Posts Tagged ‘scoliosis’

Scoliosis Spine Surgery- Patient Success Story

Scoliosis is an abnormal curvature of the spine with multiple symptoms. Surgical treatment of scoliosis usually requires a spinal fusion. About 5 years ago, I had back surgery with John Rhee, MD at the Emory Orthopaedics & Spine Center. Dr. Rhee removed pressure off of nerves in my back and joined two back bones together. Following that procedure, everything was fine. I knew at the time that I had a scoliosis that might eventually need to be addressed, but the decision was made to do the smallest operation first and just take care of the area that was causing the pain. Low and behold, the scoliosis did eventually catch up with me, and I started to experience sciatic pain from my buttock to ankle several times throughout the day. I was working, but I was taking medications to mask the pain just so I could go to work. I could not do anything else because I did not want to agitate my back.

Prior to suggesting surgery, Dr. Rhee recommended trying to rehab my back to see if a nonoperative approach would help. However, after trying, it became obvious that nonoperative treatment was not working, and that surgery would be the best option for me. About a month and half before surgery I was given exercises to complete which would end up helping me after surgery. I thought this was unique and the medical team was right, because I would not be able to rehab immediately post-surgery. I was preparing for after surgery before I even went into surgery.

During surgery, my wife was in the waiting room and she was updated on my status by the hour. Due to my severe scoliosis, it was a major fusion operation involving multiple levels from the thoracic spine down to the sacrum. However, the Orthopaedics and Spine team made her feel very comfortable. I was in the hospital for a total of 2 days, came home on the 3rd day and started my recovery. From Dr. Rhee’s nurse, Betty Dundee, to the staff, my experience was great!

Prior to me going to Dr. Rhee, I had a fraternity brother, who is an Orthopedic surgeon, take a look at my x-ray before surgery and he viewed it after surgery as well. My friend could not believe what a great job Dr. Rhee did. He said “You got a good guy!”. All of my friends call me wonder man because they can’t believe I can do what I’m doing based on seeing me beforehand. For example, my wife and another person watched me walk down the pavement to make sure I had proper form, and I did! Dr. Rhee did a great job. Even though I needed a major operation, the surgery seemed so easy and well done. I cannot see someone not going through surgery because I found it so simple. I’m very pleased and I’m on my feet once again.

A Note From Dr. Rhee About Scoliosis and Spine Surgery

Scoliosis is an abnormal curvature of the spine that can lead to nerve compression, pain, and if severe enough, deformity. Surgical treatment of scoliosis usually requires a spinal fusion. Depending on the magnitude of the scoliosis, multiple levels in the spine may require fusion, which can make it a major operation. Nevertheless, when properly executed, surgery for scoliosis is associated with excellent outcomes.

About Dr. Rhee

Dr. John Rhee, Orthopedist AtlantaSpecializing in cervical spine surgery, lumbar spine surgery, complex spinal deformity surgery (scoliosis and kyphosis), and surgery for spinal tumors, Dr. Rhee is an active researcher and sought-after teacher/lecturer at the national and international level in multiple medical societies.  He has served as faculty and been an invited lecturer at numerous meetings and courses on spine surgery.  In addition, he has served as Program Chairman at numerous national and international spine surgery meetings.   Dr. Rhee has also published extensively in a number of peer reviewed journals and book chapters, and he has received numerous awards and honors.  He is actively involved the training of international research scholars and other spinal surgeons and has been the author and editor of numerous books on spine surgery techniques.

Understanding Adult Idiopathic & Degenerative Scoliosis

spine-scoliosisScoliosis, or an abnormal curvature of the spine, affects an estimated 7 million people across the U.S., or approximately 2% of the American population. Often the onset of scoliosis begins during adolescence, but the condition can also exist in adults. When the condition is discovered after puberty, it is referred to as adult scoliosis.

