Saturday, December 22, 2012

The Post-Apocalyptic Spine Doctor

Well, the Mayan calendar gently disappeared yesterday and contrary to the wild prophecies of some, the world did not end. Instead we all move forward into the holidays and greet the end of the year, comfortable in the knowledge that our own linear calendar renews itself in another collection of Pug Puppies pictures to hang on the wall.  In a week or so, we will gratefully return to our work, in my case seeing and caring for youngsters with spine problems.

Although the more rational of us did not really think the world would come to a crashing halt yesterday, all of us must at some time have stopped and thought, what if it does?  What if the world really does shut off on 12/21/12?  Combined with the natural introspection that always accompanies the end of the year, the extraordinary event gave me a chance to review and reflect on things personal and professional.  Among other things, I spent some time thinking about more than twenty years in the spine business - what have I learned and what do I think I (and we all) still need to learn before the next Mayan calendar runs out?

What I have learned:

1)  The child of the spine is more important than the spine itself.  This is a simple statement, but in a field that is so heavily techno driven, it is easy to become caught up in metallurgy and fusion levels.  But the reason we concern ourselves with spinal curves and back pain is because of the effect it has on the child who has the condition. Each child has her own response to what is going on with her spine so that I must refrain from making generalizations and follwoing cookbooks.  I must quite simply ask, "How do you feel about this?"  It is surprising how difficult it is sometimes to ask such a simple question.

2) We treat children, not x-rays.   It doesn't matter sometimes what the x-rays are telling us.  Some kids who are doing great may have very bad x-rays and vice versa.  It never behooves us to try to make an x-ray beautiful if the child does not have any problems in the first place, and it is especially important not to ignore a child's complaints just because the x-ray may appear normal.

3) X-rays are the 2 dimensional representation of a multi-dimensional problem.  Spine doctors try to learn this early when reading films.  From a technical standpoint, it means that I always have to account for the rotation of a spine, the unseen throd dimensional plane of the x-ray.  But I have also understood that I must also be aware of the dynamic aspect of a problem.  An x-ray of the low back taken lying down may be much different than the same view taken standing up,  Also, as a child moves, the x-ray may change yet more profoundly.  Probably most importantly, the dimension that must be anticipated is that of time.   What will a curve be like in two years, five years, thirty?  How will the pain in a ten-year-old be when that child is twenty-five?  This is the hardest dimension to predict, of course, but it is the most rewarding by far.

4)  Families must be engaged in their children's care.  This is another simple truism, but you would be amazed how long it took the medical porfession to understand it.  This awarness has led, I think, to better education of parents and caregivers, as well as more involvement in the care and healing processes.  But moving forward there is still great deal of work to be done to fully engage and educate.

5)  There is safety and comfort in numbers.   There is no feeling, I believe, as scary or lonely as being a child who needs medical care.  For that child to be able to reach out to other children is of immeasurable value - if only in that it lets the child know that she is not alone.  Children will communicate with other children in a language that adults (even parents) do not share - about pain, about appearance, about social acceptance.

6)  Taking care of children keeps you young.   I don't know if this is a fact or just wishful thinking, but I cannot help thinking that the evanescent joy and radiant spirit of even a sick child, and especially the well ones, helps to keep my spirit whole.

What I need to learn:

1)  I must evaluate how best to educate the children and the parents who are in my charge.  Although I am proud of the programs I have already put in place, I think that there can be even more communication with children and parents, as well as other adults who come into contact with the kids in my care (teachers, coaches, etc.).  Venues like this blog can help keep people up to date with my thoughts, and are just an internet address away.  But other things, like outreach programs, Spine Camps, "town hall" type meetings, etc. will help immeasureably.

2)  To be both receptive and skeptical about new technologies.  The spine business is changing fast and new techniques and ideas are constantly being brought forth.  Some will have a lasting effect on spine care in kids.  Otheres are "passing fancies".  All are out there and our friend the internet makes them all readily accessible to patients and parents.  It is part of my job to be aware of the new things and to give them enough thought that I can give an educated opinion about them when asked.

3)  To include the patients and families in developing communication programs.  I am indebted to one of my grown patients for coming up with the idea of Backtalk, not only because the organization is so terrific, but because it showed me how I can interface with the folks I am caring for.  Moving forward, I hope to include more thoughts and wisdom from my young charges on these pages and to collaborate with them and their parents on up-to-date writings and educational/ fun programs about spine care.

