October 2013 - The Spine Program at The Children’s Hospital of Philadelphia (CHOP) is one of the largest multidisciplinary programs of its kind in the world. Each year, this program provides comprehensive evaluation and treatment to thousands of children from newborns to teens with common and complex spinal deformities, trauma-related spinal conditions, benign and malignant musculoskeletal tumors, genetic cervical spine conditions, and other conditions that affect the spine.

The Spine Program is a cornerstone of CHOP’s Division of Orthopedics, one of the largest and most experienced pediatric orthopedic centers in the United States, ranked among the best in the nation in U.S. News & World Report’s 2013-14 rankings of Best Children’s Hospitals. The program offers an unparalleled depth and breadth of experience, with nine board-certified orthopedic surgeons who offer nearly 250 years of collective experience diagnosing and treating pediatric spine conditions.

“We don’t just offer access to innovative treatments. We have been pivotal in pioneering many of these techniques and have led many key studies in the area of scoliosis and safety in treatment of patients with pediatric spinal deformities,” says division chief and orthopedic surgeon John P. Dormans, MD, FACS. “As a result, our team offers unmatched prowess.”

At CHOP, diagnosis and care of children with spinal deformities begins as early as possible to ensure optimal treatment and outcomes. We employ the full spectrum of diagnostic testing, including EOS imaging, a newly-FDA-approved technology that creates 3-D models while a child is in an upright or standing position. This advanced tool provides better image quality due to weight-bearing positioning and delivers a much lower radiation dose than that of computed radiography X-ray and basic CT scans (see “Imaging” story).

Treatment of each child is handled on a case-by-case basis, taking into account the severity of the spinal condition, where it occurs in the spine, the child’s age and stage of growth, as well as any other related medical issues. Surgical and nonsurgical treatments are available based on a child’s specific condition and needs.

CHOP’s Spine Program surgeons include Dormans; John M. Flynn, MD; David A. Spiegel, MD; Wudbhav N. Sankar, MD; Robert M. Campbell Jr., MD; Keith D. Baldwin, MD, MPH, MSPT; Denis S. Drummond, MD; Malcolm L. Ecker, MD; and Helen M. Horstmann, MD. The team performs more than 3,000 orthopedic surgeries a year, including more than 250 surgeries specifically on children with spinal deformities related to scoliosis. Spine surgeries offered include posterior spine fusion, growing rods, and vertical expandable prosthetic titanium ribs (VEPTR), a technique invented by Dr. Campbell (see “Devices” story).

Safety before, during and after surgery is a top priority and an area the team continues to investigate. One such study on neurologic injury and transcranial motor and somatosensory evoked potential monitoring during surgery for adolescent idiopathic scoliosis recently won the Scoliosis Research Society’s Russell A. Hibbs Award for clinical science.

The team is dedicated to the full spectrum of safety protocols, including providing the very best anesthesia and pain care during surgery; administering perioperative antibiotics to patients before surgery to reduce the incidence of surgical site infection; employing advanced navigation and imaging — such as StealthStation® and O-arm® computerized tomography scanners — to provide real-time images that aid in safe placement of instruments and support decision-making during surgery; spinal cord monitoring throughout surgery; and reporting transcranial motor evoked potentials (TcMEP) to evaluate a patient’s motor pathways and the health of the spinal cord.

Standardized postoperative clinical pathways ensure continued quality of care and have led to significant reductions in the length of hospital stays, more efficient management of hospitalized patients, and better outcomes. Patients also benefit from an all-inclusive facility with an orthotics program that fits children with custom-designed halo vests and other braces, and a pediatric rehabilitation center that offers inpatient and outpatient therapies for orthopedic patients including physical therapy, occupational therapy, athletic training, and sports nutrition. The Spine Program also offers long-term follow-up care and transition-to-adult-care programs for children who need continued medical monitoring into adulthood.

Orthopedic surgeons, physicians, and researchers at CHOP continue to investigate new diagnostic tools, treatment approaches, and ways to make surgery safer for all children with orthopedic conditions. Ongoing research focuses on the etiology of scoliosis while other research efforts promise to help us predict spine conditions and treat them before many of the symptoms begin. One such study — and another Hibbs-Award winner — identified a gene mutation as a potential cause of idiopathic scoliosis (see “Research” story).

“Our team continues to forge innovations that improve our ability to diagnose spinal conditions earlier and prevent their progression so they cause minimal interruption to childhood,” says Dormans. “That’s our goal above all else: to return children to their lives, sports, and other activities essential to childhood as safely and as soon as possible.”