Standing Tall – Orthopedics (Scoliosis Center)
December 22, 2008
Imagine a six-year-old going to a birthday party and not being able to throw off her shoes and jump in a bounce house or swing a bat at a rainbow-colored piñata, waiting blindfolded for that wellspring of candy.
“That’s the day the fun stopped.”
That day was Dec. 10, 2007, said Victoria, now 7, who was sidelined by the diagnosis of congenital scoliosis as a first-grader. This condition, which is an abnormal curvature of the spine, would ultimately require three surgeries recommended by Dr. Peter Newton of the Pediatric Orthopedic and Scoliosis Center at Rady Children’s Hospital.
Dec. 10, 2007 was her first surgery, lasting approximately six hours, where Newton removed two abnormally-shaped vertebra and performed a limited fusion, which involves joining two pairs of vertebrae with screws and rods, called instrumentation. Victoria’s condition was discovered when she changed pediatricians and was having a yearly check-up last year. Her mother, Jovita, admitted surprise as Victoria was her youngest and third child and didn’t know much about this condition or signs or symptoms to look for. Victoria’s type of scoliosis cannot be passed onto her offspring, said Newton.
After the first procedure, Victoria left the hospital after six days and was required to wear a thoracolumbar orthosis, known as a plastic fitted body brace to keep her spine aligned and allow it to heal. Jovita said she was required to wear the brace for eight to 12 hours per day. Victoria was allowed to choose the pattern of the body brace and elected her favorite colors of purple and pink hearts.
Despite the cheery-looking body brace, life as Victoria knew it instantly became non-existent. The once active girl, involved with dance, monologue and acting classes since age 3, and who used to travel with her mom to Los Angeles on auditions was now only offered the choice of swimming as an extracurricular activity. The vibrant brunette, who now flashes a jack-o-lantern smile, is represented by Abrams Artists Agency, had to immediately halt all trips to L.A. since her surgery.
Children are resilient, but so many new changes had taken place in Victoria’s life recently. Her family had relocated from Santee to Eastlake. Changing neighborhoods, schools and doctors... now this? In fact, when Victoria’s diagnosis happened, they were only given four months to wait for the first surgery date. There wasn’t a choice of whether the surgery was going to happen, Jovita said, but when. (Newton said had the surgery not occurred, her growth would have continued “increasing deformity of her back and bent trunk.”) But having two spinal surgeries within three months of each other? She expressed that had Victoria not been “so strong, brave and understanding” she doesn’t think she could have been as strong as she was, too. She credits her close-knit family, including husband Jose, Sr. son Jose and wife Hivi, grandson Jaden, and son Danny with round-the-clock support during both recovery periods.
The second surgery was Mar. 10, where Newton changed the rods from the first surgery to plan for healing of the bone and fusion of upper spine when her growth is completed. Victoria was in the hospital only three days following this second surgery, which lasted 3 to 4 hours, her mom said. Victoria proudly admitted (and to everyone’s surprise) no pain medication after this surgery!
According to Newton, her third surgery will involve another fusion with instrumentation (rods and screws) of her upper spine curve but this last surgery is “years” away from being scheduled. And that’s good news for Victoria, who welcomed the fun back to her life on Aug. 20, 2008 when Newton reviewed X-rays and released Victoria from wearing her body brace. She won’t have to wear a similar body brace after her third and final surgery, confirmed Newton.
Being sidelined with scoliosis allowed Victoria to redirect her energy to other pursuits, like swimming and reading. Her mom reported one day calling out for Victoria and when her daughter, an otherwise spirited and articulate child, didn’t respond, she started to look for her around the house. Jovita discovered that her daughter had completely rewritten her favorite author, Seuss’tale, “Green Eggs in Ham,” verbatim without the aid of the book. Dr. Seuss, it turns out, continues to be Victoria’s favorite author as she enjoys her second grade year at Liberty Elementary School.
Long-term, Victoria has a healthy outlook, despite her spinal condition and recent surgeries, says Newton. He predicts limited trunk motion (flexibility) for Victoria when it comes to certain types of sporting activities, but acknowledges that she should otherwise have no limitations in future activities. So, Victoria’s forecast for fun looks pretty bright!
Orthopedic Biomechanics Research Center helps surgeons improve patient care
The Orthopedic Biomechanics Research Center (OBRC), commonly referred to as the Biomechanics Lab, is not your average resource center. In fact, it’s not for patients, but for doctors. But what it translates to is better patient care as surgeons at Rady Children’s Hospital can try out new techniques or modify their own with this internal resource available at the Serra Mesa campus.
About 60 percent of the work performed at the Biomechanics Lab revolves around spinal deformity correction, explained Tucker Tomlinson, former OBRC director. (Arnel Aguinaldo became the director as of July 31.)
For example, Dr. Peter Newton, who performed Victoria’s surgeries for her congenital scoliosis, (see main story) is working on research including minimally invasive-endoscopic fusion techniques, instrumentation system development for infants, small children and adolescents and non-fusion treatment strategies to eliminate or reduce the need to perform fusion (growth and motion maintained).
Research, like that of Newton’s, is performed by approximately 95 percent of local surgeons, Tomlinson said. In addition to spinal research, the remainder of research is divided into sports medicine, knee, shoulder and other joints, he added.
Testing usually involves cadaveric tissue to examine the affects of two different repairs on a specific type of defect, according to Tomlinson. With the help of a sophisticated materials testing machine, doctors can apply the precise controlled load to each sample and see the end result or motion, he said.
“The analysis of these loading and motion patterns allow us to identify the relative advantages and disadvantages of each repair.” Tomlinson said. “This information, in turn, allows the surgeons to make more informed choices of treatment taking into account the specific needs of each patient.”
Originally published in Kids’ NewsDay, San Diego Union-Tribune,
October 7, 2008.