MDNews - Long Island

because of compliance issues. Although braces have become less cumbersome and can be worn beneath clothing, children often remove the braces as soon as they get to school. To remedy this, braces designed to be worn only at night are recommended. Surgery may be necessary for grow- ing children whose spinal curvature is greater than 45º or for skeletally mature adolescents with a curvature greater than 50º. Dr. George points to improved surgical techniques that provide more direct and minimally invasive access to the patient's spine as a major development. In the past, sur- geons would go through the patient's chest to fuse vertebra; now, using pedicle screws, surgeons avoid the comorbidities of moving through the chest cavity by performing short segment fusion via an incision in the patient's back. This approach also diminishes the need for thoraco- plasty — a procedure to shorten certain ribs to alleviate a rib hump that may be present with a spinal curve — which Dr. George says has been shown to affect pulmonary function. In cases involving severe spinal curvature and deformities, a larger procedure utilizing both anterior and posterior approaches may be utilized, and in some circumstances, verte- bral resection is necessary, explains Dr. George. Short segment fusion procedures are preferred to limit stiff- ness and decreased range of motion that can result from longer fusions affecting the fusing of multiple levels of the spine. Patients with thoracic and compensatory lumbar curves, Dr. George says, can be treated with the shorter fusion because the lumbar curve follows the structurally fixed thoracic curve. Longer fusion proce- dures may be necessary to achieve a positive outcome in cases of thoracic curves in conjunction with structural lumbar curves. Because the majority of children and adolescents present with thoracic NEUROSURGEON SPOTLIGHT + Elizabeth M. Trinidad, M.D., earned her medical degree at The University of Texas Health Science Center at San Antonio. She later completed a surgery internship at University of Connecticut and served as Chiari/syringomyelia clinical research coordinator at State University of New York Health Science Center at Brooklyn. Dr. Trinidad completed her pediatric neurosur- gery training as part of a fellowship at University of Colorado/The Children's Hospital. + John A. Grant, M.D., FACS, attended the Medical School of the Royal College of Surgeons in Ireland, where he earned his medical degree. He performed his general surgery internships in Dublin and at Johns Hopkins Hospital. Dr. Grant completed a neurosurgery residency at Neurological Institute of New York at Columbia University and a pediatric neurosurgery fellow- ship at Children's Memorial Hospital in Chicago. + Zachariah M. George, M.D., earned his medical degree at Upstate Medical University, College of Medicine in Syracuse, NY. He completed a surgery internship as well as his neurosurgery resi- dency and chief residency at Mount Sinai School of Medicine in New York City and a fellowship in complex orthopedic spine surgery at Beth Israel Medical Center, Spine Institute of New York. Dr. George evaluates a patient. The neurological examination is a very important aspect in the evaluation of any patient with spinal deformity and determines whether additional imaging is required. and lumbar curvatures, Dr. George explains, alternative procedures to avoid fusion surgery are rarely per- formed on pediatric patients. If an adolescent is referred with isolated lumbar scoliosis, Dr. George may perform direct lateral fusion to correct the spinal curvature. This involves making a small incision in the patient's side through which instrumentation is introduced to multiple levels of vertebrae. The patient is then turned face down and, through small incisions at different locations, Dr. George inserts screws and rods into the spine, segmentally correct- ing the deformity by restoring normal lumbar curvature. Fixing the 'C' Kyphosis, the natural 'C' shaped round- ing of the thoracic spine, is evident when viewed from the side. Scheuermann's kyphosis, a condition in which the normal roundback or humpback in the upper spine (called a kyphosis) is increased, can be identified on a thoracic MDNEWS.COM s MD NEWS Long Island | 17

• Cover