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Innovative Non-Surgical and Surgical Procedures

At Shriners Hospitals for Children — Northern California, a multidisciplinary team carefully evaluates each child, advising patients and their families on the most effective treatment options for treating their scoliosis or spinal curvature. Minimally and non-invasive options are typically the first line of treatment. Surgical options are available when necessary.

Non-Surgical Procedures for Pediatric Spine & Scoliosis

Bracing

Scoliosis Correction with Bracing

Bracing can improve some spinal curves with superior results. The on-site Pediatric Orthotics and Prosthetics Services (POPS) lab works closely with the pediatric spine team to make custom braces and monitor fit and growth while paying special attention to the patient's lifestyle. Having a “one-stopshop,” where patients’ conditions and braces are monitored simultaneously, offers greater convenience and an overall better experience to patients and their families. Our team of specialists, including orthopedic surgeons, nurses, orthotists and physical therapists, collaborate to ensure each treatment plan results in the best possible outcome.

Bracing with 3D Modeling

Viewing the spine in 3D provides an accurate representation of the curve. The 3D modeling improves on traditional 2D measurements that can underestimate values used to diagnose, monitor progression and guide treatment. Using the EOS Imaging System software available at Shriners Hospitals for Children — Northern California, technicians create 3D models, in many cases eliminating the need for repeated plaster casting. The EOS System’s upright 3D measurements also allows the team to evaluate weight-bearing impact, better guiding treatment with braces.

Rigo Cheneau Brace

Rigo Cheneau braces are custom designed with compression and breathing points. The brace applies force to the areas that will decrease curves and rotation, but does not touch the body in other areas, comfortably and effectively reducing or halting the progression of spinal curvatures. Advanced CAD/CAM technology creates a digital blueprint for the custom braces, designed and fitted by hospital orthotists. Rigo Cheneau braces are lightweight and thin. Patients find them comfortable to wear, increasing compliance to their bracing regimen.

Nighttime Bracing

Wearing a brace up to 23 hours a day is challenging for many patients. Nighttime braces are a more palatable option, eliminating the social anxiety of daytime wear. The Pediatric Spine team evaluates patients for nighttime bracing, developing an effective program for children and adolescents with certain degrees and types of curves, and for patients who have been noncompliant with bracing in the past

Pediatric Orthotics and Prosthetics Services (POPS) Lab

Every year, orthotists design and make more than 350 braces onsite at the Pediatric Orthotics and Prosthetics Services (POPS) lab. Located on the hospital’s second floor, the patient often goes directly from their doctor’s appointment to the POPS lab to be fitted for a brace. 3D scanning and CAD/CAM technology offer the most advanced brace fabrication in the area. The patient care team works side-by-side with the orthotist, making a true team approach possible. Because young patients grow and change quickly, adjustments and new braces are often required quickly and frequently to achieve a correct, effective fit. When families aren’t able to return onsite for adjustments, they can mail in pieces of the brace that require repair instead.

Customized Bracing Regimens

Because patients with scoliosis have different types and degrees of curve, combined with their changing size, age and curve progression, highly individualized bracing regimens are vital for effective curve correction. Our onsite POPS lab creates a variety of braces. Physicians adjust the regimen based on the patient’s needs and tolerance. With optimal fit and close monitoring, many patients achieve significant curve improvement without surgery.

Elongation, Derotation, Flexion (EDF) Casting

Also known as Mehta casting, EDF casting is a technique for early-onset scoliosis and is most effective for children up to age five. A series of custom-made, thoracolumbar casts offer three-dimensional correction and can control the evolution of the curve in some children. In some cases, it is possible to achieve complete correction (cure). When EDF lessens the degree of the curve, it makes additional treatment more effective when the child grows older.

Casting regimens can achieve excellent results. We do an especially great job of caring for pediatric patients and the less ordinary sorts of scoliosis you might see. We’re well-equipped in this area.

Dr. Joel Lerman

Pediatric Orthopedic Surgeon

Shriners Hospitals for Children — Northern California

Surgical Care

When less invasive options are exhausted, physicians may advise a surgical approach. The least invasive surgical techniques are preferred.

MAGEC Growing Rods

The MAGEC™ (MAGnetic Expansion Control) System is a surgical treatment option for children with significant spinal curves. Expandable rods are surgically implanted on each side of the spine. A magnetic component in the center of the rod allows lengthening during quick and painless outpatient procedures, performed every three to six months by the orthopedic surgeon. Most patients are discharged two to three days after surgery and return to full activity in about six weeks.

