New, non-surgical technique shown to cure aggressive form of scoliosis

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Reviewed

Aug 13 2007

Spine surgeon Paul Rubery, M.D., never imagined he would trade in his scalpel for Plaster of Paris, but that's exactly what he's planning to do in mid-August, when he learns a new, early treatment casting technique aimed at curing infants stricken with a devastating and aggressive form of scoliosis.

Rubery, associate professor of Orthopaedics at the University of Rochester Medical Center and director of its Spine Center, is championing a return to a technique that has largely vanished from the arsenal used to treat scoliosis. Over the years, Rubery has managed thousands of scoliosis patients, but one category of patients always proved troublesome: infants and toddlers who suffer from a very severe form of the disease, progressive infantile scoliosis (PIS).

Characterized by an acute curvature (or multiple curves) of the spine in infants and toddlers under the age of three, PIS can lead to a short, painful and crippling life. As the child ages and grows, so does the curve, and if left unchecked, produces severe deformity and can critically interfere with a child's respiratory system.

Standard treatment is to use a back brace throughout childhood to slow the progression of the curve, in an attempt to delay definitive treatment until adolescence, when surgery is typically indicated. Unfortunately, many of these children do not respond to the brace, and at that point, a spinal fusion is performed to control the curve. Such scoliosis surgery in childhood, as opposed to adolescence, significantly limits the child's growth and can have lifelong effects on breathing.

"We really don't have great solutions for patients with progressive infantile scoliosis," Rubery said. "Bracing is cumbersome for active toddlers and not terribly effective. Back surgery is invasive, restricts a child's ability to grow to a normal height, and will still not prevent some children becoming ventilator dependent. I'd like to think we can do better for these kids."

Two years ago, Rubery heard of a treatment that might just offer a better solution for his patients. An article published in the November 2005 Journal of Bone and Joint Surgery provided details of a promising non-surgical, early treatment to cure infantile scoliosis using a series of thin, streamlined and lightweight plaster casts. The author of the article, Min H. Mehta, F.R.C.S., described her experience in using a series of plaster casts on 134 PIS patients between 1975 and 2000 in Great Britain. The results of her prospective study showed that a series of plaster casts applied early and worn for less than two years actually cured children who were treated before the age of two, and significantly reduced the curvature in children who were treated after the age of two.

"The casting method uses the explosive growth experienced by infants and toddlers to gently and permanently guide the spine back into its correct position," Mehta said. "The earlier the treatment begins, the more likely a cure will occur."

Mehta will be coming to the University of Rochester Medical Center Aug. 15 and 16, to train Rubery and several other physicians from throughout the United States. As part of the two-day workshop, eight patients diagnosed with progressive infantile scoliosis will travel to Rochester from cities scattered across the U.S. to be examined, and those children who qualify will be placed into corrective casts.

"All indications are that this is a very safe and effective alternative to bracing and surgery," Rubery said. "It's my hope that we can be one of the leaders in championing this new treatment here in America."

According to the Infantile Scoliosis Outreach Program (ISOP), such casting is available on a very limited basis throughout the country, with a handful of physicians in Salt Lake City, Philadelphia, Denver, Erie, Pa., and Chicago only recently trained by Mehta. ISOP was instrumental in arranging the training in Rochester. The organization was founded in 2003 by Heather Hyatt, the mother of a child with PIS, who discovered Mehta's work, and advocated that Salt Lake City Shriner's Hospital offer such treatment. Eventually, she formed ISOP, which works to increase awareness of the early treatment casting method and to help facilitate such training seminars like the one in Rochester for physicians.

"We are thrilled that accomplished surgeons such as Dr. Rubery are willing to embrace a non-surgical procedure that offers new hope for children with infantile scoliosis," Hyatt said.