Medicine's winding road to straighten curved spines

Health: Advances in scoliosis surgery demonstrate clear progress in treatment in just one generation.

September 09, 2001|By Solana Pyne | Solana Pyne,Special to the Sun

Like many mothers, Nancy Weiss is full of praise for her 16-year-old daughter, Kimberly. The Port Washington, N.Y., mother commends Kimberly's writing ability and her quick wit, but she really raves about Kimberly's long, flat back.

Thirty-nine years ago, at Kimberly's age, Nancy spent a year in bed recovering from surgery with a cast that stretched from chest to hips. Nancy had scoliosis, a condition in which the spine curves sideways and twists, rotating the rib cage so that the flat part, which normally makes up the back, shifts to the side and a curved side shifts toward the back, creating a hump in more severe cases.

The surgery straightened her spine -- it no longer curved like a C across her back -- but the hump remained, along with a long, thick scar down the center of her back.

Kimberly also had scoliosis. About 20 percent of children of those with scoliosis will develop it, although in most cases no one knows what causes scoliosis or how it might be inherited.

Kimberly's spine was curved, her back humped and she was in constant pain. The pain became so intense she had to stop running track, her favorite sport. "When I ran," she said, "I could feel my ribs going into my lungs."

In May, she underwent an 11-hour surgery to correct the condition.

Kimberly has no cast, and her only scars are 1-inch long and hidden under her arm. After surgery, she wore a brace in the car or in other places where her back might get jostled, but she no longer needs the brace now.

The difference between Nancy's experience and Kimberly's is a striking demonstration of progress in medicine.

Only medical success

In 1962, surgeons cut into Nancy's back, making a long incision down the middle. They straightened her spine and scraped between the vertebrae to encourage the bone to grow and fuse the vertebrae, immobilizing the spine. A bone from a cadaver was attached to her spine, a standard procedure at the time, to keep it straight while her own bone grew. Her cast prevented movement while the vertebrae fused, a process that took about a year. Although it straightened her spine, the surgery left her rib cage twisted and her back humped.

"I did not get a good cosmetic result," Nancy said. "I got a good medical result but not a good cosmetic result. It was a terribly horrible surgery to just have a medical result."

Kimberly was diagnosed with scoliosis in the sixth grade, during mandatory school testing for scoliosis . She wore a brace for 12 hours each night for the next four years to try to prevent her spine from curving further.

After the trauma of her own surgery, Nancy prayed her daughter wouldn't suffer the same fate.

"I felt terribly guilty," she said. "Surgery is really the scariest thing you think about for your child. You pray the brace will work and think, God forbid my child should have to have surgery."

But the brace failed, and doctors determined Kimberly's spine had curved far enough for surgery.

The severity of a spinal curve is measured in degrees. In most circumstances, surgeons won't operate until the curve passes 40 degrees. Kimberly's curve was 16 degrees when she was diagnosed and 51 degrees when they operated.

Small incisions, big results

Modern surgeries use metal rods to straighten both the sideways curve of the spine and the twisting of the rib cage, but many are still done through a long incision in the patient's back. Some severe cases require the surgeons to get at the spine through the front of the body, which is more difficult but gets the best results.

Kimberly went to Dr. Baron Lonner of Scoliosis Associates in the Bronx. He proposed a new surgery.

Rather than cutting in through her back, Lonner entered Kimberly's chest through several small incisions beneath her arm. He deflated a lung to get a better view of the spine and inserted a camera and various surgical tools through the incisions.

Lonner removed disks, tire-shaped cushions between vertebrae, along the curve. He grafted bone chipped from Kimberly's ribs into the gaps between the vertebrae and then attached screws to each vertebra along the curve. He slipped in a long rod that he attached to the screws.

Finally, Lonner compressed and straightened the spine. The rod now holds Kimberly's spine straight while the grafts grow to fuse the vertebrae together, eventually locking the straight spine into place.

Kimberly's surgery, called thoracoscopic surgery, gets cosmetically better results, with less scarring.

"The more I see our results, the more I like the operation," Lonner said. The recovery after surgery is faster, and patients are off pain medication sooner, he added. They are also mobile sooner.

Thoracoscopic surgery works only for younger patients with still-flexible spines; of those, only about half have curves that can be straightened with the surgery.

In a year, after Kimberly's spine has completely fused, she will be able to start running, and her doctor says her back will be as flexible and strong as that of any other teen-ager.

Solana Pyne is a reporter for Newsday, a Tribune Publishing newspaper.

What is scoliosis?

Scoliosis is a sideways curvature of the spine. Some people who have scoliosis require treatment. Others, who have milder curves, may only need to visit their doctor for periodic observation.

Who gets scoliosis? People of all ages can have scoliosis . Of every 1,000 children, three to five develop spinal curves that are considered large enough to need treatment. Because scoliosis can run in families, a child who has a parent or sibling with scoliosis should be checked regularly by the family physician.

What causes scoliosis? In 80 percent to 85 percent of people, the cause of scoliosis is unknown; this is called idiopathic scoliosis. Other causes of the disease are vertebral abnormalities or deformities present at birth and muscular system and nervous system diseases such as cerebral palsy and muscular dystrophy. -- Newsday

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