Most scoliosis cases are considered idiopathic, meaning they have no known cause. Most idiopathic scoliosis cases among adults actually began during adolescence. It is important, whether you’re an adult who’s been living with adolescent idiopathic scoliosis for years, or an adult whose scoliosis has only recently discovered, that you have your spine regularly checked by a physician to monitor the curvature and its progression. In many cases, idiopathic scoliosis does not require surgical treatment, but in the event that the curvature worsens , intervention, including surgery, might be required.

In addition to idiopathic scoliosis, there are several other types of scoliosis, most of which predominantly affect children and teens. However, there is one other form of scoliosis, degenerative scoliosis that doesn’t develop until adulthood.

As we get older and our bones and joints begin to wear and break down, we can experience a variety of conditions ranging from osteoporosis to osteoarthritis. In some cases, these same diseases can also be a cause of degenerative scoliosis.

Degenerative scoliosis does not begin until after the age of 40 and is marked by degeneration of the discs in the lumbar spine and the development of a scoliosis curve in the spine. Often times, degenerative scoliosis presents as low back pain. There may be no curve present when symptoms begin, and a patient may simply visit the doctor due to a new, but persistent pain in the lower back

Once the degeneration progresses and the scoliosis curve has occurred, this combination can put pressure on the nerves in the spine, leading to numbness, tingling sensations, weakness, pain in the lower extremities, all of which can lead to difficulties with activities of daily living.

Treatments for degenerative scoliosis vary depending on the severity of the case. Usually, conservative treatment measures including exercise, medication, and use of braces or orthotics can provide sufficient pain relief and support for a deteriorating spine. In particular, strengthening and stretching of the lumbar musculature can be very helpful in decreasing pain, as well as providing “prehab”- that is, exercise treatment BEFORE surgery to maximize the chances of a good outcome.

Treatment of other conditions (osteoporosis, osteoarthritis) that may be playing a role in the degenerative scoliosis can also help improve symptoms or slow the progression of degenerative scoliosis. In some cases, significant nerve problems or pain and/or the development of other conditions such as lumbar stenosis can mean treating degenerative scoliosis may require surgery, such as a lumbar spinal fusion or lumbar laminectomy.

To learn more about scoliosis, visit the Emory Orthopaedics & Spine Center.

About Dr. Ananthakrishnan

ananthakrishnan-dheeraDr. Ananthakrishnan trained with one of the pioneers of scoliosis surgery, Dr. David Bradford, at the University of California at San Francisco. After completion of her fellowship, she practiced orthopedic and spine surgery for over three years at the University of Washington in Seattle. In 2007, she left Seattle to work with Medecins Sans Frontieres/Doctors without Borders in Port Harcourt, Nigeria. She then worked as a volunteer consultant at the World Health Organization in Geneva, Switzerland, before starting her position at Emory University, where her focus is on adult and adolescent scoliosis.

In 2009, Dr. Ananthakrishnan co-founded Orthopaedic Link, a non-profit dedicated to improving orthopaedic care in the developing world by mobilization of unused implants from the United States. She is also a candidate member of the Scoliosis Research Society.

Although Dr. Ananthakrishnan routninely performs complex spinal reconstruction surgery, an injury in 2012 caused her to reevaluate her own approach to musculoskeletal health. Her practice philosophy now focuses on strengthening, stretching and general conditioning (“prehab”) as an adjunct to surgical care of her patients.

Related Resources
Are You One of the 7 Million in the U.S. Affected by Scoliosis?

Takeaways from Dr. Boden’s Spine Surgery Chat

Thanks to everyone who joined us Tuesday, August 25, for our live online chat on “When Should You Consider Spine Surgery?” hosted by Scott Boden, MD, director of the Emory Orthopaedics & Spine Center.

If you have been told you need spine surgery, it is important to make sure you have the proper information before electing to have spine surgery. The good news is that less than 10% of patients who experience back or neck problems are actually candidates for surgery.

See all of Dr. Boden’s answers by checking out the chat transcript! Below are a few highlights from the chat:

Question: I have disc degeneration at all lumbar levels, can surgery be performed, if not, what else can be done to relieve pain?

boden-scott

 

Dr. Boden: When there is disc degeneration at all levels and the primary symptom is back pain (and not radiating leg pain), we would typically not suggest surgery. You would have to come in to see a spine specialist to fully address your pain and specific situation, though.

