Catherine WalzAbi SedelackComposition 1December 11, 2017Congenital Scoliosis In the United States, two to three percent of the population, or six to nine million people, have scoliosis (“Scoliosis”). Scoliosis can affect many people and their families; one of these people is Meg Waltz. Meg Waltz is a mother of five who currently lives in Arnolds Park, Iowa. Her youngest child, Catherine, was diagnosed with Congenital Scoliosis when she was one year old. Through this emotionally and difficult part of her life Meg learned about advancements in medicine that not only affected her daughter’s life, but helped many other people with her condition. Meg Waltz remembers the first time she heard about scoliosis. “I heard about scoliosis when I was in high school in the late 70’s, early 80’s,” she said. “We had to have mandatory scoliosis checks every, but that was really all I knew. I wasn’t aware of different types of scoliosis or how severe scoliosis could be.” She went on to say that they would have to go down to the gym and the nurse would run her hand down their spine to check if they had scoliosis. “That was basically all my knowledge on scoliosis,” Meg said (Waltz). Scoliosis is the condition where the spine curves sideways at a degree greater than 10 degrees (“What”). There are two types of scoliosis: congenital and idiopathic. The most common type of scoliosis is idiopathic, which 80% of people with scoliosis have (“What”). Even though idiopathic is the most common type, doctors don’t know how it is caused. idiopathic occurs mostly in teenagers and adults, which is why it is the most common. Congenital scoliosis is more rare. Congenital scoliosis is more rare because it is the curvature of the spine that is present at birth, and it occurs when the baby is developing in the womb from (“Congenital”). “When the doctors talked about her spine to get us to understand why it was curved they told us that one side of her spine, for some reason, was growing faster than the other side. The curve was the result of the body trying to maintain balance,” Meg explains. Meg remembers when she first noticed something might be wrong with her daughter’s spine. “I knew the day she was born that something was different. She was my sixth kid and as soon as I held her there was a little lump on her spine at birth, it wasn’t crooked, but I could feel the lump. I then asked the doctor, but he said that it must have been that she was a muscular baby and it was just muscle,” she said. “When she was about ten-months old we left her for a week with my sister-in-law Karen, who is a nurse, and she told me there was definitely something wrong with her back and that she needed to be checked by a doctor.” Meg remembers going to the doctor and treatment options. “After talking to Karen we went to the doctor’s office and talked about scoliosis. We learned that her curve was so severe (55 degrees) that if we didn’t treat it her spine would snap, and she would become paralyzed.” Meg sadly remembers. “We were told that the only treatment at that point was going to have to be surgery. Congenital wasn’t like idiopathic where she could just be in a brace or pin, she had to have spinal surgery.” There are two main options for treatment for scoliosis right now: bracing and surgery (“Treatment”). Bracing is the non-surgical option that most people with idiopathic scoliosis have the option to do. People who have bracing as a treatment plan could have a full-time brace or a nighttime brace. They are typically for people whose curve has reached twenty-five degrees or is less than twenty-five degrees but has progressed five degrees in a follow up appointment (Baaj “Scoliosis Treatment”). Scoliosis doesn’t go away without surgery, but a brace can keep the curve from increasing. People who have surgery as a treatment plan have three options: fusion, growing systems, and fusionless (Baaj “Scoliosis Surgery”). Fusion is when two or more of the vertebrae are fused together so it creates a solid bone that can’t move. They can use rods, wire, screws, and hooks to fuse the vertebrae together. While fusion has been proven to have a better curvature correction, recovery time, and long-term record for safety and efficiency, a the downside is any fusion vertebrae will limit mobility (Baaj “Scoliosis Surgery”). This means it will limit bending and twisting in the spine. Growing systems is where the patient has rods placed into their spine and every six to twelve months they have another surgery to lengthen the rods as the patient grows (Baaj “Scoliosis Surgery”). This type of surgery is typically for children so their skeleton can reach maturity and to avoid fusion surgery until they are more mature, but this is usually a delay treatment before fusion surgery not as a permanent solution. “We never discussed the growing system treatment for her. The curve was just too severe and we had to do the fusion treatment,” Meg stated. The last option is the fusionless surgery. In fusionless surgery they try to modulate the growth of the spine by putting stress or pressure on the side that is growing unevenly. By adding the pressure it will cause the uneven side to slow its growth down and stay at the rate of the slower growing side of the spine causing the spine to straighten out (Baaj “Scoliosis Surgery”). While this surgery has proven to maintain more mobility it is a fairly new surgery option and not that much data has been collected on the long-term risks. Meg remembers meeting with Doctor Longstein for the first time:When we started to look for doctors for Catherine we went to Omaha, and they kept talking about this treatment option that was done by this amazing doctor. They kept saying he was the best in the field and how he invented the surgery that she was going to have. We then found out that the doctor lived only in Minneapolis, which was the same distance to use from Omaha, so we thought ‘Well if he’s the best at this surgery then why don’t we just go to him?’