Pediatric Connection - Hospital for Special Surgery

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Pediatric Connection - Hospital for Special Surgery

Pediatric Connection

A PUBLICATION OF THE PEDIATRIC MUSCULOSKELETAL DEPARTMENT OF HOSPITAL FOR SPECIAL SURGERY

VOLUME 2 – ISSUE 3

SPRING 2010

MEDICAL STAFF

Pediatric Orthopedists

John S. Blanco, MD

Shevaun M. Doyle, MD

Daniel W. Green, MD

Cathleen L. Raggio, MD

Leon Root, MD

David M. Scher, MD

Roger F. Widmann, MD

Pediatricians

H. Susan Cha, MD

Lisa S. Ipp, MD

Stephanie L. Perlman, MD

Pediatric Rheumatologists

Alexa B. Adams, MD

Thomas J.A. Lehman, MD

Emma Jane MacDermott, MD

Pediatric Anesthesiologists

Victor M. Zayas, MD

Chris R. Edmonds, MD

Andrew C. Lee, MD

Kathryn (Kate) DelPizzo, MD

The Connection Inspection:

Teen from China Finds Help and Hope at HSS

by Adrienne Stoller, MA

“Dear Dr. Blanco:

Do you remember me? I am your patient Xiu

Qin Chen. I did my scoliosis surgery in June.

Today is Thanksgiving. For this special day,

I want say ‘thank you’ to you. Thank you for

giving me a new life.”

John Blanco, MD, Associate Attending

Orthopaedic Surgeon at Hospital for Special

Surgery, received Xiu Qin’s email message

(excerpt above) at a time that not only underscored

the meaning of Thanksgiving, but also emphasized

the impact of modern medical technology. “Her

message reinforced how we, as physicians and

surgeons, can make a tremendous difference in the

lives of our patients,” noted Dr. Blanco.

A Long Journey

Diagnosed in China with scoliosis at age 14

years, Xiu Qin suffered from impaired mobility

and constant pain. For Xiu Qin, regular activities

of daily living, such as lifting, bathing, sitting

and walking, became more difficult over time.

She was unable to stand erect and depended on

others for mobility. Compromised healthcare

resources in her region of China precluded

Xiu Qin from appropriate medical care.

“We were told that Xiu Qin should have surgery,

but that it was too risky,” explains Xiu Qin’s

mother. “I wished so much for my daughter to

PRE-SURGERY

POST-SURGERY

have a healthy and happy life.” In 2008, this

mother’s hope for her child became possible,

when the Chen family immigrated to New York

City and learned of the expertise at HSS.

Referred to the Hospital by her family physician,

Xiu Qin received a thorough evaluation by a

multidisciplinary team, including orthopedics,

genetics, and rheumatology. “She came to us

complaining of chronic back pain, but it was

much more complicated,” recalls Dr. Blanco.

“Xiu Qin presented with a severe scoliosis

that we do not commonly see, requiring a

comprehensive team approach to her care.”

Scoliosis is a progressive curvature of the spine

seen in both children and adults. The condition

is considered severe, and surgical intervention

(Continued on page 3)

Hospital for Special Surgery is an

affiliate of NewYork-Presbyterian

Healthcare System and Weill

Cornell Medical College.

For more information about HSS

Pediatrics, visit http://www.hss.edu

The Pediatric Orthopedic

Service provides coverage

to the Phyllis & David Komansky

Center for Children’s Health at

NewYork-Presbyterian Hospital.

For more information about

the Komansky Center, visit

http://www.cornellpediatrics.org

Getting back in action: Xiu Qin Chen at work with HSS physical therapist, Lisa Cannegieter.


Why sedate children

for MRI examinations?

by Li Foong Foo, MD, MRCP, FRCR

Magnetic Resonance Imaging (MRI) is an

ideal diagnostic imaging test in the pediatric

age group. It has the advantages of improved

inherent tissue contrast, absence of ionizing

radiation, and direct multiplanar capabilities.

However, MRI is also a long examination.

Any movement during MRI will degrade

image quality and often require repeated

image acquisitions, thereby prolonging

the examination.

At HSS, we have found that adequate sedation

minimizes the motion degradation of images

and need for image re-acquisition, allowing

for shorter imaging time. Sedation of pediatric

patients is performed by a speciality-trained

pediatric anesthesiologist-led team at HSS,

with strict attention to safe practice, routines,

and procedure.

Prior to MRI, parents and/or caregivers of

pediatric patients who will undergo image

testing are given complete information

about the exam, including reasons for

recommended sedation.

Save the Date!

