Challenging Orthopedic Conditions: Caring for a Growing Need

Care for spinal deformities and other challenging orthopedic conditions requires specialized training and benefits from a multidisciplinary approach. As the team of orthopedic and spinal specialists at Arkansas Children's has grown, so has the number of complex orthopedic cases that present. 

"Arkansas Children's Hospital has provided expert care for challenging orthopedic conditions for years," said Matthew Landrum, M.D., board-certified pediatric orthopedic surgeon at Arkansas Children's Hospital. "However, there are only 24 hours in a day, and a single surgeon can only do so much. By spreading the caseload between multiple specialists, the number of pediatric patients we can serve has significantly increased." 
 

Improved Treatment Increases the Need 

While new surgeons increased the program's capacity for complex orthopedic patients, the caseload grew courtesy of medical advances, particularly in the care of spinal muscular atrophy (SMA). Only a few years ago, lung and muscle issues related to SMA resulted in premature death, negating the need for pediatric orthopedic care. With the advent of new neuromuscular medications, such as Spinraza, life expectancy for those with SMA increased drastically, and new medications in development promise even greater outcomes. 

Due to this improvement, orthopedic specialists were suddenly tasked with identifying potential orthopedic issues stemming from SMA and determining the best way to manage these issues. As patients with SMA aged, other comorbidities presented additional unique complications requiring the team to develop new individualized treatments. 

"Innovation is necessary to address patient needs, and there is no cookie-cutter solution for this population," Dr. Landrum said. "We take established principles and build on them, which our team does exceptionally well." 

Continuing to Innovate 

Such innovation requires Arkansas Children's Hospital specialists to participate in research for congenital scoliosis, adolescent idiopathic scoliosis, neuromuscular and syndromic scoliosis, and more. Such research led Arkansas Children's Hospital orthopedic surgeon Richard McCarthy, M.D., to pioneer the Shilla procedure, a landmark in scoliosis care that permits spinal growth, manages deformity and limits surgical intervention.  

Additionally, orthopedic team members remain eager to learn from other experts. As part of multiple research programs, including the Scoliosis Research Society and Pediatric Spine Study Group, they share new findings and learn approaches that may serve future patients well. They also use their knowledge to comfort and educate anxious family members. 

"Parents play an integral part in the success of their children's treatment, so we take a whole-family approach," Dr. Landrum said. "We're here to better the lives of children who have challenging conditions, and we meet this goal with buy-in from referring physicians and parents and input from our multidisciplinary team." 

Who Carries the Load 

Five surgeons care for complex orthopedic needs at Arkansas Children's Hospital. Two provide surgical intervention for adolescent idiopathic scoliosis, and three care for congenital and early-onset spinal muscular atrophy (SMA). Together, these surgeons perform one or more complex spinal surgeries each week.  

Before deciding on a treatment plan, the team meets with everyone involved in the patient's care - pediatric anesthesiologists, pulmonologists, cardiologists and others. This meeting ensures the entire team understands the child's overall health and reduces the likelihood of unforeseen events occurring during and after surgery. It also provides a mechanism to ensure patient optimization before surgery and that all potential solutions receive appropriate consideration. 

"Because we all have unique backgrounds and training, we come at problems with disparate philosophies and approaches," said Matthew Landrum, M.D., board-certified pediatric orthopedic surgeon at Arkansas Children's Hospital. "We use these varied perspectives to develop a treatment approach that is appropriate for every individual patient." 

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