So there in a nut-shell are the kernels of my 2013 professional New year's resolutions.  I resolve to add entries to this blog more frequently and to keep my mind and soul open so that I can have a constant supply of fresh topics to discuss.  I resolve to continue to be state-of-the-art with regards to technology, but to never lose sight of the humanity of what I am doing.  An most improtantly, I resolve to continue to love what I am doing and to derive joy and happiness from my interaction with patients and family, and with you my readers.

Happy and bright holiday and New Year's wishes.  Or as the Mayans might say, "Cha'an!"

Sunday, September 30, 2012

A Busy Autumn For Spines - World Spine Day and Spine Camp

As the weather in Raleigh cools and the leaves start to change color, the atmosphere is ripe for a harvest of Spine Information programs.  This fall will be a particularly busy one in Raleigh and across the world.

To begin with, October 16th has been designated World Spine Day, in conjunction with the AAOS' extended Bone and Joint Decade Initiative.  This year the focus is "Straighten Up and Move" with an emphasis on exercise and spine safety.  A website (www.worldspineday.org) has information about global and local activities as well as brochures and information.  My office will take the week to feature instuctional handouts and demonstrations in order to better inform all my patients about the need for good posture and good spine function as they grow.

The Pediatric Spine Information Season peaks on Saturday, November 3 with the Fifth Annual WakeMed Spine Camp.  This program, co-hosted by me and WakeMed's rehabilitation department, is a morning of information, events and fun geared towards a better understanding of the spine and spinal conditions that affect kids.  Every year we have demonstrations of back and core exercises, discussions of nutrition (with milkshakes!), art activities and, possibly the most popular part, technical exhibits of spine braces, equipment and instrumentation that allow the children and their parents to get hands on experience with the equipmnt that ultimately may affect their lives.  It's hard to be as scared of a spinal rod when you have actually placed one in a sawbones and seen how it works to correct a curvature.

This year, in an effort to include a larger segment of the population, we will also feature information and demonstrations on proper back function and backpack safety.

The Spine Camp is part of my continued efforts to demystify and destigmatize spinal conditions in the minds of the patients, their families and their friends.  The Camp is wholeheartedly supported by Backtalk, who have a table and put on an open session for all attendees.  It is our feeling that the more people who understand spine conditions, the better the individual with a scoliosis or kyphosis will be able to deal with her own condition.

So I invite anyone in the Raleigh area or any reader of this blog who wants to see how Backtalk and our Spine programs work to attend this wonderful event.  Again, it is Saturday, November 3 from 9 AM to noon at the HealthPark on the WakeMed Raleigh campus.  It is FREE and I can guarantee it will be FUN!

Oh, and happy World Spine Day!

Sunday, August 5, 2012

Athletes and Scoliosis

With the Olympics in full swing, it is easy to be captivated by the sheer beauty and majesty of the athletes as they use every portion of their skill and training to perform daily miracles.  The athlete's body is a finely balanced machine, with each muscle playing a complex role in allowing that extra twist and turn, that last surge of power at the finish or that last soaring leap to the distance marker.

Every child that I see with scoliosis asks a variation on the same question - will I still be able to do sports or dance with my diagnosis?  The anwer is an emphatic "Yes!"  There is nothing about spinal curvature that disqualifies children from playing hte sports they love.  I have patients with scoliosis practicing everything from gymnastics to Indian dance - and to my knowledge none of them has had to limit their activities.

I do caution kids that even small curves may cause imbalance in the back muscles and may lead to some back pain.  I strongly recommend for all children, but especially for those with spine problems, that they take extra time to stretch both before and after sports and that they maintain their back and core strength as much as possible (see my post from January 2012).  But even these aches and pains should allow kids to fully participate.

After spine surgery is a somewhat different concern - will I be able to return to sports?  The simple answer to this question is also "yes," but with the understanding that the road back may take a while and may have some twists and turns.  Although there are very few sports that are not safe to play after a spinal fusion (high contact sports like college football for instance), some may require flexibility that the fuse spine no longer has.  Certainly the way the spine works after fusion may be changed enough that the young athlete may have to relearn a lot of her technical skills.  But, having said that, I have patients after spinal fusion who have returned to soccer, basketball, dance, cheerleading and even gymnastics at a high level, and others who still participate in a wide variety of sports on a daily basis and make athletics or dance as a important part of their lives.