MAGEC is a less invasive alternative to spinal fusion or traditional growing rods. Patients experience fewer surgeries and achieve long-term curve correction with retained spinal flexibility. Our orthopedic surgeons are skilled and experienced in the effective and safe implantation and use of MAGEC rods.

Candidates for MAGEC have significant, progressive scoliosis that cannot be controlled with bracing or casting. It is ideal for patients who are still growing, too young for spinal fusion, or who are at risk for thoracic insufficiency syndrome.

Traditional Growing Rods

Shriners Hospitals for Children — Northern California offers traditional growing rods for patients who are too small for MAGEC rods. The implanted rods straighten and control spinal curves, and may eliminate the need for spinal fusion.

Vertebral Body Tethering System

For children over age 10 with worsening spinal curves between 35 and 70 degrees, The Tether™ - Vertebral Body Tethering System (VBT), or spinal tethering, allows for continued growth and mobility while correcting curvature. This innovative, minimally invasive surgery is offered at only a few hospitals nationwide.

Body tethering involves anchoring titanium bone screws to each vertebral bone in the curved area of the spine. A flexible tether is attached to each screw and tension is applied to straighten the spine. Patients show immediate improvement after surgery, and typically continue

Advantages of Vertebral Body Tethering:

  • Minimally invasive, incisions are made on the side and below the arm.
  • Patients typically experience 50-75% curve correction on the date of surgery.
  • VBT allows continued spinal growth and may preserve motion.
  • After surgery, spinal growth is modulated so the curvature continues to decrease.
  • Patients experience low blood loss and quicker recovery times.
  • VBT requires minimal hardware, lowering potential complications.
We have extensive experience with the Vertebral Body Tethering device. And, we’re going to follow these kids for 60 months through all of their growth and sometimes until the age of 21.

Dr. Rolando Roberto

Medical Director Of Pediatric Spine Surgery

Shriners Hospitals for Children — Northern California

Vertical Expandable Prosthetic Titanium Rib (VEPTR)

Vertical expandable prosthetic titanium rib, or VEPTR, is designed for patients with thoracic insufficiency syndrome. This implanted device stretches the rib cage, making more space available for the patient’s lungs to grow and expand. The VEPTR also helps straighten the child’s spine and stabilize the diaphragm. At Shriners Hospitals for Children — Northern California, surgeons implant new VEPTRs, every year. We monitor patients throughout treatment which usually requires repeat surgery every six months. VEPTR is part of a comprehensive treatment plan, involving orthopedic, general and thoracic surgeons and pulmonary medicine.

Benefits of VEPTR include:

  • A more normal growth pattern.
  • Decreased chest, spine and rib deformities.
  • Decreased need for supplemental oxygen.
  • Expanded lung volume.
  • Increased life span.
  • Increased physical activity capability.
  • Improved psychosocial health.

Spinal Fusion

When curvatures are greater than 50 degrees, severe (80 degrees or greater), patients have stopped growing, or a patient’s condition eliminates other treatment options, surgeons may recommend spinal fusion. In addition to traditional spinal fusion, our Pediatric Spine Program offers:

Spinal Fusion with Halo-gravity Traction

Halo-gravity traction applies a slow stretch to the spine, aligning vertebrae in a straighter position before surgery. This technique results in significantly greater curve correction and lower blood loss, improving effectiveness and safety of spinal fusion surgery. Patients are admitted to the hospital and surgically fitted with a halo attached to a weighted pulley system. Over the course of the patient’s hospital stay, the spinal curvature is slowly corrected under the influence of mechanical traction. A team of physicians, occupational and physical therapists and nurses ensure each child is comfortable and able to play and move while traction is applied.

Spinal Fusion with Hemivertebrae Excision

Our surgeons are skilled and experienced in correcting the abnormally shaped or hemivertebrae in patients with complex congenital scoliosis. After the hemivertebrae is removed from the spine, the vertebrae above and below are fused. This specialized surgery is usually followed by bracing or casting.

Complex Spinal Revision Surgery

Our orthopedic surgeons are experienced and have successfully revised prior scoliosis surgeries. With the depth of techniques available and expertise with a variety of issues, surgeons correct problems, minimize complications and achieve improved results.