Our Pediatric Spine Center offers a specialized program for the
evaluation and management of pediatric spinal disorders, such as
idiopathic and congenital scoliosis, Scheuermann’s kyphosis,
spondylolisthesis, spinal fractures and tumors.
From common idiopathic adolescent scoliosis to the most complex
young spine deformities, we believe each child deserves an
individualized treatment plan utilizing the most advanced spine
surgery and innovative spine care techniques. Our focus is early
detection and fusionless treatments for the growing spine, as
well as minimally invasive (nonfusion) to advanced surgical
techniques in children who require spinal fusions.
Our EOS Imaging
System (EOS) is helping us provide the highest quality
care while reducing exposure to radiation for our patients. We
are honored to bring orthopaedic patients this new technology and
are grateful for the funding that was made entirely by donations.
Make an appointment
If your child has a condition that can be treated by Shriners
Hospitals for Children – Northern California, please call our
Referral Center to schedule an appointment,
call (916) 453-2191 or via
email referrals.ncal@shrinenet.org.
A Referral Coordinator will partner with you to gather the
necessary information to allow our physician leadership to
evaluate the best path for your child. All care is provided
regardless of the family’s ability to pay.
Conditions Treated
- Idiopathic scoliosis, including infantile, juvenile and
adolescent
- Congenital scoliosis
-
Scoliosis with syndromes
including:
- VACTERL
- Marfan
- Neurofibromatosis
- Klippel-Feil syndrome
- Thoracic insufficiency syndrome and other rib cage
impairments
- Torticollis
- Cervical instability
- Neuromuscular scoliosis associated with:
- Spinal cord injury
- Cerebral palsy
- Spina bifida
- Tethered spinal cord
- Kyphosis, including Scheuermann’s
- Spondylosis and spondylolisthesis
- Curve progression after spine surgery
- Abnormal posture
- Hemivertebrae with fused or absent ribs
- Scoliosis after thoracotomy
Nonsurgical treatment options
Bracing
Nonoperative treatment for idiopathic scoliosis:
- May be combined with prescribed scoliosis specific exercise
- Can be effective in stopping the progression of the curve
- Schedule and type of brace will depend on the location and
degree of curve
- Compliance with wearing the brace is vital to the success of
bracing treatment
Serial casting
For infantile scoliosis when the curve is progressive:
- Requires cast changes under anesthesia every two to three
months
- Casting straightens the spine through the continuous
application of external force
- Casting is an option versus bracing for improved compliance
Surgical treatment options
Fusionless surgery
Innovative newest treatment options for children with scoliosis:
-
Anterior vertebral body tethering
(AVBT) – AVBT is a minimally invasive
procedure, which produces stabilization for the anterior
thoracic and lumbar spine and avoids spinal fusion. VBT uses a
strong, flexible cord to gently pull on the outside of a
scoliosis curve to straighten the spine. A screw is placed in
each vertebra of the curve and then attached to the flexible
cord with the spine in a straighter position. Scoliosis
progression is stopped, the spine is realigned and can continue
to grow, and flexibility is maintained. As the child grows, it
is anticipated that curve progression will be halted and the
spine will remain straight. The Tether straightens the spine
using the patient’s growth process. The pressure from the cord
slows the growth on the tall side of the vertebra, so that the
short side can grow and catch up. This novel technology allows
for both correction and continued motion at the levels of the
spine treated, unlike fusion surgeries.
Growing systems
Expandable devices used in growing children with scoliosis:
-
Vertical expandable prosthetic titanium rib (VEPTR or
titanium rib) – This is a titanium rod curved to
fit the back of the chest and spine, and is designed to
primarily be used for growing children with a chest wall
deformity and thoracic insufficiency, helping to correct spinal
deformity and allow for the development of the chest and lungs.
-
Growing rods – Growing rods allow for
continued and controlled spine growth. This is performed as a
surgical procedure through the back where the rods are attached
to the spine both above and below the curves with screws. The
growing rods will need to be lengthened under anesthesia every
four to six months, depending on the advancement of the
curvature of the spine.
-
MAGnetic expansion control (MAGEC) spinal bracing and
distraction system – MAGEC rods are for younger
children with curves less than 50 degrees. With MAGEC rods, a
surgical procedure for implantation is required, but the
noninvasive lengthening procedure eliminates the need for
repeated lengthening surgeries. The MAGEC System is composed of
two magnetic, telescoping rods that can be gradually lengthened
from outside the skin after initial implantation. This
procedure uses an external remote controller in the outpatient
department.
Spinal fusion surgery
Spinal fusion surgery is recommended to correct a curve or stop
it from progressing when the patient is still growing and has a
curve that is greater than 50 degrees. Rods and screws are
attached to the curved part of the backbone and the spine is
straightened. Small pieces of bone graft are then put over the
spine; this will grow together with the spinal bone, fusing it
into the proper position. In addition to improved internal
fixation, posterior spinal fusion allows earlier mobilization of
the patient. A spinal fusion also helps prevent severe deformity
and can avoid years of bracing.
Spine Research
Shriners Hospitals for Children-Northern California has a
multi-disciplinary team of physicians, psychologists, nurses,
therapists, bio-mechanical engineers, and clinical research
professionals on our orthopaedic clinical research program.
Our pediatric spine surgeons are the principal investigators
on several studies focused on improving pediatric spine care.
Their research initiatives include a Scoliosis Outcomes Database
Registry, a study of Scheuermann’s Kyphosis, Bracing in
Adolescent Idiopathic Scoliosis and Pediatric Spinal Deformity.
The Medical Team
Eric Klineberg, M.D.
Orthopaedic Spine Surgeon
Joel Lerman, M.D.
Pediatric Orthopaedic Surgeon
Debra Templeton, M.D.
Pediatric Orthopaedic Surgeon
Rolando Roberto, M.D.
Orthopaedic Spine Surgeon
Yashar Javidan, M.D.
Pediatric Orthopaedic Surgeon
Prarthana Mysore, P.A.
Physician Assistant
Melina McCahon, P.A.
Physician Assistant