Which brings us back to the spectacle of the Olympics.  Among the tremendous athletes lining up today is a Jamaican sprinter named Usain Bolt - arguably the greatest sprinter who ever lived who set the world aflame in Beijing four years ago by winning both the 100 and 200 meter races in world record time.  Although in interviews he talks about back injuries when he younger, now he cites his core strength as a reason why the curve in his spine has not hampered his rise to greatness.

Watch Usain Bolt (and all the Olympians) race today with pride and wonder at the amazing things that the human body and spirit can do.  And pass the message on to kids with scoliosis that they can be a part of this amazing endeavor as well.

Sunday, June 3, 2012

National Scoliosis Awarenss Month

As always, June is Scoliosis Awareness Month.  There is a busy, informative website (http://sites.google.com/site/wwwscoliosisorgawareness/Home) which describes events and has some useful resources.

Like many health processes, Scoliosis is a condition that many people know about.  With a prevalence of 1-2% or more, it is most likely that everybody knows somebody with a spinal curvature.  Why then is a National Awareness Month so important?

Simply put, Scoliosis is one of those things that folks know exists but just don’t talk about.  And that is a shame, because there are many myths and misconceptions about the condition which never have a chance to be corrected.  People who get scoliosis are already among the most secretive and insecure of demographics, teenagers.  They are far less likely to open up about their concerns and ask the vital questions about any medical condition, let alone one that makes them stand out even more as ‘different’.

What helps most is reaching out to teens with scoliosis and encouraging them to talk with other teens with similar problems.  Outreach groups, like our own Backtalk or the National Scoliosis Foundation, are extremely successful in establishing peer interactions so that teens can find their own way in dealing with their curvature.  Teens with scoliosis need guidance and knowledge to be sure, but mostly they need a friendly face of someone who has been through the same issues, and maybe needs a helping hand and some guidance of her own.  It is astonishing how often people will respond to others’ requests for help when they will not seek it themselves.

Scoliosis Awareness Month is also about letting people without Scoliosis know about the workings of the spine and know that even a crooked spine is not a damaged one.  It is about acceptance of spinal curvatures in the same way we accept red hair or left handedness.  Most of all, it is about giving information to those with spinal curvatures and those without, so that we can demystify the process and let the kids get on with other far more important aspects of their developing lives.

This month I urge everyone at some point to say out loud, “I love someone who has Scoliosis!”  The vast likelihood is that you do and it will do her endless good to hear it.

Thursday, May 3, 2012

MEET THE SURGICAL TEAM

On March 17 of this year, Backtalk hosted their annual Meet the Surgical Team session at WakeMed.  The session included myself as well as representatives from anesthesia, surgical nursing, floor nursing and neurologic monitoring.  During the two hour program, we described the typical surgical day for a child undergoing instrumented spinal fusion. Each participant gave a brief interactive presentation followed by a Q&A session.  The meeting was attended by members of the Backtalk group as well as parents and children who are facing the procedure.  I've posted videos of the session in the Videos tab of this blog and it is also accessible through the Backtalk website.

I really enjoy these unscripted sessions with children and parents.  The casual interactivity allows us to discuss topics that are important to the group and not just read a cookbook of information.  The Q&A always keeps me on my toes, since I never know what the attendees will ask and what specific aspect of the surgery they will find most interesting.

The most important take home message of the talks is not the specifics about when to arrive or what pajamas to pack.  It is to see that the entire team is focussed so fully on the care of the child undergoing an operation and that, because of that focus, we can work seamlessly for the child's safety.  I find it comforting as surgeon to know that I have such devoted and caring folks on my team.  I think it must be particularly comforting for the parents and the child to see them as well.

