Saturday, 14 April 2018

Scoliosis Surgery Improves Quality of Life in Children with Cerebral Palsy, Study Suggests

Surgical treatment for scoliosis significantly improves the quality of life in children with cerebral palsy, outweighing the risks of surgery-related complications, a study suggests.
Up to 35 percent of cerebral palsy patients with severe motor disability are at increased risk of developing a progressive spinal deformity that cannot be stopped by wearing a brace.
Spinal fusion surgery — a procedure that fuses together painful vertebrae so that they heal into a single solid bone — can be performed to prevent scoliosis from progressing, but the true risk-benefit ratios are difficult to quantify in complex clinical contexts like cerebral palsy.
In the study “Assessing the Risk-Benefit Ratio of Scoliosis Surgery in Cerebral Palsy: Surgery Is Worth It,” researchers determined the long-term benefits and risks of having scoliosis surgery in children with cerebral palsy. The report was published in The Journal of Bone & Joint Surgery.
A total of 69 children with cerebral palsy with a mean age of 13.4 years were enrolled. The children underwent spinal fusion for scoliosis between 2008 and 2011 and were followed up for at least five years.
All of the children were severely disabled, and the majority (88.4 percent) were at level V of the Gross Motor Function Classification System, a scale from I to V with V as the most severe. The other children in the study were at level IV.
The primary outcome measured was health-related quality of life assessed before surgery and at one, two, and five years after surgery.
Quality of life was primarily determined using a questionnaire filled out by parents or other caregivers, called the Caregiver Priorities and Child Health Index of Life with Disabilities (CPCHILD). This is a validated tool specifically designed for children with severe cerebral palsy.
The questionnaire contains 37 questions about personal care and activities of daily living, positioning, transferring, mobility, comfort, emotions, communication and social interaction, general health, and overall quality of life.
Caregivers’ answers showed that significant improvements in personal care, positioning, comfort, and overall quality of life were seen one year after surgery, and persisted for the entire five years of follow-up.
Ninety-two percent of caregivers reported an improvement in the quality of life of their child at the first year after surgery, whereas only 6.3 percent reported deterioration. The remaining 1.7 percent reported no change in the child’s quality of life.
As expected, complications from surgery were common, affecting 46 percent of the patients during the first year post-surgery. The most frequent complications were pneumonia, surgical site infections, and pancreatitis.
However, first-year complications had very little or no impact on the patients’ and caregivers’ quality of life. There was weak or no correlation between the occurrence or number of complications and the quality of life reported on the questionnaires.
“Scoliosis surgery in patients with CP leads to a significant improvement in health-related quality of life, which is maintained five years following surgery,” researchers wrote. “The substantial complication rate does not correlate with health-related quality of life changes postoperatively, suggesting that the benefits of surgery outweigh the risks in this fragile population.” 
The benefits of scoliosis surgery for cerebral palsy patients have been debated by some researchers, particularly in light of the substantial risk of complications.
The research team believes that these results provide encouraging data that may help patients and healthcare professionals make a more informed decision when considering surgery.
“We are encouraged that the results of this multi-center study will provide patients, caregivers, and treating surgeons some guidance when faced with the decision of moving ahead with surgery,” Firoz Miyanji, MD, of British Columbia Children’s Hospital and first author of the study, said in a press release.
Paul Sponseller, MD, of Johns Hopkins Children’s Center and coauthor of the study, also said, “I am pleased to see that the data could provide useful information which helps patients with CP and their parents make good decisions. These families place an enormous amount of trust in our recommendations and this helps to give the advice a more solid basis, which they deserve.”

