Spine Surgery in Kids and Teens

Curves of the spine due to conditions like scoliosis, kyphosis, spondylolisthesis and some spinal injuries can sometimes be treated with treatments like bracing and physical therapy. While the orthotists and physical therapists at Children's Healthcare of Atlanta are specially trained to treat these conditions without surgery, sometimes surgery is necessary based on a child's age, spinal curve and remaining growth. In some cases, severe spinal curves can become painful and may cause changes in heart and lung function or damage spinal cord function if a surgery is not performed. 

Spine surgery can help stabilize these curves, which prevents the curves from getting worse and can help improve spinal alignment. The type of spine surgery recommended for your child or teen depends on several things, including his unique condition, health history, previous treatments, and age or remaining growth.

At Children’s, we assess every step of the spine surgery journey, looking for ways to improve. This dedication to quality has led to our Scoliosis and Spine Program achieving some of the best outcomes in the nation, with patients spending less time in the hospital and having higher patient satisfaction.

• Stop the curve’s progression, specifically in scoliosis and kyphosis patients.
• Balance the spine and pelvis region.
• Help your child sit and stand upright again and maintain healthy posture.
• Help improve lung function.
• Reduce pain caused by a spine condition or injury.
• Avoid complications and create a solution that keeps the spine's curve controlled throughout your child’s life. 

If surgery is needed, our spine surgeons will use cutting-edge technology, instruments and techniques to speed up healing and help reduce complications. Children’s surgery options include spinal fusion, growing rods, computer-navigated scoliosis surgery, serial casting and more.

A spinal fusion is sometimes referred to as the “gold standard” for spinal curve corrective surgery. It uses metal implants, or rods, that join, or fuse, some of the bones of the spine. The rods and a bone graft are used to realign the spine to minimize the curve as much as possible and permanently keep the spine in its new, balanced position. The procedure is typically used to treat scoliosis that has continued to worsen despite nonsurgical treatments. It may be recommended for children, teens or young adults with curves greater than 45 degrees.

There are three approaches to spinal fusion surgery:

1. Anterior: Performed on the front part of the spine through an incision in your child’s side.
2. Posterior: Performed on the back of the spine through an incision in your child’s back. This is the most common.
3. Anterior-posterior: Performed on the front and back part of the spine through two incisions.

All three surgical methods use bone, metal rods and screws to fuse the backbones together. The metal rods and screws help keep the bones in the right place and hold them straight. A bone graft acts as a bridge and grows into the spaces between the backbones, fusing them together. The bone graft can come from:

• A piece of bone from your child’s own body—this is called an autograft. This piece of bone is usually taken from the spine during the spinal fusion surgery, but is sometimes taken from the hip.
• A bone bank from someone who donated his or her bone—this is called an allograft.

The main goal of a spinal fusion is to fuse the spine and keep the spinal curve from getting worse, but it may not completely correct the curve. In some instances, flexible curves that are fairly small can be almost completely corrected. In other cases, it can be dangerous to achieve complete correction. Your child’s doctor will talk about your child’s specific surgery goals.

Part of what makes a spinal fusion so effective is that the spine is fused in place, preventing the spinal curve from getting worse over time. For patients who have finished growing or are almost finished growing, this option can keep their spinal curve from worsening for the rest of their lives.

Similarly, for some patients who are still growing (typically over age 10), this is not a problem either because the straightening that happens from surgery makes up for any remaining growth. Usually, the height that is gained from surgically correcting a curved spine is the same as (or more than) how much the child’s spine would have naturally grown.

In younger patients who still have more growing to do but need a spine surgery to prevent their spinal curve from worsening, there are growth-friendly options. Curve modulating, or adjusting, procedures combine a smaller number of fusions with special rods that can be extended to help limit the spine's curve from worsening all while allowing the child to continue growing. This device functions as an internal brace that allows continued spinal growth but limits the worsening of your child’s deformity. These growth-friendly options include:

• Vertical expandable prosthetic titanium rib (VEPTR) device
• Traditional growing rods, which are designed to be temporary and allow your child to continue growing
• Magnetic expansion control (MAGEC) rods, which are also designed to be temporary and allow your child to continue growing
• Halo-gravity traction
• Shilla technique 
• Vertebral body tethering

VEPTR surgery 

VEPTR surgery is performed on children with severe chest deformities and spinal curves and helps expand and support the chest wall so that a child can breathe. Children’s is one of only a few pediatric hospitals in the country that performs VEPTR surgery. It is recommended for children between the ages of 18 months and 5 years—but other ages may benefit—and can help children who have scoliosis and other spine conditions, such as thoracic insufficiency syndrome.