Monday, April 9, 2012

BACK PAIN IN CHILDREN
There was a time when back pain was so unusual in children that it was felt that there was always some underlying disease.  Mechanical back pain is for adults, we learned, so look for the fracture or the infection or some other rare cause in those infrequent cases that come into the clinic.
In reality, I think back pain was always there but we were not listening.  Thinking that something is rare gives one license to make it invisible – you can’t be in pain, because kids simply don’t have pain like that.  It’s growing pains or a pulled muscle.
Back pain certainly exists now.  In my pediatric back clinics a full third or more of my patients present complaining of daily pain that interferes with their regular activities.  Many of these patients have not had injuries.  Most of them do not show signs of the typical causes of back pain that we are taught – infection, bony growths or stress fractures.   All of a sudden, kids are catching up to adults in back related problems.
Why are we seeing this rise in back pain in the younger population?  I think there are four major reasons why more children are having adult type pain:
1)      Childhood obesity – The American Academy of Pediatrics has tracked rising BMI in kids over the last decade and there are a concerning number who are morbidly obese.  As in adults, increased weight leads to increase stress on the back and more pain
2)      Strenuous athletic programs – Especially in the Raleigh area where I live, but all over America, kids are playing organized sports to the extreme.  Even when not training and practicing for specific sports, many children are involved in strenuous weight and conditioning programs, like P90X or similar, which may not be appropriate for their age and muscular development.  Also the use of weight and diet supplements has been shown to cause muscle symptoms as well.
3)      Backpacks – The weight that we are requiring children to carry on a daily basis is absurd.  It’s been recommended that a child should carry no more than 10% of body weight at any time.  I have had 70 pound girls in my clinic carrying 40 pound backpacks!  The packs themselves may be a problem as well.  The typical rucksack type may not distribute the weight properly and may lead to increased back stress.  Other types of pack may be better for the child, but are not judge “cool” or are forbidden by the schools for various reasons.
4)      Psychological stress – The level of pressure and number of stressors on children today are at an all-time high.  Kids today not only have to deal with the typical internal stresses of adolescence, but external stresses like the economy, war, the general state of the Earth that may be adding higher amounts of pressure leading to psychomotor strain.
I think the most important thing we can do for children now is recognize that back pain and these factors all exist.  If we can communicate with the kids to understand how they are feeling about life and the world around, teach them coping skills, review their sports and conditioning programs and take steps to reduce the book loads that they must carry on a given day, we should be able to give children and parents the tools to manage the back pain and keep it from becoming a chronic adult-type problem.
The most radical point is taking the time to communicate and understand the problems and challenges facing a young person today.  We should let them know that we respect their back complaints and that their problem is not invisible to us.

Monday, March 12, 2012

Genetic Testing of Scoliosis

As we learn more about the genetic basis of scoliosis, the importance of gene testing becomes clearer, both to evaluate family members for potential involvement and to determine the prognosis of curves that have already been detected.

A simple expedient test for scoliosis has been available for about two years and I have used it in my practice with some surprising results.  Curves I thought were at risk clinically were low risk by the test and vice versa.  So far the test has panned out accurately in all cases.

As with all new technology, the use of the test is being challenged by the insurance industry, claiming that it is "unvalidated", "experimental" or an "overpriced screening device".  The following is a letter I wrote to one such insurance company in response to their challenge.  I feel the battle still lies ahead, but this is one circumstance where the effort is well worth it in terms of the peace of mind that the test may afford patients and parents, and the important information that it certainly affords their doctors:

AN OPEN LETTER TO THIRD PARTY INSURANCE COMPANIES

To whom it may concern.

As a pediatric orthopaedic spine specialist, I am extremely concerned by your company's apparent determination to deny payment for the Scoliscore scoliosis gene test.

Let me state that I have no financial interest in Axial Biotech, the company that developed the test, or in Smith & Nephew who distribute it.  I do not personally bill for the test or charge for administering it.  Ordering Scoliscore tests does not in any way benefit me financially.

As a recognized expert in pediatric spinal conditions, I feel strongly that the Scoliscore test is one of the most powerful diagnostic tools that has been developed in recent years.

As you may or may not know, Scoliscore is a salivary test that evaluates the presence of genes that are known to be associated with progression of scoliosis.  On the basis of the number of genes present as well as age of the patient and magnitude of curve, it factors a score from 1 to 200, where 200 is most severe.  In general, the higher the score, the higher risk of progression of the disease.  The test is both highly sensitive and specific.  The positive predictive value of a high score (180 and above) for progression is upwards of 95%.  The negative predictive value of a low score (under 40) is 99%.  As such, it is one of the most accurate prognostic tests available today for any medical condition, and is markedly more accurate than the clinical and radiographic predictors that re currently in use.  The test was prevalidated extensively and is FDA approved.  After two years of widespread availability, it has been validated in clinical use in peer reviewed journals1,2,3.  As such, it is hardly an “experimental test.”

