Special to the Tribune
ust six months after undergoing surgery to straighten her curved spine, 10-year-old Raven Willis jumps rope double Dutch. The Evanston 5th grader had adolescent idiopathic scoliosis, a common cause of spinal curvature that can lead to uneven shoulders, poor posture and even lung disease if not treated.
Last November, Raven had short segment spinal instrumentation and fusion surgery, a new procedure revolutionized in Japan and performed by a handful of orthopedic surgeons in the U.S., including Dr. Eldin Karaikovic and his spine team at Evanston Northwestern Healthcare. Physicians fuse as short a spine segment as possible, resulting in greater range of movement, less pain and faster recovery than the traditional procedure, which fuses more spine.
Although scoliosis affects boys and girls, it is more common in girls. Studies indicate that about 2 percent of teens over 14 have some sort of curve, but only 10 percent of those will require some form of treatment. The condition usually is detected by a physician during a routine physical exam or during a school screening. Some states require screening in school, but Illinois does not.
Scoliosis is characterized by an S- or C-shaped curve. The new technique can treat either curve. S-shaped curves have a major curve and a compensatory, or minor, curve that develops in response to the major curve to keep the head in balance.
“The beauty of this new technique is that in S curves, if you correct the larger curve, the smaller curve corrects itself,” Karaikovic said.
In the traditional procedure, surgeons make an incision in a patient’s back and straighten the spine by fusing several vertebrae. Due to the length of the fusion, this approach restricts a patient’s flexibility and spinal range of motion.
The short-segment technique involves an incision either in a patient’s chest or abdomen and implantation of a series of screws and rods between the vertebrae at the most prominent part of the curve, the apex. In most cases, this technique results in a fusion that is half the length of a traditional procedure.
Candidates for the new technique are children who failed treatment with a brace or whose curve is large with the potential to progress. Most patients are 15 to 18.
“We consider a patient’s age, potential for growth and the stiffness and size of the curve,” Karaikovic said.
When surgeons enter through the chest or abdomen, they are better able to reach the most curved part of the spine, said Karaikovic. They can then fuse a shorter segment and preserve flexibility and range of motion for the rest of the spine. “When you enter from the back, it’s harder to control the spine, so you have to fuse more of it.”
Another advantage to entering from the front, or anterior, is reduced pain after surgery. When physicians access the spine from the back, they must strip muscles from the bone and pull them to the side, Karaikovic said. This can cause significant pain from scarring and decreased spinal range of motion.
When Raven saw her doctor for a school physical last June, he noticed the curvature and recommended she see an orthopedic surgeon.
“I was kind of surprised,” she said, because she had no symptoms. Bracing was not an option because her curve was large, stiff and had the potential to progress due to her age, Karaikovic explained.
“When we saw the X-ray after surgery, Raven’s spine was almost perfectly straight,” said her mother, Denise Jackson-Willis. Healing was fast. Three weeks after surgery, she walked four blocks. After five weeks, she returned to school part time.
“It was a little scary,” Raven said of the experience. Two weeks after surgery, she began six weeks of physical therapy. She’s once again playing basketball and other limited gym activities at school. She’s also excited to show her science classmates what scoliosis looks like using a model of the spine that Karaikovic lent her. There was an added surprise for her classmates: Raven was 2 inches taller after surgery. She’s 5 feet tall now.
Risks are the same as with any spine procedure, including infection, injury to vessels and nerves, paralysis and excessive bleeding. Some experts remain cautious until there is more experience with the technique.
“Certainly it seems attractive to fuse less of the spine,” said Dr. Paul Sponseller, director of the division of pediatric orthopedic surgery at the Johns Hopkins Children’s Center in Baltimore. “The only drawback is that sometimes, if one cuts corners by not fusing the whole curve, the parts that are not fused will curve more. This is especially true in the lower curve. Due to the lack of long-term experience with this technique, we do not know the implications of this.”
Whether this new procedure will overtake the traditional surgery remains to be seen.
“I do not think there is enough evidence that it will help with most curves,” Sponseller said. “There is little written on it, and it depends on how reproducible and applicable it is to many different types of curves.”
Those interested in the procedure can call 847-570-2825.