 

Question: If less than 10% of patients who experience back or neck problems are candidates for surgery, why is that?

boden-scott

 

Dr. Boden: The majority of back or neck problems will resolve with time or non-operative treatments such as physical therapy or medications. Only a very small percentage will require or benefit from surgery.

 

Question: Could you walk us through a general sequence of determining whether or not a patient should consider surgery following a disc herniation, PT and epidural steroid injections? Having a hard time sorting out the difference between patience to allow healing and delaying and inevitable surgery now 2 years post injury.

boden-scott

 

Dr. Boden: In general, a disc herniation might need surgery if the primary symptom is radiating leg pain rather than just low back pain.

 

 

The majority of disc herniations – over 90% – resolve on their own within three months. During that time steroid injections, physical therapy and medications can be tried to help relieve pain while the body heals the disc.

If the leg pain persists longer than 3 months than the ideal surgical window is between 3 and 6 months after the leg pain started. You can still get acceptable results after 2 years, but the likelihood of success is slightly smaller.

Watch as Dr. Boden shares more insight into when it’s time to consider back surgery in this Fox5 Atlanta news feature. (Note: this news segment contains advertisements and external links which are not endorsed, administered or controlled by Emory Healthcare.)

At the Emory Orthopaedics & Spine Center, our team of highly-trained spine specialists work together to diagnose and treat cervical spine and lumbar spine conditions ranging from herniated discs to more complex problems such as spinal tumors and scoliosis.

To make an appointment with an Emory spine specialist, call 404-778-3350 or complete our online appointment request form >>

 

 

When is Spine Surgery Necessary?

spine-surgery-chatIf you have experienced ongoing back or neck pain, you may have asked yourself at one point, “do I need surgery?”

Low back and neck pain are common conditions that can range from dull, constant aches to sudden, sharp pains that make it difficult to move. There are many causes of spine pain, including injury, ruptured discs and the normal wear and tear that comes with aging. Some diseases and spine conditions may also cause pain, such as:
– Arthritis
– Scoliosis
– Spinal stenosis
– Spondylolisthesis
– Spondylosis

Seek an evaluation from a spine specialist if your pain is severe or persistent. The good news is that less than 10% of patients who experience back or neck problems are candidates for surgery. Many spine conditions can be treated non-operatively, but if you’ve been told you need spine surgery, it’s important to have the proper information before making a decision.

On Tuesday, August 25, 2015, at noon EST, join Scott Boden, MD, director of the Emory Orthopaedics & Spine Center, for an interactive web chat to discuss when you should — and shouldn’t — elect to undergo spine surgery. Sign up for the chat >>

Sign Up for the Chat

Related Resources
When Should You Consider Spine Surgery?
Emory Orthopaedics & Spine Center
Should You See a Spine Specialist? Take our quiz and find out>>

About Scott Boden, MD

boden-scottScott D. Boden, MD, is Professor of Orthopedic Surgery and Director of the Emory Orthopaedics & Spine Center. Dr. Boden started practicing at Emory in 1992. During his fellowship at Case Western Reserve Hospital in Cleveland, Dr. Boden trained with one of the founding fathers of modern spine surgery, Dr. Henry Bohlman. A primary original researcher on bone growth factor development and spine fusion technology, Dr. Boden is also an internationally renowned lecturer and teacher and the driving force behind the Emory University Orthopedics & Spine Hospital (EUOSH).

 

Dr. Boden’s Clinical Interests:
Dr. Boden’s areas of clinical interest include surgical and nonsurgical management of adult degenerative spinal disorders including herniated discs, spinal stenosis, and spondylolisthesis in the cervical and lumbar spine. He was recently named in another Becker’s list of Top 50 Spine Surgeons in the U.S. and is a skilled surgeon with techniques of microdiscectomy, laminectomy, spinal fusion, and laminoplasty.

