Scoliosis and Back Pain: A Q&A With Dr. Jennifer Bauer
Jennifer Bauer, MD, MS is the only orthopaedic surgeon at Seattle Children’s whose elective practice is singularly dedicated to the treatment of pediatric spine problems.
She has been selected this year for both the Scoliosis Research Society’s Edgar Dawson North American Traveling Fellowship and the Pediatric Orthopaedic Society of North America’s International Traveling Fellowship, both of which will bring her to other leading centers to exchange ideas, give lectures and discuss research collaboration.
What is the basic treatment algorithm for idiopathic scoliosis?
Dr. Bauer: In general, children with curves of 20 to 25 degrees on an upright spine radiograph who still have at least a moderate amount of growth remaining (Risser 0-2) will be recommended a thoracolumbosacral orthosis (TLSO) brace to keep the curve from progressing, as well as offered scoliosis-specific Schroth physical therapy as an adjunct to the brace. This is continued until growth stops. If a child is younger than 5, they may be casted instead of braced. Children with curves over 45 to 50 degrees who still have a large amount of growth left will be offered surgery with growth-friendly implants that allow continued height. These will be converted to a final fusion once appropriate growth has completed. In patients with curves of this size without as much growth left (at least after their tri-radiate cartilages have closed), a final fusion may be recommended. The goal for surgery is to stop a curve from progressing, as curves that reach 70 to 80 degrees affect pulmonary function, and secondarily to correct deformity. The majority of curves over 50 degrees, even after a child stops growing, will continue to slowly progress, and thus these are offered surgery. Read full post »