FIGURE: Scoliosis presentation similar to that of the patient in this case.
A pediatrician observed an unnatural curvature in the spine of a 10-year old girl that appeared to be early evidence of scoliosis. After conferring with the patient’s parents, the physician referred the patient to Duke for further assessment.
Question: What novel procedure did a Duke orthopaedist perform to promote more natural growth of the young patient’s spine and preserve future flexibility?
FIGURE: Vertebral tethering procedure in a patient with scoliosis. A polypropylene rope is used to promote a convex curve.
Answer: Robert K. Lark, MD, MS, a pediatric orthopaedic surgeon who also specializes in spine procedures, performed a vertebral body tethering procedure. Approximately 10 such surgeries have been performed in the United States.
The growth modulation technique is designed to promote straighter, more natural spine growth in young patients with scoliosis. During the procedure, the surgeon uses a polypropylene rope to tether the spine to promote a convex curve, Lark says. Because of the spine’s natural growth, its concavity eventually catches up with the convex curve.
“This is a way to modify the growth of the spine and avoid spinal fusion,” Lark says. “We are able to adjust the angular deformity with a tether that can be removed at the appropriate time.”
Lark and the patient’s parents are pleased with the outcome and prognosis 3 months after surgery. “We are already seeing that her waistline has straightened out and her shoulders are not protruding as far,” Lark says. “She’s had a very successful outcome.”
Vertebral body tethering remains a relatively rare procedure, Lark says. Only 2 academic medical centers in the eastern United States are able to offer the option to appropriate candidates.