Scoliosis is a Growing Concern for Parents. This Philly Hospital Takes an Innovative Approach to Addressing the Problem

When you’re parenting a young child or adolescent, some amount of growing pains in their ever-changing body is, of course, normal. But it’s important not to write off all your child’s aches and pains as part of the process, especially when some of them may indicate a more serious ailment.

For an increasing number of children in the United States, some of their aches, pains and physical idiosyncrasies can be signs of scoliosis, a condition in which a child’s spine develops a lateral curve (i.e., curves to the side). It’s not just an aesthetic concern–in its worst cases, the condition can lead to significant pain and even limited mobility.

“It’s really important to have a low threshold for being concerned or suspicious about scoliosis,” says Dr. Amer F. Samdani of Shriners Children’s, where a focus on innovative treatments for children has led to major advancements in scoliosis care. “The key is that, if you identify it early, there’s so much more you can do. Today, we’re able to do more than we were able to even 10 years ago.”

Samdani leads a team here in Philadelphia that has helped usher in a new era of scoliosis treatment. If scoliosis calls to mind the primitive back braces or dramatic spinal surgeries that you heard about when you were a kid, then you can take a breath. Since the turn of the century, rapid advancements in everything from preventative scans to innovative “tethers” have transformed spinal care, giving parents and kids more options than ever to overcome the symptoms of scoliosis early and permanently. That innovation is having a global impact as Samdani’s team works to get that care to more children.

“At Shriners Children’s, we take care of patients without regard to their ability to pay, and what I love about our hospital is that we have patients who fly in from a small village in Africa for care. And then we have patients who are the children of high-level executives flying in from California. And the most beautiful part of our hospital is that they both get exactly the same treatment,” Samdani says.

Fortunately, Philadelphians can benefit from that care right here at home, and it all starts with being aware of the warning signs and seeking help without delay. So, as the summer begins and the next school year is around the corner, it’s a good time to brush up on your knowledge. To help with that effort, we spoke to Samdani about the latest insights on how parents can help catch and get treatment for scoliosis — and ensure those growing pains really are nothing more than growing pains.

Prevention and Diagnosis

According to Samdani, it isn’t always clear why scoliosis occurs. Most scoliosis diseases are idiopathic, meaning they develop without a clear cause. But understanding the factors that may lead to scoliosis and being able to notice its symptoms is your best bet when it comes to prevention.

That process can start even before scoliosis rears its head. A family history of scoliosis is correlated with the development of scoliosis, so if either your grandparents, parents, or you had it, then be on the lookout–your child has a higher chance of developing the condition.

Behavioral factors may be at play as well. Everyone knows the age-old direction from their parents to sit up straight, and as kids are glued to their screens earlier and earlier in life, this piece of advice may become more important. Beyond parents’ ideas of what an upstanding citizen looks like, posture could be critical for your spine health. Samdani explains to his patients who are concerned about developing scoliosis that they should resist poor posture and limit backpack weight to 10-to-15 percent of the child’s body weight, while keeping both straps tight to the back.

If either family or behavioral concerns apply to your child, you might want to consider reaching out to a physician. But because scoliosis can happen to anyone, the most important step is to know the signs.
If you see your child start to favor one side over the other, or one shoulder tends to creep upward asymmetrically while sitting or standing, that’s a sign of the lateral curve that defines scoliosis. A bump or protrusion is also a clear indicator, while even simply feeling uncomfortable or uneven while sitting in a chair can be worth looking into.

The Big First Step

If you do have concerns or notice signs of a developing condition, there’s no need to panic. According to Samdani, new advancements in safe scanning have allowed doctors to more rapidly identify and understand each child’s unique problem.

“I’m very proud to say here at Shriners Children’s, we were the first ones in the region to get a machine that has a very low dose of radiation,” Samdani says. “It’s called EOS, and it gives one-twentieth of the radiation dose that someone would get with a traditional X-ray. But no matter where you go, you want to go to centers that have a low-dose X-ray machine.”

That lower radiation dose gives physicians and patients a greater understanding of the problem and allows for long-term monitoring. This means that even if the scan does pick up signs of concern, your care team may be able to pursue a less intensive, preventative fix like physical therapy, which is far more targeted than a parent’s direction to stop slouching.

“The exercises can range anywhere from 10 minutes a day to up to 20 minutes per day, depending on the program,” Samdani says. “As long as you’re working on core strength, posture, awareness and flexibility, those are the three core elements.”

