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Left to right: Elizabeth M. Trinidad, M.D.; Zachariah M. George, M.D.; and John A. Grant, M.D., FACS, pediatric neurosurgeons with Neurological Surgery, P.C., outside the Commack office neither physical therapy, medication nor injection therapies. On rare occasion, the condition is congenital; however, Dr. George typically sees this condition in children who are very athletic and participate in activities requiring a great deal of arching. Pars fractures revealed on X-rays suggest this condition; if seen, Dr. George says patients should be referred for evaluation. To facilitate diagnosis, Dr. George conducts a full office workup, including a single photon emission computed tomography (SPECT) scan — if X-rays reveal multiple pars defects — to provide a timeline and determine areas of greatest sensitivity. An MRI may reveal herniated discs, and a computed tomog- raphy (CT) scan is used to analyze any associated bony anatomy. In the case of congenital spondylosis, coexisting spinal anomalies such as spinal bifida occulta may be present. These can be detected by using X-rays and flexion/extension exams, which involve positioning the patient with the spine bent forward and then extended backward to identify any vertebral movement due to a pars defect. Typically, Dr. George says, spondylosis can be treated conservatively. Pain management is usually required, along with TLSO bracing, which can also help with pain. If a patient with spondylosis presents with a herniated disc or bony changes in the anatomy — or in the event one vertebra moves over another, a condition called spondylolisthesis — Dr. George recommends fusion surgery. If the patient has no additional spinal defects, Dr. George usually opts for a simple pars repair, involving the placement of screws into the fractured vertebral body to promote fusion. This approach will not limit the patient's postsurgical range of motion. An Expert Team of Support At Neurological Surgery, P.C., physi- cal therapists and pain management physicians are available to work with Dr. George to give precise updates on his patients, when necessary. For children who undergo back surgery for these conditions, however, rehabilitation is usually not necessary, according to Dr. George. "For the most part, kids will not need significant rehab for scoliosis, Scheuermann's kyphosis or spondylosis procedures," says Dr. George. "We recommend they stay away from the BLTs — bending, lifting and twisting activities — while their bones heal and fuse. We have physical therapists and pain management physicians who give us up-to-the-minute updates on our patients. We have pediatric neuro- surgeons to address the rare instances in which scoliosis is associated with a tethered spinal cord." Symptoms of neurological conditions present an anxious and confusing situation for parents, and the possibility of neurosurgical intervention can be a frightening proposition. Communication and teamwork between the specialists at Neurological Surgery, P.C. and referring physicians can assuage the fear of the unknown and foster the most effective treatment plans for each patient. "The doctors at Neurological Surgery, P.C. are available and present to help," says Dr. Trinidad. "Neurological condi- tions present a scary reality because there are a lot of unknowns. Working together with referring physicians as a team, we can solve complex problems, but communication is important. Physicians should not hesitate to ask questions." For more information about Neurological Surgery, P.C., please visit www.nspc.com. s MDNEWS.COM s MD NEWS Long Island | 19