Early diagnosis and treatment are crucial to mitigate the potentially significant long-term effects of spinal curvature in infants, toddlers and young, school-aged children. The more growth that lies ahead for a child, the greater the risk that the spinal deformity will worsen, potentially leading to thoracic insufficiency syndrome, according to David Bumpass, M.D., orthopedic surgeon at Arkansas Children’s Hospital and associate professor of orthopedic surgery and neurosurgery at the University of Arkansas for Medical Sciences (UAMS).
"In severe cases of early onset scoliosis, the concern is that there would, potentially, be a limitation of lifespan," Dr. Bumpass said. "Secondarily, severe spinal deformity is going to have significant implications on lifetime function, appearance, and the ability to pursue a vocation of the patient's choice and be a productive member of society. We want to help these children have as much motion in their back as possible and as much growth as they can achieve."
To do that, Arkansas Children’s Hospital orthopedic surgeons, in partnership with colleagues in neurosurgery, use a spectrum of treatments ranging from conservative to surgical.
“The treatment of early onset scoliosis is complex,” said Richard McCarthy, M.D., orthopedic surgeon at Arkansas Children’s Hospital and professor in the Department of Orthopedics and Neurosurgery at UAMS. “Because of the varied diagnoses that we care for, the treating physician has to have, as I tell our residents, many arrows in their quiver so they can tailor the treatment to the needs of the child. As a consequence, at Arkansas Children’s Hospital, we use all of the devices that are available at different times of the child’s life to fit the treatment to his or her needs.”
In some cases, a waterproof cast for infants or a brace for older children is effective at controlling or halting scoliosis progression. In other cases, however, the spinal curvature may continue to worsen, necessitating surgical intervention.
"Decisions to operate require a tremendous amount of expertise and experience, and we have both at Arkansas Children's Hospital," Dr. Bumpass said. "We use current, leading-edge surgical techniques, including magnetically controlled growing rods, limited spinal fusion, vertebral resection and the Shilla technique."
Multidisciplinary expertise and a commitment to being in the vanguard of surgical evolution underpin successful scoliosis management at Arkansas Children’s.
"We have an excellent record of neurological safety for these procedures, based on national data," Dr. Bumpass said. "The complexity and severity of what we're addressing at Arkansas Children's Hospital isn't surpassed elsewhere."
One of the pivotal moments in the history of early onset scoliosis care at Arkansas Children's Hospital occurred in 2004, when Dr. McCarthy performed the first Shilla procedure. The surgery was the culmination of Dr. McCarthy's effort to develop an effective alternative to the traditional growing rod, which required additional surgeries at regular intervals to lengthen the device.
Dr. McCarthy was inspired to invent the Shilla technique, which corrects spinal curvature during natural growth using rods loosely attached to the spine with pedicle screws, after observing a South Korean surgeon’s unique method of treating scoliosis with the screws.
"I'd been trying to figure out a better way of treating children with early onset scoliosis, but the surgeon I spent time with in South Korea didn't treat these patients," Dr. McCarthy said. "However, watching some of his techniques with pedicle screws inspired me to come up with an idea for a new technique, which I decided to call the Shilla after the hotel where I was staying in Seoul."
With Shilla, the rods can remain in place for years as the child grows without requiring lengthening surgeries. The medical technology company Medtronic developed Dr. McCarthy's idea, and the Shilla Growth Guidance System received FDA approval in 2014. Dr. McCarthy estimates he's treated 150 to 160 patients representing every type of early onset scoliosis with the Shilla technique.
"The goal in the treatment of early onset scoliosis is to get patients into adolescence where a sufficient amount of growth has occurred in the spine to allow for the natural growth of the internal organs," Dr. McCarthy said. "With the Shilla device, in long-term follow up, we've seen these children grow into adolescence and go on into adulthood, and what we've done at the completion of their growth is remove the growing rod. In most cases, we put in a permanent fusion rod that stays with them for the rest of their life."
A second iteration of the Shilla device is now in the works.
For Dr. Bumpass, his colleague's invention of the Shilla technique is a prime example of a commitment to innovate in pursuit of better care for children with early onset scoliosis. That commitment continues with Arkansas Children's Hospital's membership in several study groups comprised of high-volume early onset scoliosis surgery centers.
"We're part of a multicenter, prospective study looking at how best to treat congenital scoliosis, which is scoliosis due to vertebral malformations that occur in utero," Dr. Bumpass said. "It's one of the most challenging conditions we treat, with some of the most unanswered questions in terms of how best to treat these patients."
This effort is just the latest chapter in Arkansas Children’s Hospital’s decades-long quest to help children with early onset scoliosis enjoy longer, more fulfilling lives.