Source : CerebalPalsyNewstoday , 13 April 2018 

First Dynamic Brace Sheds Light on Spine Deformities

The Robotic Spine Exoskeleton consists of two six-degrees-of-freedom parallel-actuated modules connected in series, each with six actuated limbs. Each module controls the translations/rotations or forces/moments of one ring in three dimensions with respect to the adjacent ring. Credit: Sunil Agrawal/Columbia Engineering
A new spine brace has allowed researchers to measure for the first time the 3D stiffness of the human torso, opening the door for new treatments for spine deformities.
A team from Columbia University has developed a new brace called the Robotic Spine Exoskeleton (RoSE) and conducted the first study that looks at in vivo measurements of torso stiffness, characterizing the 3D stiffness of the human torso.
“To our knowledge, there are no other studies on dynamic braces like ours. Earlier studies used cadavers, which by definition don't provide a dynamic picture,” the study's principal investigator Sunil Agrawal, a professor of mechanical engineering at Columbia Engineering and professor of rehabilitation and regenerative medicine at Columbia University Vagelos College of Physicians and Surgeons, said in a statement.
“The RoSE is the first device to measure and modulate the position or forces in all six degrees-of-freedom in specific regions of the torso. This study is foundational and we believe will lead to exciting advances both in characterizing and treating spine deformities.”
RoSE consists of three rings placed on the pelvis, mid-thoracic and upper-thoracic regions of the spine, with the motion of two adjacent rings controlled by a six-degrees-of-freedom parallel-actuated robot.
Overall—the system, which can apply corrective forces in specific directions while allowing free motion in other directions— has 12 degrees-of-freedom controlled by 12 motors.
The brace is able to control the motion of the upper rings with respect to the pelvis ring or apply controlled forces on the rings during the motion.
The researchers examined eight healthy male subjects and two male participants with spine deformities in the pilot study and controlled the position and orientation of specific cross sections of the subjects’ torsos while simultaneously measuring the exerted forces and moments.
The results revealed that the 3D stiffness of the human torso can be characterized using the special brace. The team also found that spine deformities induce torso stiffness characteristics differently from the healthy subjects. Because spinal abnormal curves are three-dimensional, the stiffness characteristics are curve-specific and depend on the locations of the curve apex on the human torso.  
Spine deformities like idiopathic scoliosis and kyphosis are characterized by an abnormal curvature in the spine, forcing children with the spinal deformities to wear a brace that fits around the torso and hips to correct the abnormal curve.
“Our results open up the possibility for designing spine braces that incorporate patient-specific torso stiffness characteristics,” the study's co-principal investigator David Roye, a spine surgeon and a professor of pediatric orthopedics at the Columbia University Irving Medical Center, said in a statement. “Our findings could also lead to new interventions using dynamic modulation of three-dimensional forces for spine deformity treatment.”
While braces can prevent progression of the abnormal curve, the underlying technology has not changed much in the last 50 years. Current braces give the wearer a number of limitations due to the rigid, static and sensor-less designs of the brace. Users often complain that the brace is uncomfortable to wear and causes skin breakdown from prolonged, excessive force.
The inability to control the correction provided by the brace makes it difficult for users to adapt to changes in the torso over the course of treatment, resulting in diminished effectiveness.
The team has also designed a female version of RoSE, as idiopathic scoliosis is 10 times more common in teenage females than males.
The study was published in IEEE Transactions of Neural Systems and Rehabilitation Engineering

Source : RDmag , 10 April 2018 

Tough surgery helps young scoliosis patient

Leigha Boatwright is back to following her dreams after a local doctor successfully performed a surgery to fix the 12-year-old’s scoliosis that others said was too difficult. 
Alecia Coleman, Leigha’s mother, says she started noticing a difference in her daughter’s posture, and her ability to stand up straight.
“We were worried about her having health issues and health concerns, as well as having physical issues that may have affected her confidence as a pre-teen or a teenage girl,” Coleman said.

Dr. David Siambanes says Leigha’s issues with her spine were the result of a rapid growth spurt. It happened so quickly that there was no time to use a brace or other conservative remedies.
“She ended up with a very severe curve, of severe magnitude," Dr. Siambanes said. "And a very stiff curve, you can tell it’s very stiff because we do side-bending x-rays where you can tell the flexibility of the spine.”
To correct it, he says flexibility was needed. He used a scope to release the disks between the bone to help the curve. Then, an incision was made on the back of the spine.
“The best thing about these procedures is it stops the progression of that deformity, it stops it from getting worse," Dr. Siambanes explained. "Her spine is nearly straight. She’ll have no difference in back pain, or impairments or restrictions or anything that any other child her age will have, that we can tell. So it really has changed her future."
Leigha wears a bone stimulator every day to fuse the bones together and help promote them to grow straight with the rods.
According to the National Institutes of Health, Adolescent Idiopathic Scoliosis affects an estimated two to three percent of children in the U.S., but the severe curve of Leigha's spine, Dr. Siambanes said, is even more rare. 
For Detailed Video : http://www.fox13news.com/news/local-news/tough-surgery-helps-young-scoliosis-patient

Source : Fox 13 News , 2nd April 2018 

Scoliosis surgery readmissions increase total costs $86k in 2 years: 6 things to know

A new study published in the Journal of Bone and Joint Surgery examines how readmissions increase the total cost of care for spinal deformity surgery.