The VEPTR device is a curved metal rod. It is designed to help straighten a child’s spine and separate the ribs for lung growth and improved breathing. The rod is made of titanium, which is a strong metal that is also able to stay in a child’s body without rejection.

The device works by attaching the rods vertically from rib to rib, or from rib to hip bone, which allows it to expand as a child grows. For a child with scoliosis, the ribs are separated during the first implant procedure. A VEPTR device will then be attached from the top of the rib cage to the bottom of the rib cage. Another device will be shaped to fit from the top of the rib cage to the lower spine. This way, the device controls the curvature of the spine through the ribs, which are attached to the spine.

As your child grows, the rod expands. Eventually, your child will need surgery to expand the rod farther and allow for more growth. When your child has finished growing, you and your child’s doctor will discuss whether the device is still needed.

After VEPTR surgery:

• Your child will stay in the hospital for two to five days.
• The metal rod will need to be surgically expanded every four to six months until your child stops growing.
• Your child may be fitted for a thoracolumbar sacral orthosis (TLSO) brace to wear after surgery.
• Your child can start being active in about a month.

Traditional growing rods

Traditional growing rods are placed along the spine and are surgically extended as a patient grows. They are used temporarily to help improve the spinal curve when a child still has a lot of growing to do. The rods attach to the spine at the top and bottom of the curve with hooks or screws. The surgery is done through the back of the spine, under general anesthesia (while your child is fully asleep).

Traditional growing rods require a return trip to the operating room every six months for a mechanical lengthening. This keeps the spinal curve from getting worse while still allowing your child's spine to continue growing. Once your child is older and his spine has finished growing, the doctor will remove the traditional growing rods and perform a spinal fusion with metal rods that do not expand to permanently keep the spine's curve from worsening.

MAGEC rods

MAGEC rods are mechanical growing rods that help temporarily correct the spinal curve and control the curving of the spine in children who have quite a bit of growing left to do. Growing rods like these allow for continued, controlled growth of the spine. Like traditional growing rods, the rods attach to the spine at the top and bottom of the curve with hooks or screws. The surgery is done through the back of the spine, under general anesthesia (while your child is fully asleep).

Your child’s surgeon will attach a metal rod to the spine, which—unlike traditional growing rods—can be lengthened in the clinic using a magnetic controller. The magnetic controller uses a magnetic force to painlessly lengthen the rods through the skin. Because the rods can be lengthened without surgery, it can be done more often to keep up with the growth of your child's spine. Once your child is older and his spine has finished growing, the doctor will remove the MAGEC rods and perform a spinal fusion with metal rods that do not expand to permanently keep the spine's curve from worsening.

Halo-gravity traction

Halo-gravity traction, also known as halo traction, is a way to gently stretch and straighten a curved spine prior to spine surgery using a large metal halo ring and pulley system. Not every child who needs spine surgery will require halo traction, but it can be an option regardless if your child is done growing.

Spine surgery is a big deal—especially when it’s your child. So you want your child in the hands of an experienced pediatric spine surgeon. Here are some things to consider as you plan for your child's surgery. 

Your child’s spine deserves the best pediatric spine surgeons available and the expertise of a team trained specially to take care of growing kids or teens. Spine surgery takes extensive knowledge and precision. Our surgeons are all fellowship-trained and are among the leaders in their field when it comes to spinal surgery navigation and robotics. Your child will be cared for by a team that performs hundreds of spine surgeries a year.

Members of the Children’s Orthopedics Program, which is consistently ranked among the best children’s hospitals in the country by U.S. News & World Report,** collaborate on patient care. We work closely with specialists from across the country and around the world to help establish best practices for pediatric spine care, and we are on the forefront of advanced technologies. 

Doctors in our Scoliosis and Spine Program also collaborate with neurosurgeons, anesthesiologists, physiatrists and other specially-trained physicians to care for kids, teens and young adults with complex neurological spine disorders, like certain types of scoliosis. Our Orthopedics Program and Neurology and Neurosurgery Program are both nationally ranked, combining experience and specialized training from two of the top programs in the Southeast to treat chronic back and neck pain, herniated discs, spinal cord tumors and degeneration and other conditions in patients from 0 to 18 years old.  

The Scoliosis and Spine Program at Children’s is led by Nicholas D. Fletcher, MD, Medical Director, and Joshua Murphy, MD, Medical Director, Spine Quality and Outcomes.

Children’s Physician Group–Orthopaedics and Sports Medicine

Orthopedic surgeons:

• Jed Axelrod, MD
• Robert W. Bruce Jr., MD
• Dennis P. Devito, MD
• Jorge A. Fabregas, MD
• Nicholas D. Fletcher, MD
• Joshua Murphy, MD
• Michael L. Schmitz, MD

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