The Road to Emory: Education
• Medical School: University of Pennsylvania School of Medicine, Philadelphia, PA 1986
• Internship: George Washington University Medical Center, Washington, D.C. 1987
• Residency: George Washington University Medical Center, Washington, D.C. 1991
• Fellowship: Case Western Reserve University Hospital, Cleveland, OH 1992

Personal:
Dr. Boden is the proud father of triplets who graduated first and tied for second in their high school class. He is also a baseball aficionado and coaches high school and travel softball teams.

Emory Spine Patient Story: “I wanted to walk down my long driveway – I can now.”

By Sara Dollar, Emory Orthopaedics & Spine Center patient

Scoliosis PatientAt the age of 12, I started seeing a chiropractor. In my early teenage years, I was diagnosed with severe scoliosis. Doctors told me that by the time I reached the age of 45, I might not be able to breathe if the scoliosis got bad enough. My spine was shaped like a perfect “S.” I had my first surgery in 1977, followed by several more surgeries. Surgery after surgery left me in excruciating pain. I lived my life, but because my spine was stuck in a bad position, I walked crooked, I couldn’t stand up straight, I couldn’t walk my dogs, and I couldn’t walk five feet without my back spasming. I had become like a hermit crab.

In September 2014, I was referred to John M. Rhee, MD, a spinal surgeon at the Emory Orthopaedic & Spine Center, because I had a very delicate problem that my former surgeons could not handle. Dr. Rhee explained to me what could be done, and I was so excited that I wanted to have surgery on the same day as my office visit! But because my problem was very severe, and the required surgery would be complex, Dr. Rhee asked me to go home and discuss this with my family. I was so grateful for this! After much thought, I decided to have surgery – a lumbar osteotomy, which is a major operation done only at highly- specialized spine centers, like Emory, because of its complexity.

I had done so much research on Emory and Dr. Rhee that even before my first scheduled appointment I knew that I had made the right decision. I felt comfortable. Before I went into surgery, I made some goals that I wanted to attain after my procedures: mainly, I just wanted to live without pain. I am happy to say that Dr. Rhee helped me achieve this!

I had two planned surgeries to correct my severe scoliosis and kyphosis. They were done on January 22 and 23, 2015. Compression on the nerves had to be relieved along with fusion and correction of the deformed areas of the spine. My previous hardware had to be removed and repositioned properly, and a wedge of bone was removed from one of my vertebrae in order to realign my spine so I could stand up straight again. This was a major procedure because I had had multiple prior surgeries that left my spine severely deformed.

At my six week checkup, I was walking without any assistance from a cane, walker or person. I think I surprised Dr. Rhee with how well I was doing and how quickly I had recovered.

While I am still healing, I am not in any pain and am accomplishing all of my goals. I wanted to walk down my long driveway – I can now. I wanted to be able to walk down the beach – I can now. I wanted the freedom of walking into a store to grab some milk and bread without needing or using a shopping cart – I can now. When the time comes, I want to run after my future grandchildren, and because of my surgery, I believe I will be able to.

My advice to others considering spine surgery; do not be afraid, stop living in pain, quit suffering and get your good quality of life back. Surgery is not the answer for everyone, but if it is, I would not trust anyone other than the renowned spine surgeons at Emory Orthopaedic & Spine Center. Thanks to them, I am living well and attaining my goals.

About Dr. Rhee

John Rhee, MDJohn M. Rhee, MD, is a Spinal Surgeon and Associate Professor of Orthopaedic Surgery specializing in cervical spine surgery, lumbar spine surgery, complex spinal deformity surgery (scoliosis and kyphosis) and surgery for spinal tumors. Dr. Rhee is an active researcher and sought-after teacher/lecturer at the national and international level in multiple medical societies. He has served as faculty and been an invited lecturer at numerous meetings and courses on spine surgery. In addition, he has served as Program Chairman at numerous national and international spine surgery meetings. Dr. Rhee has also published extensively in a number of peer reviewed journals and books, and he has received numerous awards and honors. He is actively involved the training of international research scholars and other spinal surgeons and has been the author and editor of major textbooks on spine surgery techniques.