The study authors examined records from 659 patients who underwent adult spinal deformity surgery at a single center from 2005 to 2013. The costs are expressed in 2010 dollars. Study authors found:
1. The readmission rates were 24 percent overall, and cost around $10.1 million for the population studied.
2. Around 8.8 percent of the admissions occurred within the first 30 days after surgery, accounting for $3.2 million, and 11.7 percent of the readmissions occurred within the first 90 days, accounting for $4.6 million.
3. Pseudarthrosis was the most expensive readmission, costing around $92,755; infections and kyphosis were also expensive readmissions, costing around $75,172 and $66,713 respectively. As a result, the complications increased the average readmission cost by:
• Pseudarthrosis: 105 percent
• Infection: 72 percent
• Proximal junctional kyphosis: 63 percent
These three complications represented 73 percent of the costs for readmission.
4. Two years after surgery, the average readmission cost was $86,081.
5. The factors associated with increased risk for readmission include:
• Older age
• Eight or more levels fused
• Longer length of index stay at the hospital
6. The researchers reported patients who underwent thoracic only curve or double curve procedures and those who had an anterior-only or posterior-only approach were associated with lower costs.
"Although reducing the 30-day and 90-day readmission rates and costs are important, adult spinal deformity surgery is unique, because the most common and most expensive complications occur after one year," concluded the study authors.

Source : Beckers Spine Surgery , 26th March 2018 

Cardiff teen goes to Germany for scoliosis surgery on spine

Erin Morgan-Ring with Dr Per TrobischImage copyrightFAMILY PHOTO
Image captionDr Per Trobisch will carry out the procedure on Erin Morgan-Ring
A teenage runner and gymnast will travel to Germany on Saturday for ground breaking spinal surgery which is not yet available on the NHS.
Erin Morgan-Ring, 14, from Heath, in Cardiff, has been diagnosed with scoliosis, which means her spine twists and curves to the side.
She is the third Welsh child to travel abroad for the operation in a year.
The Welsh Government said NICE would assess any new evidence that supports introducing it on the NHS.
Meanwhile, all three Welsh families have had to raise thousands of pounds to pay for the treatment.
The most common surgery available in the UK, known as full fusion surgery, sees metal screws attached to the vertebrae which are then connected to rods to try to correct the curve.
Erin's mother, Ceri Morgan, said her daughter would be forced to give up competitive sport if she opted for the NHS procedure, as experts concede it can leave patients with a more limited range of movement.
Image copyrightSPIRE HOSPITAL
Image captionAn X-ray revealed Erin's spinal curvature
The family found out a new operation called Vertebral Body Tethering (VBT) was being offered by surgeons in the US and Germany - which uses screws and cord to correct the spinal curvature.
Experts say the keyhole surgery is less invasive and patients retain greater mobility.
The procedure has only been around for 10 years and is limited to teenagers and young people.
About 1,000 patients have been operated on during that time, but it is not approved by the NHS.
Ms Morgan said she noticed something was not quite right with Erin's spine during a holiday in 2016.
"She was in a bikini and I just noticed that she wasn't standing straight, when we came back we went straight to the doctor and were referred," she said.
Doctors diagnosed scoliosis after seeing X-rays of Erin's spine.
Gareth Bale with his signed shirtImage copyrightFAMILY PHOTO
Image captionWales footballer Gareth Bale is among the sportsmen to help raise funds for Erin's treatment
Full fusion surgery was offered by the NHS, but Ms Morgan heard about VBT which it is hoped will allow Erin to return to gymnastics, running and riding.
The family made contact with VBT expert Dr Per Trobisch at the St Brigida Hospital in Simmerath, Germany, and he agreed to carry out the procedure.
Ms Morgan said: "Erin literally did a back flip in his office."
Erin's family have been fundraising to secure the £42,000 needed to pay for the operation and Wales rugby player Sam Warburton and footballer Gareth Bale, are among those to donate items for auction to help raise money.
Emiah and her parents Simon Ellis and Menna Garland-EllisImage copyrightFAMILY PHOTO
Image captionEmiah Ellis has already had the treatment and was back at school within six weeks
Dr Trobisch said he was convinced VBT surgery would become part of NHS treatment for selected patients but said it could take a few years to collect data to support its capabilities.
But he added: "It is important to know that VBT is not suitable for every scoliosis patient. Ideal patients are those who have residual spinal growth and a flexible scoliosis.
"Therefore, time is an important factor. Once a scoliosis with more than 40 degrees has been diagnosed, consulting a scoliosis expert should be arranged as soon as possible."
In August last year, 14-year-old Emiah Ellis, from Brynna, Rhondda Cynon Taff, travelled to the same hospital in Germany for VBT surgery and was back at school within six weeks.
Her mother Menna Garland-Ellis, said: "It's amazing, she can do everything she did before, she doesn't have any pain, we're very happy."
Ten-year-old Megan Sadler, from Pembroke, travelled to the US for the operation last May. Her mother Laura said: "She's doing great, you would never know she's had the surgery."
Only a small number of studies about the results of VBT have been published so far.
Experts say the failure rate of the procedure is less than 10% and patients whose treatment fails can be offered traditional spinal fusion.
A Welsh Government spokesman said VBT was not routinely commissioned by the NHS, but the National Institute of Health and Care Excellence (NICE) guidance would assess new evidence that may come to light in support of the procedure.
Nikul Bakshi, from the British Scoliosis Research Foundation, added: "There are currently no long-term results for VBT although early results in the US and UK look promising.
"As with many new treatments, there is currently a lot of patient, family and social media interest. However there are still a number of checks and balances which will be considered by bodies such as NICE."

