Gillette is rare and unmatched in the region, if not the country,” Smith says.
Hosting assistive technology capabilities on-site allows the physicians at Gillette to collaborate quickly with orthotists while streamlining care for patients. For example, new patients who are prescribed a brace for the first time can typically be seen for molding purposes on the same day as their appointment, instead of waiting days or weeks to be fitted.
“Being on-site allows for open and direct communication with the physician and other allied health providers so that we can create the best treatment plan for each patient,” Smith says. “We’re able to oversee every step of the fabrication process and offer same-day coordinated appointments with both physicians and orthotists, which lets families take less time away from work and school.”
Into the Future
Gillette’s history of excellence hasn’t caused the institution to rest on its laurels. Its research component strives to find new treatments and technologies to improve patient care.
“We’ve had spine surgeons who were real pioneers in this field and active researchers,” says Jennifer Laine, MD, pediatric orthopedic surgeon and Associate Medical Director of Research and Clinical Outcomes at Gillette. “Big names such as John H. Moe, Bob Winter and Jon Lonstein have written landmark papers, and our current spine staff is continuing with that tradition by providing advanced care to children with basic and complex spine deformities.”
Indeed, all spine surgeons at Gillette engage in research, which is critical to the care they provide.
“Our spine team’s mission is to optimize outcomes in the nonoperative and operative care of children with spinal disorders while minimizing discomfort and reducing costs,” Dr. Laine says. “We want to translate our findings to the care and outcomes in our own practice, but we also want to communicate them to other institutions outside of Gillette, so that other patients can benefit from what we know here.”
Current research includes the study of advanced imaging of intervertebral discs in patients with spine deformities, as well as alternative pain management methods for children undergoing surgery.
“We’re looking at alternative methods of addressing pain for operative spine patients, such as the use of virtual reality,” Dr. Laine says. “We are also taking a prospective look at the use of opioids for spine surgery, especially in regard to safety.”
To learn more about how Gillette Children’s Specialty Healthcare is advancing pediatric spine care, visit gilettechildrens.org.