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Multidisciplinary approach offers successful management of adolescent idiopathic scoliosis By H. Sheldon St. Clair, MD, and John K. Birknes, MD
Summary: At CHKD, pediatric orthopedic surgeons and neurosurgeons collaborate to achieve best outcomes for children and young adults with adolescent idiopathic scoliosis.
ACL repair in young female athletes
Adolescent idiopathic scoliosis (AIS) is the most common form of scoliosis. It affects females 10 times more often than males and typically presents during the pre-adolescent growth spurt – at around age 10 for girls and age 14 for boys.
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CHKD welcomes new surgeons CHKD Surgical Group Journal is a publication of Children’s Hospital of The King’s Daughters Health System
H. Sheldon St. Clair, MD
Medical Editors: Joseph F. Dilustro, MD, FACS Robert E. Kelly Jr., MD, FACS, FAAP Jyoti Upadhyay, MD, FAAP Douglas Mitchell, MD, FAAP
Managing Editor Ridgely Ingersoll Director of Marketing
Editor Sharon Cindrich Marketing & PR Manager
Graphic Designers Liz Lane Eric Cardenas
John K. Birknes, MD
The classic evaluation for scoliosis is the Adams forward bend test. When a child with scoliosis bends forward, an asymmetrical elevation of the ribs may be present on one side. Asymmetrical alignment of the shoulder or hip, scapular prominence, or trunk shift may also be present. Other less obvious symptoms of AIS may include lesions along the back and pelvic obliquity. Pediatricians should also look for limb length discrepancies if AIS is suspected. (To see a brief video demonstration of a scoliosis screening with Dr. John Birknes, visit CHKD.org/Scoliosis.) To best address the complex interdependency between the nerves of the spinal cord and the vertebrae of the spinal column, Children’s Hospital of The King’s Daughters offers a team approach to scoliosis treatment and spinal surgery. In addition to pediatric orthopedic surgeons and neurosurgeons, the team includes pediatric specialists in physical medicine and rehabilitation, anesthesiology and physical therapy, plus pulmonology and cardiology when appropriate. The team performs approximately 225 spinal surgeries a year on patients under the age of 21; two-thirds of these are for scoliosis. Treatment plans are developed at weekly team conferences and are based on the location, shape and severity of curve, the number of curves and whether there is rotation of the spine, which occurs in many cases. Early diagnosis of scoliosis can allow treatment that prevents further progression of curves while the spine continues to grow. When scoliosis is suspected in pre-adolescents, an MRI may be indicated to rule out any alternative causes of a spinal deformity, such as a neurological lesion. In cases of moderate severity, bracing is the most common first treatment for scoliosis. Bracing rarely corrects curves, but it can keep them from progressing and therefore prevent the need for surgery when they get older. CHKD surgeons