Emory Spine Center Patient: “Dr. Ananthakrishnan is a miracle worker.”

By Renee Godley, patient at Emory Orthopaedic, Sports & Spine Center

Emory Orthopedics PatientIn 1969, I had scoliosis surgery. During this surgery, my spine was fused and a Harington Rod was attached to the muscles in my spine. After the surgery, I was bedridden for six months and in a body casts for a total of nine months. I recovered well and learned how to live with my limitations.

In 1990, I started to suffer from lower back pain. I visited Emory Orthopaedic, Sports & Spine Center, in Atlanta, Georgia and I was informed that I needed to have additional surgery. The wear and tear on my lower three discs had progressed to the point that I would need to have them replaced and fused within 10 years. I said no immediately because I knew the process, I had a three year old daughter at home and I would again, be bedridden for three months and in a body cast that extended down to my right knee. I was unwilling to go through the process a second time. Fear lead me to that decision.

From 2007 until 2012 I saw a pain management orthopedist, which helped me to numb the pain. Then I was advised to see Emory Orthopaedic, Sports & Spine physician, Dheera Ananthakrishnan, MD. Fear once again took hold of me. I had done research and quickly realized I was suffering from Flat Back Syndrome. I read information about the surgeries (two, for a total of at least 12 hours), and started to panic. I finally reached the point where the pain was too much and I just couldn’t take it anymore. I did not want to have surgery and I did not know what to do.

My life had become very restrictive. I could no longer go out to eat or even sit on the living room couch for an extended period of time, rather I had to lie down to lessen the pressure on my spine. I loved attending Georgia football games and could no longer attend any games, the car ride, walk to the stadium and sitting in the stands were beyond my capabilities. I just could not go anymore. My husband wanted to go to the movies, and you guessed it, I could not; I couldn’t do anything.

After much fear, unbearable pain and many days and nights spent crying, my life would soon change. I was referred to Emory Spine Center to see Dr. Ananthakrishnan (Doctor A). Doctor A examined me and ran numerous tests and the diagnosis was, as predicted, Flat Back Syndrome. Although I did not want to have the surgeries, I had no choice. I was scheduled for surgery in December of 2012. For thirty days I was taken off my medications (anti-inflammatories) and realized just how disabled I had become. I was immobile, I couldn’t walk, much less do anything.

On, December 7, 2012, I had surgery at Emory University Orthopedics & Spine Hospital with Dr. Ananthakrishnan that included three replacement discs. A second surgery was held on December 11, 2012 where two rods and 16 one inch titanium screws were placed in my back.

Thanks to Dr. Ananthakrishnan, for the first time in 30 years, I had no pain in my back! This is the best feeling that I’ve felt since I met my husband and got married. Dr. A is a miracle worker. In the two years since my surgery I have begun to walk for exercise, averaging approximately five miles of exercise per day. I went from not walking at all to averaging over 70,000 steps per week.

Everyone I see can’t believe how good I look. I stand straight. I am no longer hunched over. When someone tells me they are experiencing back pain, the first thing I ask them is, “Have you gone to Emory yet?” I would not have the quality of life I have today without Dr. Ananthakrishnan.

A note from Dr. Dheera Ananthakrishnan

I vividly remember the first day that I met Mrs. Godley. She was still so traumatized from her scoliosis surgery all those years ago! I was very worried that she would have difficulty coping with such a large revision surgery. Was I ever wrong! She sailed through two really large surgeries, and has been a textbook patient, inspiring others to follow in her footsteps.

One of the great joys of performing surgery is to see how life-altering it can be for patients who have lived with disability and pain for a long time. Mrs. Godley embodies this for me. It has been my great pleasure to know her and care for her. Now the only tears that are shed during our visits are tears of joy.