Pediatric Orthopaedics for

the Primary Care Provider 2010

November 19, 2010

LOCATION

Hospitalfor SpecialSurgery

Richard L. MenschelEducation Center, 2nd Floor

535 East 70th Street | New York City

INFORMATION

www.hss.edu/cme | 212.606.1613

Programs Promoting

Musculoskeletal Health

Non-Surgical Treatment for Spinal

Deformities: Scoliosis Bracing

by Andrew Tse, CO

Scoliosis braces are designed to stop

the progression of side bending spinal

deformities in growing children. Patients

who have curves measuring between 20

and 40 degrees with growth remaining may

require a scoliosis brace also known as a

thoracolumbosacral orthosis (TLSO).

The goal of bracing is to prevent further

curve progression while the patient grows,

avoiding the need for surgical correction.

Once skeletally mature, patients no longer

require brace treatment.

Depending on the curve pattern, the physician

may prescribe a full-time brace (e.g., Boston

brace) or a night-time brace (e.g., Charleston

bending brace). As a result of extensive study,

these two types of braces have been shown to

be an effective and conservative means to halt

progression of the spinal deformity.

Boston Brace

The Boston brace is a full-time TLSO for non-operative treatment of

idiopathic scoliosis that is made using a custom-made plastic module

fitted with foam pads and trimmed asymmetrically with relief windows,

an armpit extension, as well as hip extensions to counter specific curves

and to set the spine in a balanced position. Developed in the 1970s, this

therapeutic approach was an answer to the difficulties patients had with

wearing a Milwaukee brace. The difference is in the design.

The Boston brace is an underarm plastic brace worn under clothing,

while the Milwaukee brace is fabricated with a neck ring and vertical

metal struts attached to a pelvic girdle and could not be concealed under

clothes. Since its introduction, the Boston brace has been found to be just

as effective as an underarm brace to control curve patterns below the

shoulder blades when compared with the Milwaukee brace. It manages

single as well as double curve patterns effectively and is currently the gold

standard in full-time scoliosis braces.

Charleston Bending Brace

The Charleston bending brace is a part-time TLSO worn at night during

sleep. It is as effective on lower single curves as the Boston brace.

Essentially, the brace holds the torso in an overcorrected bending position

directly opposing the scoliosis curve. The patient sleeps on the back or

the belly while bending to their left or right side. Many patients may find

this brace more appealing because they spend less time in it and, more

importantly, it does not need to be worn to school.

No matter the chosen method, successful bracing is best achieved by a

team approach. The physician, orthotist, patient, and family all play an

important role in treatment. The physician will monitor the patient’s

progress throughout the treatment and the orthotist will make periodic

adjustments to the brace due to growth or increased flexibility. Moreover,

the patient should understand the process and the importance of wearing

the brace to maximize compliance and minimize anxiety. Good family

support is also essential to the physical as well as the emotional well-being

of the patient to achieve optimal results.

2


Teen from China Finds Help and Hope at HSS

(Continued)

is recommended, when a spinal

curve is greater than 50 degrees.

In Xiu Qin’s case, the curvature was

over 90 degrees.

Dr. Blanco recommended surgery

for Xiu Qin as the best option for

correcting her spine and alleviating

pain. “Traditionally, the goal of

Xiu Qin Chen scoliosis surgery was to prevent

the curve from getting worse, but now we can dramatically

improve the spinal deformity during surgical correction,” explains

Dr. Blanco. Dr. Blanco also points out that in patients like

Xiu Qin, in which scoliosis measures more than 80 degrees, lung

and heart function also may be compromised. For this reason,

spine correction not only can improve a patient’s quality of life,

but also preserve it.

Extremely frail and underweight, Xiu Qin began a year-long

process of preparing for surgery, with the assistance of many

HSS patient services, including language services, food and

nutrition, patient education, and social work. “What comes

to mind is the dedication of Xiu Qin’s family and their endless

cooperation,” says Amy Silverman, LCSW, ACC Social Worker

in Pediatrics. “In particular, I was struck by their level of

patience with all the steps needed to make sure that Xiu Qin

had her surgery.”

Formula for Success

Although anterior and posterior surgery of the spine is often

performed simultaneously, Xiu Qin’s scoliosis condition and her

weakened constitution required two operations which included

nearly 10 days of recovery time in between procedures.

“Same-day front and back operations are long, about 14 hours,

but lead to less overall time spent in the hospital,” explains Dr.

Blanco. “For Xiu Qin, however, the magnitude and duration of

the operation, the amount of blood loss anticipated, combined

with her still frail medical condition presented too great a risk.”

At 16 years of age, Xiu Qin underwent her first operation on

June 3, 2009. The procedure consisted of releasing the ligaments

and discs in the front of the spine to increase the flexibility of her

curve. During the second operation, on June 12, Dr. Blanco

attached two metal rods to Xiu Qin’s spine, using hooks and

screws attached to the vertebral bodies. Rods attached to the

spine ensure that the backbone remains corrected while the spinal

fusion takes place. Bone graft material is used to solidly fuse

the spine. The rods remain attached to the spine for the rest of

a patient’s life.