. Doctor John Lonstein is a South African Orthopedic surgeon of the spine in St. Paul, Minnesota. He has been in practice for fifty-three years, and graduated from the University of the Witwatersrand Medical School in Johannesburg, South Africa. He is a part of the Healthgrades Honor Roll, and he treats many spinal conditions such as: intervertebral disc degeneration, scoliosis or kyphoscoliosis, fractures, dislocations, sprains, lateral epicondylitis, rheumatoid arthritis, and spinal stenosis. He also does many procedures such as: spinal cord surgery, spinal fusion, and spinal surgery (“John”). Meg continues by saying:Right away we loved Doctor Longstein, and he absolutely adored Catherine. He explained the benefits and risks of the surgery and how with the degree of curvature of her back her best option was fusion surgery. He told us the risks of the surgery were that it wouldn’t slow down or stop the curve; however, the benefits would be her spine wouldn’t be severed and that her balance was good enough that it wouldn’t affect her long-term balance. He also said that with the fusion surgery that, if anything went as well as we hoped, then she wouldn’t need surgery again. The surgery went well and she went home. She had to wear a full body cast for about three month and then a brace for six months. After that she was healthy and never had any problems since. With the straightforwardness of her daughter’s surgery Meg didn’t realize until later the big advancements just in treatment of scoliosis has changed since she was younger. “I remember seeing those huge braces that people with scoliosis had to wear. They were basically like metal cages,” Meg recalls, “When they thought my sister had scoliosis we had to go to a hospital called The Crippled Children’s Clinic, and that progress on how they see scoliosis now alone has really been amazing.” Just even in the last ten years there have been advancements that her daughter didn’t have access to. A new treatment that recently came out was a fusionless surgery called Vertebral Body Tethering (VBT) that have given people more options for treatment.VBT in essence is not a new idea, but the surgery has just started to be put into effect. It is based on the Hueter-Volkmann principle. In this principle it states that bone under more pressure will grow slower and denser than bone not under stress, so the bone on the inside of the curve will grow slower and denser than the bone on the outside of the curve (Betz). VBT is then used by putting bone screws into each vertebral bone that is apart of the curve. Cords, or tethers, are then attached to each screw and tensioned to achieve the necessary degree of spine straightness (“VBT”). VBT is used for patients that are ten years-old or older with a spinal curve of thirty-five to seventy degrees. There are many benefits to VBT. One of the benefits of VBT is that it is minimally invasive, which will carry less risk for the patient and better recovery time. VBT can also preserve the growth in the patient, so their spine can keep growing and allow the curve to correct itself. It will also preserve the flexibility, so the patient can move, bend, and experience more comfort and freedom of movement. VBT has also been shown to “Correct the spine almost fully,” according to Dr. Baron Lonner. Also since it’s a one time surgery, so if anything happens and they need to do another type of treatment they still have the option to do so (Betz).Another medical advancement that is similar to VBT is Vertebral Body Stapling (VBS). VBS is similar to VBT, but it uses staples instead of bone screws and cords. Unlike VBT, VBS was first conceived many decades ago, but has only recently gained popularity in 2002 due to the invention of new staples made of memory shape alloy (“VBT”). VBS was invented because many patients, especially younger patients, don’t like to wear a brace for as often and as long as required in order to keep a curve from getting larger. The idea of an “internal brace” that would work 24/7 to keep a curve from getting larger may be particularly attractive. In some cases, stapling would not just hold the curve but also correct the curve as well. This solves the initial concern that the staples would become dislodged. VBS has been used as an “internal brace” to help with preserving motion and less chance of back pain, but it only works for patients with a thoracic vertebral curve of under thirty-five degrees (“VBT”). Through Meg’s life there have been significant advances in surgical techniques that have led to improved fusion rates, greater three-dimensional correction of spinal deformities, lower complication rates and quicker postoperative recovery. However, improving spinal alignment with fusion occurs at the cost of permanent, non movability of the fused area. Even to this day new techniques, such as VBT and VBS, are being invented are improved on to better the treatment of patients everywhere.