About Dr. Ananthakrishnan

Dheera Ananthakrishnan, MDDheera Ananthakrishnan, MD, trained with one of the pioneers of scoliosis surgery, Dr. David Bradford, at the University of California at San Francisco. After completion of her fellowship, Dr. Ananthakrishnan practiced orthopedic and spine surgery for over three years at the University of Washington in Seattle. In 2007, she left Seattle to work with Medecins Sans Frontieres/Doctors Without Borders in Port Harcourt, Nigeria. She then worked as a volunteer consultant at the World Health Organization in Geneva, Switzerland, before starting her position at Emory University. She maintains an interest in developing-world orthopedics through her non-profit, Orthopaedic Link, and is currently involved in projects in the Philippines, Nepal, and Bulgaria.

Dr. Ananthakrishnan’s practice focuses on adult scoliosis and degenerative conditions. She also treats adolescent spinal disorders as well as tumors and cervical conditions. She has been at the Emory Orthopaedic and Spine Center since 2007.

Get the Facts about the Orthopaedic Considerations for Children with Cerebral Palsy

Cerebral palsy (CP) is the most common motor disability during childhood. It is a life-long condition that affects the communication between the brain and the muscles and the condition can cause a variety of motor disabilities and issues. Disability resulting from cerebral palsy can be very mild, with the child appearing to be a little clumsy, to more severe, where the child may be unable to walk. Despite the difficulty with motor control/movement, many children with cerebral palsy have normal intelligence.

Common Symptoms of Cerebral Palsy include:

The signs and symptoms of cerebral palsy vary depending on the type of cerebral palsy, degree of disability, and how each child experiences these symptoms.

• Muscle weakness
• Difficulty controlling the arms or legs
• Shaking of the arms or legs (called spasticity)
• Muscle stiffness in the legs
• Clenched fists

Causes of Cerebral Palsy 
The cause of cerebral palsy is often unknown, but there are some links to premature birth, severe jaundice after birth, and an injury to the brain. If you have any concerns about your child’s development, talk to your pediatrician at your routine visit.

Unfortunately there is no cure for cerebral palsy right now. The best course of action is to manage the symptoms with a team of specialists including an orthopedic surgeon. At Emory Orthopaedics and Spine Center, when it comes to pediatric patients coping with cerebral palsy, we focus on preventing or minimizing deformities.

Orthopaedic Considerations & Risks From Cerebral Palsy:

Limb Shortening 
As a child develops, some children will develop a shortening of the leg and arm on only one side of the body. The difference between the legs can be up to two inches. If the parent notices a shortening, please contact a pediatric orthopedic surgeon who will be able to help determine the degree of difference between the legs and recommend appropriate treatment options. The surgeon may recommend a heel lift that is to be worn in the child’s shoes. A heel lift may also help prevent problems in the hip and spine. A leg length difference left untreated could eventually lead to a curvature of the spine called scoliosis.

Scoliosis
Scoliosis is a curvature of the spine and is very common in children with cerebral palsy. One in five children with CP will have scoliosis so it is very important to see a pediatric orthopaedic surgeon to help monitor it. Scoliosis is usually mild and will not need anything more than regular observation by your doctor. Occasionally scoliosis can worsen and require more extensive treatments.

At the Emory Orthopaedics and Spine Center, we typically use non-operative treatments such as modification of a wheelchair, bracing or casting to minimize the worsening of scoliosis before we consider surgical treatments. Surgery is typically reserved for more severe cases of scoliosis. Emory pediatric orthopaedists Dr. Robert Bruce, Jr. and Dr. Nicholas Fletcher have extensive experience with growing rod and Vertical Expandable Prosthetic Titanium Rib (VEPTR) for the management of severe scoliosis in young patients. These techniques allow for continued growth of the spine in younger children to allow normal development and function. Some older children may need true spinal fusion surgery in order to stop the spine from curving.

Joint Problems
In children with cerebral palsy, it is often difficult to prevent “contracture,” an extreme stiffening of the joints caused by the unequal pull of one muscle over the other. The child will usually work with his or her care team to learn how to stretch the muscles to try to help prevent the joints from stiffening. The orthopaedic surgeon may also recommend braces, casting, or medication to improve mobility in the child’s muscles and joints. Occasionally contractures may begin to cause significant problems in the joints such as an inability to straighten out the leg and stand or a hip which may slide out of the socket. These are problems best managed by a surgeon with lengthening of tendons or perhaps a joint realignment surgery.