Due to the complex nature of the surgical procedure,

Dr. Blanco requested the assistance of Dr. Michael LaQuaglia

from Memorial Sloan-Kettering’s Pediatric Surgical Service.

Dr. LaQuaglia is a leading specialist in anterior spinal surgical

approaches. His expertise ensured that the vital organs

surrounding Xiu Qin’s spine were carefully manipulated during

surgery and blood loss was tightly controlled. Following the

operations, Xiu Qin was transported next door to the Pediatric

ICU at NewYork Presbyterian Hospital-Weill Cornell Medical

Center for intensive monitoring.

“From initial evaluation to post-operative management, cases like

Xiu Qin’s truly speak to the multidisciplinary, cross-institutional

approach to patient care at HSS,” says Dr. Blanco. “It is extremely

important that we share expertise and resources to achieve the

best possible outcomes for our patients.”

Rehab and Recovery

Xiu Qin was on her feet and taking the first steps toward

rehabilitation the day after her second surgery. With a height

gain of three inches (from 5 ft 3 to 5 ft 6), she was among the

few patients who required temporary post-operative bracing to

provide extra support to the spine due to her weakened bones.

Xiu Qin was sent home only one week after the second surgery.

She then began a comprehensive program of pain management,

nutrition, and physical therapy—a regimen which continues today.

“At the start of post-operative therapy, Xiu Qin presented with

a great deal of weakness and decreased endurance. She lacked

flexibility and looked down while walking,” recalls Lisa

Cannegieter, PT, DPT, a rehabilitation specialist at HSS.

“Now she is moving with greater ease, better control, and is

standing proud.” Xiu Qin’s twice weekly rehabilitation includes a

consistent routine of balance and strength training as well as lowimpact

cardiovascular activity and a daily home exercise program.

Alongside rehabilitation, Xiu Qin also receives treatment for an

underlying rheumatologic condition discovered during her initial

evaluation. The need for further surgery remains to be seen, but

thus far Xiu Qin’s prognosis is promising. “The progress Xiu Qin

has made since her first visit has been remarkable,” says Dr.

Blanco. “Her body and will to succeed are strong and getting

stronger everyday.” Today, at 18 years, Xiu Qin is a successful

high school student in Brooklyn, where her family has established

their new home. “I owe my second life to Dr. Blanco and

everyone who helped me at the Hospital,” says Xiu Qin. “As the

Chinese saying goes, ‘sunshine always follows the storm.’”

3


535 East 70th Street

New York NY 10021

NON-PROFIT ORG.

U.S. POSTAGE

PAID

LAKEWOOD, NJ 08701

PERMIT NO. 186

Pediatric Connection

A PUBLICATION OF THE PEDIATRIC MUSCULOSKELETAL DEPARTMENT OF HOSPITAL FOR SPECIAL SURGERY

Question of the Quarter

Can a patient’s saliva be used to predict curve

progression in adolescent idiopathic scoliosis?

By Shevaun M. Doyle, MD

Q& A

When initially diagnosed with idiopathic scoliosis, patients

between the ages of 9 and 13 years can undergo a simple genetic

test to help determine the likelihood that their curve will progress.

The genetic test is called the ScoliScore TM test, which extracts

DNA from a patient’s saliva. The DNA contains specific genetic

markers that are analyzed and scored. A high score would indicate

a high number of genetic markers, hence a higher likelihood that

the scoliotic curve will progress with skeletal growth. In addition

to a thorough history, physical examination, and radiographs,

the ScoliScore TM test can provide the physician with additional

information to help individualize treatment recommendations

based on risk of progression.

www.hss.edu/peds

Editor

Shevaun M. Doyle, MD

For inquiries, please call (877) HSS-1KID

or e-mail: Peds@hss.edu

The HSS Pediatric Musculoskeletal Department:

First Row (from left): David M. Scher, MD; Cathleen L. Raggio, MD;

Shevaun M. Doyle, MD; Roger F. Widmann, MD; Leon Root, MD.

Second Row: H. Susan Cha, MD; Victor M. Zayas, MD; Lisa S. Ipp, MD;

Stephanie L. Perlman, MD; Thomas J.A. Lehman, MD; Daniel W. Green, MD;

John S. Blanco, MD. Third Row: Emma Jane MacDermott, MD; Andrew C.

Lee, MD; Kathryn (Kate) DelPizzo, MD; Chris R. Edmonds, MD;

Alexa B. Adams, MD.

©2010 Hospital for Special Surgery.

All rights reserved.

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