Source : BBC , 6th April 2018 

Sunday, 25 March 2018

My fight with scoliosis has made me stronger

Conor Coughlan, 16, Ballinhassig, Alex Ronan, 16, Cobh, and Ciara Leahy, 17, Mogeely, pictured at the launch of Straight2Swimming.Pic Diane Cusack
Conor Coughlan, 16, Ballinhassig, Alex Ronan, 16, Cobh, and Ciara Leahy, 17, Mogeely, pictured at the launch of Straight2Swimming.Pic Diane Cusack

My fight with scoliosis has made me stronger

FOR many teenagers, a sudden growth spurt is just a normal part of transitioning into young adulthood. But it was a different story for 17-year-old Ciara Leahy from Mogeely, East Cork.
The teen quite literally experienced growing pains when she was diagnosed with scoliosis back in October, 2015. The condition, characterised by abnormal curvature of the spine resulting in a ‘hump’ like shape on the back, can take two forms — congenital or Idiopathic. The latter predominantly affects adolescents, with teenage girls being disproportionately affected at a rate of 10:1.
Due to its sudden onset and the fact that no known cause can be detected, it came as quite a shock to Ciara, who attends St. Mary’s High School, Midleton.
“I noticed a lump on my back during the summer when I was wearing tight clothes, and one evening I was sitting on the ground doing a puzzle with my brother and mum actually saw the C shape as I was kneeling over, so that’s how we copped on to it,” she said.
Ciara’s mother, Anne, readily admits that she initially panicked when her daughter first received the diagnosis from her GP.
“When you get the diagnosis first, it’s like ‘Oh, my God’ and the first thing you do is turn to the internet — which can be good and bad!” she said.
A referral to a consultant soon followed where the initial diagnosis was confirmed, but unfortunately this was just the start of what was to prove quite an arduous journey, both literally and metaphorically, with Ciara forced to seek medical treatment in Dublin and swim therapy in Kildare.
Anne explained: “We heard about the Straight2Swimming programme from a friend of Ciara’s but it was only taking place in Kildare at the time, on a Sunday, so we used to drive up every weekend.
“We did carpool with another family but you’d be leaving at 12pm every Sunday.”
Launched in Belfast in 2014, Straight2Swimming provides swim therapy for pre and post-surgical scoliosis patients under 18 years of age. The initiative, which is free of charge to participants and is sponsored by American specialist spine medical device company K2M, is the first of its kind in the world.
Ciara Leahy centre.
Ciara Leahy centre.
Despite the long travelling distance, the Straight2Swimming programme proved to be invaluable not just to Ciara but for Anne and her husband as they found great comfort and support in meeting other parents whose children also had the condition.
“For us, the benefit was meeting other parents who were on the same journey — in particular, it was great to meet people out the other side of it. Just by sitting down and talking to other parents who had been through it, we got huge amounts of information,” said Anne.
Although fortunate enough to be able to access private health care, Ciara still had to wait almost two years from the time of diagnosis to the time of undergoing the operation to straighten her spine. This, as Anne explains, is due to the lack of staff available in Ireland to carry out the corrective surgery.
“We had private health insurance so we were lucky — the public system is ridiculous — but two years is still a long time in a teenager’s life. There is only a limited pool of surgeons in the country and the theatre in Crumlin is only operating a few days a week because they haven’t got the theatre staff to man it,” Anne said.
Whilst waiting for her operation, Ciara’s condition rapidly deteriorated in a short space of time, with the curvature in her spine significantly increasing.
“I had a huge growth spurt between Christmas and the new year and the curve increased by 20 degrees in a few weeks. I began the Straight2Swimming programme in February and that September I had the surgery. The surgeon encouraged me to keep up sports and to keep fit though and that definitely paid off.”
Last September, the Straight2Swiming programme came to Cork where it operates out of the Mardyke Arena pool every Saturday evening for both pre-op and post-op patients. This was a welcome relief to Anne and the rest of her family.
“When it came to Cork it was great because prior to that I was always trying to ‘farm’ my other kids out to people on a Sunday because your whole day is taken up driving up to Kildare,” said Anne.
