Caring for Children With Spine Congenital Anomalies

An estimated 0.5-1 out of 1,000 children are born with spine congenital anomalies. These anomalies range in severity, with some children experiencing life-altering paralysis and others living with asymptomatic conditions that go undiagnosed through the duration of their pediatric years. Thanks to long-established standardization of folic acid supplementation during pregnancy, fewer children are born with spina bifida. However, other spine anomalies have become more common as patients with once-fatal congenital conditions live long enough to develop related conditions, such as scoliosis. 

"New treatments for spinal muscular atrophy (SMA) have allowed patients to live longer," said Matthew Landrum, M.D., board-certified pediatric orthopedic surgeon at Arkansas Children's. "Eventually, many of these young patients present with scoliosis. So, while we've seen a decrease in one pathology, we've seen an increase in another. The age of presentation has simply changed." 


Care for Complex Conditions  

At Arkansas Children's Hospital, a well-rounded team of orthopedic experts works to detect, treat and manage these conditions, regardless of the age of presentation. Team members see congenital, neuromuscular and syndromic patients across Arkansas and beyond. 

Of the more common congenital spine conditions, spina bifida occulta is a regular diagnosis, and idiopathic scoliosis is the most common condition managed. As with other congenital conditions, spinal anomaly care management benefits from a multidisciplinary team. Pediatric specialists who may engage in a patient's care include: 

  • Anesthesiologists
  • Cardiologists 
  • Neonatal intensive care unit physicians 
  • Pulmonologists 

Treatment Starts Before Birth

When a child receives a spine-related diagnosis in utero, the orthopedic team at Arkansas Children's Hospital offers prenatal orthopedic consultations. The multidisciplinary care teams coordinate treatment with neonatologists and other specialists before birth and evaluate children soon after birth, moving them seamlessly to the care and management they need. Due to this exceptional care, Arkansas Children's Hospital attracts high volumes of patients with skeletal anomalies, skeletal dysplasia, congenital spasticity or cerebral palsy, spinal anomalies and other concerns involving the health of the musculoskeletal system. 
This whole-patient care model is nationally recognized. Arkansas Children's Hospital is one of just 12 Cure SMA centers in the United States and one of the few Duchenne Care Centers in the Southeast. 

 

Low-Dose Imaging for Long-Term Monitoring

Children with spine congenital anomalies often require multiple X-rays each year to permit the care team to observe pathology progression in the spine or legs. However, repeat radiation exposure poses a danger for children, who are more sensitive than adults to ionizing radiation - that is, their risk of cancer per unit of exposure is greater. Radiation doses delivered by equipment designed for adults may also be excessive for children.  

To minimize radiation exposure and increase safety for young patients, Arkansas Children's Hospital houses an EOS Imaging System. With EOS, children undergo X-ray examinations with less than half the radiation exposure of a traditional X-ray. Full-spine and lower extremity images procured through EOS are also accurate, allowing for head-to-toe measurements and three-dimensional modeling. The images aid in diagnosis, preoperative planning and templating in preparation for spine and hip procedures.  

"This is a fantastic imaging technology that exposes children to extremely low radiation doses," Dr. Landrum said. "The cube-shaped form allows us to take weight-bearing two- and three-dimensional images of children as they stand in the machine. It allows us to capture needed images in a short amount of time, with minimal stress on our young patients." 


Expanding the Team

The innovative orthopedic approaches at Arkansas Children's Hospital continue to attract new talent. Dr. Landrum, for example, came to Arkansas Children's on June 1, 2023, drawn by what he describes as the team members' reputation for excellence.

Related Content