Dr. Jennifer Bauer is chief of spine surgery at Seattle Children’s. She is a committee member of leading international and national pediatric spine societies and study groups and an editor and reviewer for scientific journals.
Q: When should a child with scoliosis see a specialist?
Dr. Bauer: Kids with a thoracic or lumbar rib hump on an Adams forward bend who have a scoliometer reading of 3 to 5 degrees should be rechecked in six months by their PCP. For a scoliometer reading over 5 degrees, we recommend ordering a two-view standing PA/LAT spine radiograph. If it shows a Cobb angle over 20 degrees for any age child or over 10 degrees in a child under 10 years old, we recommend referral to Seattle Children’s. If they don’t meet those thresholds, we advise a follow-up X-ray in 6 months and referring to Orthopedics if any increase in curvature is seen.
We recently developed an algorithm for scoliosis that offers guidance on how to assess the pediatric spine and when to refer to orthopedics.
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Samuel Browd, MD, PhD, is a neurosurgeon and surgical director of the Tone Management Program at Seattle Children’s. He is a world leader in training surgeons in selective dorsal rhizotomy (SDR) procedures. Roughly 1 in 4 surgeons in the United States who offer SDR trained under Dr. Browd, in addition to many doctors from around the world.
Q: Who is SDR for?
Dr. Browd: Any child with high tone (spasticity) in their lower extremities is a possible candidate for SDR [selective dorsal rhizotomy] surgery. This includes many children with cerebral palsy. Providers and parents often think of surgery as a last resort, but in the case of kids with high tone, we encourage them to think of it as an early option instead. Even if their spasticity is being reasonably well-managed by medication and/or therapies, SDR can help them reduce or even get off their medication. With better physical functioning and mobility, we see kids do better with their social, family and school life too — because they’re putting less physical and mental energy into controlling their body and more time into doing things that are fun for them. Longer-term, kids are less likely to require more surgeries or experience some of the serious health consequences of having high tone.
Ages 3 to 5 is when we like to see kids get evaluated for SDR because their neuroplasticity is so high at that age, but we also consider the surgery for older children.
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Seattle Children’s was awarded reverification as a Level 1 Children’s Surgery Center this month. Seattle Children’s is the only children’s hospital in Washington, and one of only 55 in the nation, to achieve this highest level of certification for pediatric hospital surgical programs.
New This Year
New standards this year are focused on multidisciplinary care, opioid stewardship, antimicrobial stewardship and our perioperative risk assessment program. Seattle Children’s initially received the Level 1 designation four years ago when it was first given.
We are honored that the survey team found Seattle Children’s to be an ‘exemplary’ children’s hospital and specifically recognized the robust support from senior leadership for our quality and safety initiatives, and our effective institutional structure that prioritizes and strives to deliver high quality and equitable care in all clinical areas,” said Dr. Andre Dick, senior vice president and surgeon-in-chief.
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In Part 1 of our Epilepsy Q&A, we asked neurosurgeon Dr. Jay Hauptman how brain surgery for epilepsy has evolved in recent years and why major brain surgery for infant Jiana was his first choice for treating her epilepsy. In Part 2 next month we will hear from Dr. Hauptman and Dr. Ghayda Mirzaa about how patients are benefitting from new treatments derived from genetic research underway at Seattle Children’s and the Center for Integrative Brain Research.
“The brain surgery of today is completely different than the brain surgery of 20 years ago. And our understanding of epilepsy is completely different than it was 20 years ago. And because of that, our treatments have become so much better, so much more tailored and so much more effective.” – Dr. Jay Hauptman
Q: Can you explain why a more significant surgery on a young child with epilepsy may be a better approach than a more conservative surgery?
There are a lot of things that we have learned in the last 20 years that have taught us that being aggressive, going for cure, is perhaps the most important thing in the management of epilepsy in children. We know from studies that were done quite some time ago that when children are on two antiseizure medicines — it doesn’t even matter which two those are, they can be the oldest ones that we have in history of epilepsy medicines or the newest ones that just came out of a clinical trial in the last year — and they continue to have seizures, the likelihood of a third or a fourth medicine ending their epilepsy is near zero, less than 5%. Read full post »
