5 Trends Impacting Adolescent Idiopathic Scoliosis Care

Scoliosis Care: As a pediatric spine surgeon at Children’s Hospital Los Angeles, Michael Heffernan, MD, performs nearly 100 spine surgeries a year—and treats many more scoliosis patients with nonsurgical approaches. That includes young people with the most common form of spinal curves: adolescent idiopathic scoliosis.

Dr. Heffernan is one of three Board-certified spine surgeons at CHLA, which is home to the largest children’s spine program on the West Coast and ranked No. 4 in the nation for orthopedic care by U.S. News & World Report. He shares his thoughts on five trends impacting adolescent idiopathic scoliosis care—including enhanced recovery protocols, a new mobile monitoring app, and a growing focus on psychosocial support.

1. Faster recoveries after surgery

“We used to keep kids in bed for an entire day after surgery to let them rest,” Dr. Heffernan says. “Now, we expect them to be up and walking at 9 a.m. the morning after surgery. That really speeds their recovery.”

Children’s Hospital Los Angeles is one of a select number of top centers in the country where patients go home a mere two days after spinal fusion surgery—versus five days at most hospitals. Early mobilization is one of the keys to that rapid recovery, along with a multimodal pain regimen that de-emphasizes narcotic medications.

“At two weeks, when kids come back to the clinic, I expect them to be walking a mile, and more than half aren’t even taking Tylenol anymore,” he adds. “That quick recovery makes a big difference in the patient’s experience. It’s much less of an ordeal than in the past.”

2. An app to monitor curves

Recently, CHLA became one of the first test sites for a new smartphone app that remotely monitors curve progression. The app, from Momentum Health, uses artificial intelligence-driven 3D scanning technology to predict curve progression, based on a 45-second video taken at home. Under the pilot study, the app’s results will be compared with traditional X-rays.

“The goal is to minimize radiation and save families the burden of travel and time off for multiple appointments,” Dr. Heffernan says. “It also allows for more frequent monitoring, which is critical when scoliosis is progressing more rapidly.”

CHLA also minimizes radiation with the EOS system, an advanced 3D X-ray system that uses 90% to 98% less radiation than standard scoliosis imaging.

3. A more limited role for tethering

Approved by the Food and Drug Administration in 2019 as an alternative to spinal fusion surgery, vertebral body tethering (VBT) has so far had mixed results—and carries a 15% to 20% complication rate.

“In contrast, a selective thoracic fusion carries a complication rate that is almost zero, and patients are back to sports and activities very quickly,” he notes. “VBT is not the clear-cut choice based on those numbers, but it can have excellent results in a carefully selected patient.”

Dr. Heffernan adds that tethering has even more potential as a treatment for lumbar curves—a location where flexibility is important—but the tethers are prone to breaking in that region. “As the technology improves, I do think there will be a role for tethering. The key to success will continue to be patient selection.”

4. Spinal navigation for surgeons

Two years ago, CHLA began using a new intraoperative CT imaging system called the O-arm. The system allows surgeons to obtain high-definition 3D images of the spine during surgery and features a navigation system that can guide surgeons when placing pedicle screws.

Although this navigation can be helpful, “freehand” screw placement is still the norm for many surgeries, Dr. Heffernan notes.

“The worse the curve, the less accurate it is, so it’s not suitable for everyone,” he says. “We’ve found it to be particularly helpful when operating on the cervical spine, but those cases are less common.”

5. A focus on psychosocial needs

“As surgeons, we usually make decisions based on whether a curve is going to impact a patient’s health or cause pulmonary issues down the road,” he says. “I think we underestimate the impact that appearance and psychosocial issues have on adolescents with scoliosis.”

At CHLA, a clinical psychologist is embedded in the Jackie and Gene Autry Orthopedic Center and helps support patients who struggle with bracing or the idea of surgery. Another increasingly popular option that can help patients concerned with appearance is a type of physical therapy called the Schroth method.

“Some patients have curves that aren’t large enough for surgery, but they struggle with the asymmetrical way their back and shoulders look,” Dr. Heffernan explains. “These scoliosis-specific exercises can help patients retrain their posture so they look more balanced. Many kids like it.

“It doesn’t replace bracing,” he stresses. “But if it helps adolescents feel better about themselves and their scoliosis, then it’s worth doing. It’s important to support the whole child and family through this process.” Newswise/SP