At Shriners Children’s in particular, their Motion Analysis Center is a key part of therapy, as well as post-operative treatment. The center is filled with equipment to guide children through exercises that demonstrate challenges in movement and work to overcome them. More importantly, it’s equipped with multiple cameras that allow for a 360-degree record of a patients’ movements, based on markers placed on their body.

After a motion study, the patients’ care team analyzes the resulting video for as deep an understanding as possible of how the patients’ body moves. They then adapt their exercises for the next session to account for even small challenges in movement that may have otherwise gone unnoticed.

A Better Brace

If a curve has started to form but is still small, your child will likely need a brace. Even if you do need to take this step, you shouldn’t have to worry about their self-esteem. Modern braces are designed to be more comfortable and go unseen underneath clothes, so kids can stand naturally and without self-consciousness around their classmates. And evidence suggests that, for the majority of scoliosis cases, it will be worth it in the long run.
“Seventy-five percent of the time you can actually avoid surgeries by wearing a brace for 14 hours a day,” Samdani says. “The potential is really high for being able to control small curvatures.”

A modern, advanced program like Shriners Children’s even custom-designs braces to fit individual bodies, with support by their in-house brace design. According to Samdani, that all-in-one approach–where scans, braces, and surgical treatment are all handled by one system–is critical for scoliosis treatment.

“I can have our therapist see a patient right away if I feel they need therapy. If they need a brace, I just walk over to the brace shop. If they’re going to need surgery, we’re able to perform all those procedures,” Samdani says. “It truly is the entire spectrum of care under one roof, in a very patient-centered, family-centered environment.”

Curing Scoliosis

Sometimes, even with preventive measures, a treatment plan that includes surgical options is the best way to address scoliosis. But if you’re worried about old-fashioned rods and screws, you can breathe easy. Surgery to correct scoliosis has undergone a sea change in the last few decades.

“We’ve gotten so much better at understanding anatomy in three-dimensions, and that’s led to better surgical results,” Samdani says.

In part thanks to factors like the aforementioned advanced scanning and body analysis, physicians have a better understanding than ever before of scoliosis. That’s led directly to life-changing innovations that have made treatment for scoliosis more accessible and less invasive.

Samdani’s program at Shriners Children’s has often taken the lead in that innovation. While for decades, the primary treatments for scoliosis involved metal rods or spinal fusions, which can limit or artificially alter a child’s growth, Shriners Children’s collaborative approach helped lead to the adoption of vertebral body tethering.

“Fifteen years ago, in Philadelphia and our surrounding hospitals, we really started pioneering the technique,” Samdani says. “We were one of the first health systems here in Philadelphia to go ahead and perform that procedure. And around the world, we’re one of the centers that really helped bring this to market. We were able to get approval for that device in 2019, and now, there are more than 100 centers around the world that perform this procedure.”

The innovative technique uses a strong tether attached by tiny metal screws to guide the patients’ spine into a more natural position as it grows. Because the tether can more easily be inserted into the body than a rod, major surgery is avoided. At the same time, the flexibility of the tether allows the spine to move and grow more organically, avoiding any negative impact on development or a definite need for multiple future surgeries.

It’s an ideal treatment for clear, moderate cases of scoliosis, and while it currently makes up about twenty percent of the surgical scoliosis treatments that Shriners Children’s performs, Samdani projects that it could grow to more than forty or fifty percent.

But even for severe cases, ones that can cause significant pain or limit mobility, today’s treatments are designed to provide the children who need them with greater support–getting their growth on the right track, rather than sidelining it. Advances in fusion surgeries have allowed surgeons at Shriners Children’s to limit fusions to just a few vertebrae, making sure that, instead of a rigid spine, the child’s growth and movement stay as natural as possible.

“When I see a patient a decade later who, because of our care, has not needed additional surgeries that they probably would have otherwise, I feel really, really good about what we’ve been able to give them for their future,” Samdani says.

So no matter which approach a child needs, whether simple prevention or a more comprehensive treatment plan, options for parents exist–and the fight to provide life-changing care to those faced with this serious health challenge is being led right here in Philadelphia.

To learn more about scoliosis care at Shriners Children’s, click here.

This is a paid partnership between Shriners Children’s Philadelphia and Philadelphia Magazine