Foot Problems
Children with cerebral palsy will often also have difficulties with their feet due to the unequal pull of one muscle over another. These can result in problems with things as basic as getting a shoe on to walking or running. Most patients can be managed with physical therapy or possibly a special brace to hold the foot in a better position. Problems that are more severe may require surgery to rebalance the muscles in the foot or realign the foot so that it functions better.

If you have additional questions about Cerebral Palsy and its implications for pediatric patients, please leave them for us in the comments below.

About the Authors

About Robert Bruce, Jr., MD
Dr. Bruce has been a fixture in the Atlanta community for 17 years having started practicing at Emory in 1995. He is the director of the Children’s Healthcare of Atlanta (CHOA) cerebral palsy program and has a tremendous experience caring for all types of orthopaedic conditions in children with cerebral palsy from the spine to the hips to the feet. Dr. Bruce is also specialty trained in Ilizarov and the treatment of leg length differences and angular deformities. Outside of his clinical duties, Dr. Bruce serves on the CHOA medical board, is the past medical director of Egleston campus, and is currently the head of the orthopaedic team at Egleston hospital.

About Nick Fletcher, MD
Dr. Fletcher has been practicing at Emory since 2010 and cares for all forms of pediatric spinal problems including adolescent scoliosis, neuromuscular scoliosis, congenital scoliosis, early onset scoliosis, kyphosis, and spondylolisthesis. 
He also has spoken locally, nationally, and internationally on his research in scoliosis. His work on adolescent scoliosis has been presented as far away as Japan and he has published multiple studies on early onset and adolescent scoliosis. He also received the 2010 T. Boone Pickens Award for Spinal research for his research in Adolescent Idiopathic Scoliosis. Dr. Fletcher is a current member of the Pediatric Orthopaedic Society of North America’s (POSNA) evidenced based medicine committee and the Children’s Healthcare of Atlanta spinal infection prevention taskforce. His current research on post operative care following spinal surgery will be presented at this year’s POSNA annual meeting in Toronto, Canada.

Dr. Fletcher also specializes in pediatric and young adult hip conditions including hip dysplasia, femoroacetabular impingement (FAI), perthes disease, avascular necrosis, and slipped capital femoral epiphysis. He is one of only a handful of surgeons in the southeast with expertise in the Ganz or periacetabular osteotomy (PAO) for hip dysplasia and the modified Dunn osteotomy for slipped capital femoral epiphysis. He takes care of children of all ages with hip conditions in addition to young adults with hip dysplasia and impingement. He also has extensive experience in hip reconstruction for children with cerebral palsy and hip conditions such as dysplasia, subluxation, or dislocation.

Are You One of the 7 Million in the U.S. Affected by Scoliosis?

Scoliosis, or a curvature of the spine, is a condition that affects almost 7 million people in the U.S. While it does occur in adults, it is most commonly seen in children, especially girls, during periods of growth. Although the deformity is complex and 3-dimensional, often times the spine in a person with scoliosis looks like an “S” or a “C” instead of a straight line.

Scoliosis

Adolescent scoliosis is the most common spinal deformity affecting pre-teens and teenagers, however it does not always result in significant pain or discomfort. Scoliosis may also occur in younger children and is often referred to as early onset scoliosis (EOS) in children less than five years old. EOS may significantly worsen as the children grow and cause severe spinal deformity and problems with the lungs or other internal organs.

Signs & Symptoms of Scoliosis

  • Uneven musculature on one side of the spine
  • Uneven hips, shoulders, or legs
  • Difference in the chest or breast area
  • Slowed nerve action (in some cases)

Causes of Scoliosis

About 65% of scoliosis cases are from unknown causes. Congenital scoliosis (caused by abnormally shaped vertebrae) accounts for about 15% and the rest is speculated to be caused by neuromuscular disease. Some researchers think genetics may play a role in who develops scoliosis, but it is not completely understood at this point.