The dedication of the Straight2Swimming staff and their belief in the programme is evident in the fact that co-founder Edel Convery and Programme Director Edel Brown travel down to Cork each week to facilitate young people in Cork and surrounding areas who have been diagnosed with scoliosis.
Straight2Swimming was formally launched in Cork just this month.
After Ciara’s operation, performed by Mr Pat Kiely, Consultant Spine Surgeon from The National Children’s Hospital — affectionately referred to as ‘Magic Hands’ by patients and colleagues alike — Ciara literally reached new heights.
“I went into surgery 5’7 and came out 5’11! The swimming definitely did help me with my fitness levels — I was walking on the first day after my surgery.”
Now, six months after the operation, Ciara says she enjoys “a totally new quality of life”.
“I used to be really self-conscious — I used never tie my hair up in a pony tail, never tie it up in a bun.”
The young woman is eager to offer hope and encouragement to other young women who may be going through the same experience.
“Scoliosis is a problem but it can be fixed and it’s amazing what surgery can do. I had a white board in my bedroom and I used to have a quote written on it: ‘When something bad happens to you, you have three choices — let it define you, let it destroy you or let it strengthen you’ — I let scoliosis strengthen me.”
Olympic swimmer Andrew Bree pictured with Emily Jane O'Mahony, Clonakilty, Alex Ronan, 16, Cobh, and Liam Leisk, 12, Blarney, at the launch of Straight2Swimming, a new free swimming programme to help scoliosis sufferers. Pic Diane Cusack
Olympic swimmer Andrew Bree pictured with Emily Jane O'Mahony, Clonakilty, Alex Ronan, 16, Cobh, and Liam Leisk, 12, Blarney, at the launch of Straight2Swimming, a new free swimming programme to help scoliosis sufferers.
Pic Diane Cusack
Straight2Swimming, a unique programme for young people with scoliosis, has announced its expansion to Cork. Already a huge success in Belfast and Kildare, the world’s first tailored swim program for pre and post-surgical scoliosis patients under 18 years of age is now available at the Mardyke Arena.
First launched in 2014 in Northern Ireland, the free of charge swimming programme has proved a great success and further expansion into other countries is in the pipeline. The Cork launch was held on March 10 and attended by specialists in the world of adolescent psychology, sports medicine and orthopaedics as well as participants and their families.
The brainchild of Philip and Edel Convery, the Straight2Swimming programme has grown to include 150 young swimmers in fewer than three years, and the new addition of the Cork session each week will initially enable up to 25 additional swimmers to join the programme whilst cutting the travel commitments for many members who travel across the country each week to attend.
Programme Director Eimear Brown explained how far they have come and their delight at launching in Cork.
“Straight2Swimming launched in September 2014 in Belfast with just eight swimmers. Since then the programme has grown to include over 150 members in May 2017, and we are delighted to announce that the weekly free of charge swimming sessions is coming to the Mardyke Arena in Cork.”
Echoing Eimear’s sentiments, Mr Pat Kiely, Consultant Spine Surgeon from The National Children’s Hospital, said: “I welcome the addition of a third Straight2Swimmingprogramme in Cork to accommodate the growing number of young people eager to take part in this unique initiative. Straight2Swimming is the most positive single action in enhancing scoliosis patients’ capacity, allowing them to be themselves and all that they can be.”
Scoliosis is a condition that affects as many as two in every 1,000 children in Ireland. With many patients facing extensive wait times to receive their corrective surgeries, Straight2Swimming has offered an invaluable service, working to help build body confidence among its swimmers, improve swimming techniques, and boost overall fitness, therefore reducing recovery times for many who have undergone spinal surgery, and acting as a gateway for many young people in returning to sport.
Funded by US specialist spine medical device company K2M, the weekly swimming programme also provides a supportive forum for the families of those who are impacted by the condition as they help their loved ones through the painful condition. While young swimmers train parents gather each week to consult with experts in the field of scoliosis and treating young people with the condition to compare stories and experiences and offer support for those going through similar journeys.

