3-D ultrasound of diffuse abnormal vertebrae
Congenital spine deformities — which include coronal plane abnormalities (scoliosis) and sagittal plane abnormalities (kyphosis and lordosis) — occur as a result of abnormal vertebral development. They are often diagnosed during the detailed sonographic anatomical evaluation between 18–24 weeks gestation.
At the Center for Fetal Diagnosis & Treatment, a team of high-risk maternal-fetal medicine specialists, pediatric surgeons, anesthesiologists, advanced practice and surgical nurses, radiologists, genetic specialists, neonatologists, and orthopaedists comes together to offer an unparalleled level of expertise in the diagnosis of these conditions.
Fetal CT showing sagittal view of single anomalous vertebrae
Families referred to the Center with a suspected spine deformity undergo a one-day evaluation that may include a low-dose fetal CT, which gives us the ability to understand the shape of the vertebrae and their relationship to the chest wall. This imaging combined with our team’s experience with prenatal diagnosis enables us to more accurately predict a child’s prognosis. We meet with families and explain the impact the anomaly will likely have on their child’s growth and function and potential treatment options after birth.
Our Spine Program is recognized as one of the best and most innovative programs of its kind in the world. The program is staffed with six board-certified pediatric orthopaedic surgeons, each of whom has their own area of special focus among the hundreds of spine and spine-related conditions we treat.
Postnatally, we offer:
- A full spectrum of diagnostic testing including new technologies (e.g., EOS® imaging, dynamic MRI, cartilage mapping) and standard technologies (X-rays, MRI, CT scans).
- State-of-the-art operating rooms that use cutting-edge image-guided navigation and imaging equipment during surgery, such as StealthStation® and O-arm® Surgical Imaging.
- Continuous anesthesia and surgical monitoring during surgery, including specialized spinal cord monitoring.
- Enhanced safety protocols before, during and after surgery to decrease the risk of infection and increase positive outcomes. These include giving patients perioperative antibiotics and implementing postoperative clinical pathways to ensure quality and standardization of care processes.
- Custom-designed back braces, halo vests and other bracing devices.
Some congenital spine abnormalities may prove to be benign and cause no spinal deformity after birth, while others can result in severe and progressive spinal deformity. Care initially involves monitoring over the first year or two of the child’s life. We delay bracing, casting and surgical instrumentation for the first couple of years to see whether the deformity is progressive. Many of the isolated hemivertebra are not progressive and actually don’t need any treatment at all. Our focus is on ensuring that each child gets the most effective, but least invasive, treatment possible. We offer very sophisticated braces and advanced physical therapy approaches that are effective at stopping the progression of scoliosis before it gets severe enough to require surgery.
Surgical options we offer include spinal fusion, implantation of growing rods, MAGnetic Expansion Control (MAGEC®) growing rods, vertebral column and hemivertebra resection, correction of severe spondylolisthesis, resection of benign and malignant lesions, cervical spine surgery, novel non-fusion techniques, Mehta casting and the vertical expandable prosthetic titanium rib (VEPTR) — which was invented by Robert M. Campbell, MD, Director of CHOP’s Center for Thoracic Insufficiency Syndrome. We see more than 400 spine surgical cases each year