Scoliosis Treatment Options
At Emory, we typically use non-operative treatments to minimize the worsening of scoliosis before we consider surgical treatments. Surgery is typically reserved for more severe cases of scoliosis. The vast majority of adolescent scoliosis can be managed with non operative measures including careful observation or spinal braces. Our surgeons have access to many local orthotics groups allowing for accurate and effective bracing for scoliosis.

Emory’s Experience in the Treatment of Scoliosis
Emory Healthcare orthopaedic surgeons have tremendous experience in caring for children of all ages with scoliosis. Our physicians are also unique in that they provide care to patients with scoliosis of all ages. When combined with our adult spine center, Emory is the only center in Georgia capable of treating patients from infancy into adulthood.

Emory pediatric orthopaedists Dr. Robert Bruce, Jr. and Dr. Nicholas Fletcher have extensive experience with growing rod and Vertical Expandable Prosthetic Titanium Rib (VEPTR) for the management of severe scoliosis in young patients. These techniques allow for continued growth of the spine in younger children to allow normal development and function. Emory is also one of the few centers in this region offering Mehta casting which is a non-surgical treatment in which the doctor manipulates the spine and then places the child’s torso in a plaster cast. This is especially useful for young children with early onset scoliosis and has been found to actually correct the curvature in certain patients.

Scoliosis Research On the Horizon
Our physicians have been involved in research evaluating opportunities to maximize scoliosis care in children of all ages and assess the long term outcomes of scoliosis surgery. Our research has been presented locally, nationally, and internationally in places as far away as Japan. Dr. Fletcher’s research has focused on clinical outcomes following scoliosis surgery including one of the longest term follow up studies on modern surgical treatment ever published.

Drs. Bruce and Fletcher are currently heading a study highlighting our post operative care following scoliosis surgery which has resulted in discharge 50% faster than the national average without any difference in complications allowing for early return to school for children and work for their parents. Another study is examining discrepancies in access to healthcare and the impact this may have on scoliosis severity.


Dr. Robert Bruce, Orthopedic SurgeonAbout Dr. Robert Bruce, Jr.
Dr. Bruce has been a fixture in the Atlanta community for 17 years having started practicing at Emory in 1995. His interests in spinal conditions include caring for all forms of pediatric spinal problems with an emphasis on idiopathic scoliosis and scoliosis in patients with cerebral palsy and other neuromuscular disease.

He is the director of the Children’s Healthcare of Atlanta (CHOA) cerebral palsy program and has a tremendous experience caring for all types of orthopaedic conditions in children with cerebral palsy from the spine to the hips to the feet. Dr. Bruce is also specialty trained in Ilizarov and the treatment of leg length differences and angular deformities. Outside of his clinical duties, Dr. Bruce serves on the CHOA medical board, is the past medical director of Egleston campus, and is currently the head of the orthopaedic team at Egleston hospital.

Dr. Nicholas FletcherAbout Dr. Nick Fletcher
Dr. Fletcher has been practicing at Emory since 2010 and cares for all forms of pediatric spinal problems including adolescent scoliosis, neuromuscular scoliosis, congenital scoliosis, early onset scoliosis, kyphosis, and spondylolisthesis.

He also has spoken locally, nationally, and internationally on his research in scoliosis. His work on adolescent scoliosis has been presented as far away as Japan and he has published multiple studies on early onset and adolescent scoliosis. His current research on comparing spinal casting and growing rod surgery was recently nominated as a top 10 podium presentation at the Pediatric Orthopaedic Society of North America meeting. He also received the 2010 T. Boone Pickens Award for Spinal research for his research in Adolescent Idiopathic Scoliosis.

Dr. Fletcher also specializes in pediatric and young adult hip conditions including hip dysplasia, femoroacetabular impingement (FAI), perthes disease, avascular necrosis, and slipped capital femoral epiphysis. He is one of only a handful of surgeons in the southeast with expertise in the Ganz or periacetabular osteotomy (PAO) for hip dysplasia and the modified Dunn osteotomy for slipped capital femoral epiphysis. He takes care of children of all ages with hip conditions in addition to young adults with hip dysplasia and impingement.
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