Source : Evening Echo , 23 March 2018 

Surface Topography Can Assess Improvements in QoL Following Scoliosis Surgery

Baron  Lonner, MD Professor of Orthopaedics Icahn School of Medicine at Mount Sinai

Baron  Lonner, MD

Professor of Orthopaedics
Icahn School of Medicine at Mount Sinai

MedicalResearch.com: What is the background for this study? What are the main findings?
Response: 2-3% of adolescents have idiopathic scoliosis and 1 in 10 of these individuals will require surgery to correct severe scoliosis which if left untreated can lead to back pain and disability as well as pulmonary (breathing) problems later in life. For the adolescent with curvatures that require surgical treatment, body image and self esteem are big issues as they are for all adolescents going through their developmental stages.
Scoliosis has an impact on body shape, which is seen by the affected individual looking in the mirror as well as by their peers and those around them. This can lead to self esteem and body image disturbance issues. We set out to explore the body shape distortions that occur with scoliosis, that are not depicted by x-rays that are standardly used to assess curvatures of the spine, and the improvements in parameters of body shape that occur with corrective surgery. We can assess body shape directly through surface topography imaging, that is light-based, thus, not involving x-ray exposure. This technology (Diers Formetrics) uses the same scientific methodology that is used to create modern topographical maps through satellite imagery. We found dramatic improvements in body shape asymmetry with surgery that correlated with some improvements in quality of life for the adolescent in this cohort of 23 patients as well as with the improvements in curvatures evaluated by x-rays. 
MedicalResearch.com: What should readers take away from your report?
Response: This approach, the use of this technology, will provide those of us who treat scoliosis patients with information that can be used to counsel patients and their families about the improvements in their body shape that can be expected with surgery and use this to modify corrective strategies as needed to improve body shape and by extension, self-image of the patient. Over longer term follow up, we will show how these improvements correlate with quality of life indicators for the individual.

Surgery for scoliosis is effective in improving the body shape distortions that are caused by the scoliosis. Not only is the spine corrected, but the patient’s body symmetry is restored to a great extent and this can be evaluated with the surface topography technology we utilized. 
MedicalResearch.com: What recommendations do you have for future research as a result of this work? 
Response: We are in the proccessing of assessing the distortions of body shape in the frontal view (what the patient directly sees in the mirror) and the body shape improvements of those asymmetries. We have collected information on over 50 patients already and intend on collecting this data on all patients going forward.
Disclosures: Dr. Lonner is the President of the Surface Topography Study Group
AAOS 2018 abstract: Changes in Body Shape Following Surgical Correction in Adolescent Idiopathic Scoliosis Surface Topography Changes are Associated with Improvements in Health-Related Quality of Life

Source : Medical Research , 19th March 2018