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In the Independent Public Clinical Hospital. prof. A. Grucy CMKP in Otwock, an innovative spine surgery was performed on a nine-year-old girl. – It definitely changes the life of a sick child – says Dr. Marcin Tyrakowski, who carried out the procedure. Medicine still does not know the causes of most scoliosis, i.e. spine deformities. However, thanks to breakthrough inventions, he is able to deal with them better and better.
- Scoliosis is one of the most common “curvatures” of the spine. The condition is usually diagnosed in children. In some cases, surgery is required to correct a defect
- A 9-year-old girl required such an operation. The implant, which will grow with her, was placed in her body by doctors from the Independent Public Clinical Hospital. prof. A. Gruca CMKP in Otwock
- We talk to Dr. Marcin Tyrakowski, who operated on the girl
Halina Pilonis: The surgery you performed begins a new era in the treatment of spine defects in children in Poland. What does this mean for little patients?
Dr. Marcin Tyrakowski: The girl we operated on with our team is less than 9 years old, and has already had several major spine surgeries. If we had not implanted her with an implant that would grow with her, she would probably have to undergo further operations every six months until she stopped growing.
Are the spines straightened just to make the children’s silhouette look correct?
The most important reason is to stop the deformation of the chest, which threatens the proper functioning of the respiratory and circulatory systems. The idea is for the lungs to develop, allowing you to breathe normally, and for your heart to have enough space to work. Failure to do so may result in a life-threatening condition. This does not change the fact that a symmetrical waistline is very important for a teenager. It influences self-esteem, and therefore proper emotional and social development. In severe scoliosis, the waist is significantly indented on one side, and there is no such indentation on the other. In addition, the rib hump resulting from deformation is also a significant aesthetic problem for patients. After surgery, children say that they run better and breathe easier. Small patients with cerebral palsy after scoliosis surgery have a better appetite, sit more willingly, and thus, among others, they are less likely to suffer from pneumonia. Apart from the aesthetic aspect, the largest scoliosis increases with age and therefore requires surgical treatment.
What causes children to seek treatment?
Scoliosis does not hurt, so the deformity is most often noticed by a doctor examining the child for another reason or by the parent himself.
What is spine straightening surgery?
The skin on the back is cut and the muscles separated to make the spine visible. Special screws are screwed into the altered vertebrae, to which a bar is attached that runs along the spine, which straightens it. It’s like wanting to stretch the letter “C” to straighten it out and make it an “I”. After the operation, the patient does not experience any significant restrictions in movement. In younger patients, the problem is that the baby grows and the rod does not.
How have you dealt with it so far?
Every six months this bar had to be stretched surgically. This meant a stay in the hospital and an operation under general anesthesia, which always comes with some risk. And the limitations associated with the wound healing process after surgery.
What is the cancer solution?
The rods used during the last operation have a magnetic mechanism, and thanks to it, we can extend such a rod without the need for surgery. Every two months, the child comes only to the clinic, where within a dozen or so minutes, using a special device applied to the skin on the back, we stretch the rod by a few millimeters. Previously, we had to surgically stretch the spine by about 1 cm every six months. It was such an average value, assuming that the child’s height increases roughly every six months. The new method allows for a more natural adjustment of the length of this implanted implant to the child’s growth.
How does such a stretching bar work?
A bit like an extending telescopically folded fishing rod. The telescopic elements are connected by a magnetic mechanism. When a special remote control is placed on the skin – a device generating an electromagnetic field, this very mechanism causes the telescopic elements to extend – that is, the rod extends. The operated girl is now almost 9 years old, so she will probably stop growing significantly in about three or four years. During this time, it has a great chance of avoiding spine surgery.
And what next?
Then a permanent implant is inserted, which remains for the rest of your life.
Will the method become widely available?
It is relatively new. The first studies of its safety and effectiveness began in Europe a few years ago. It was registered in the USA three years ago. Implanted rods – implants are not cheap. But since scoliosis affects about 3 percent of children, and this innovative method is dedicated to a small percentage of them, I think we can count on public funding for this procedure. Apart from the obvious medical aspect, the economy may also speak in favor of using a more expensive solution that has the potential to reduce the number of surgical procedures. Overall, it may also be beneficial for the payer.
Is this a big breakthrough in the treatment of scoliosis?
Huge, I believe. Since we do not know the causes of scoliosis, we cannot prevent them, i.e. carry out any prophylaxis in this area. Therefore, we must focus on the early detection of the disease, and in patients requiring surgery, use the least bothersome procedure for the child.
What are the hypotheses regarding the formation of scoliosis?
Theories about the causes of scoliosis have been and are various. The genetic factor seems to be important, i.e. the existence of a certain gene defect or perhaps many genes that determine the development of scoliosis. There are also hormonal theories due to the fact that scoliosis is more common in adolescent girls. Therefore, medicine faces a serious challenge – to detect the causes of scoliosis. Only this may change the approach and start looking for methods of its prevention.