Scoliscore is not a screening test and to my understanding was never intended as such.  There is currently no role for its use in the general population to determine who might someday have scoliosis.  Its indications are strictly to determine risk of progression in growing patients with known mild to moderate scoliosis.  The benefits of accurate prediction of the behavior of scoliosis should be evident and embraced.  If a child is at high risk, early intervention such as appropriate bracing may ultimately spare the need for surgical correction and fusion, with its subsequent risks and problems..  If at low risk, the child will require fewer screening visits and radiographs.  By my estimation, a child of nine with a Scoliscore of 25 may be spared up to 25 or more clinical visits and x-rays over a course of a life time, which represents a huge savings in time, money and, possibly most important, radiation dose.  By this factoring, the Scoliscore test would more than pay for itself.

In two years of using the test personally, I have seen these benefits at both extremes.  I have one young lady, who despite having a relatively small curve (18 degrees at first visit) had a Scoliscore of 193.  By typical clinical pattern, she would have been seen at an interval of six months and reassessed.  Because of the high Scoliscore, I brought her in at two months.  As predicted, she demonstrated rapid progression of the curve and is now in a brace that is containing the scoliosis.  Similarly, I have many children who have scored under 40 despite moderate curves (20-25 degrees) and have been stable enough to put on once yearly surveillance with clinical examination rather than aggressive radiography.

Beyond the immediate clinical benefit, the knowledge that we are obtaining about scoliosis from Scoliscore is of immeasurable value.  Each child will add her story to our collective understanding of the causes of Idiopathic Scoliosis, and may someday lead to a medical understanding of the disorder that may preclude the need for x-rays, braces or even surgery.

Your marketing campaigns have always emphasized your company’s dedication to the patient’s well-being through stressful medical situations, and my and my patient’s experiences have generally borne this out.  However, there is arguably no more continuously stressful circumstance for a young teenager than a spinal deformity.  The peace of mind afforded by accurate and reproducible prognostic information in this setting cannot be underestimated and would seem to fit squarely with your organization’s advertised mission and vision.

I strongly urge you to support the use of Scoliscore and to allow medical coverage of this extremely important modality.

Thank you for your kind consideration.

Sincerely,


Keith P. Mankin, MD FAAP
Raleigh Orthopaedic Clinic
WakeMed Children’s Hospital


1Ward K, Ogilvie JW, Singleton, MS, et al. Validation of DNA-based prognostic testing to predict spinal curve progression in Adolescent Idiopathic Scoliosis. Spine. 2010;35(25):1455-64.

2Ogilvie JW.  Update on prognostic genetic testing in adolescent idiopathic scoliosis (AIS).  Pediatr Orthop. 2011 Jan-Feb;31(1 Suppl):S46-8.
3Ogilvie JW.  Adolescent idiopathic scoliosis and genetic testing. Curr Opin Pediatr. 2010 Feb;22(1):67-70.

Sunday, February 19, 2012

ART and SCOLIOSIS

Artist Ian Barrie stands in from of his exhibit at ROC's Harden Road Pediatric Office

LAST MONTH, an exhibition of four art pieces inspired by the human skeleton went on display at ROC’s Harden Road office. The works were completed by Ian Barrie, a young man from Raleigh, studying art in the Boston area. He also happens to have scoliosis and was treated by me with a spinal fusion. The art is colorful and playful, exploring the natural shapes with a somewhat stylized line and in fanciful colors. I find the pieces whimsical and joyful and they are well worth stopping by and viewing.

Ian’s artist’s statement for the exhibit is as follows:

"Ever since I had my spinal fusion surgery I became fascinated with the internal structure. As I am studying to be an artist, I want to go into further exploration. So I decided to create visual representations of various parts of the internal structure. In my work I like to explore different styles of mark making, movement, and color. "

Although he acknowledges that his medical condition and subsequent care inspired his interest in the skeletal system as a form, Ian told me that he was not necessarily making a statement about his own health, and merely exploring the shapes and textures. However, his two pieces that include the spine both feature complex twists and turns. It is hard to imagine that the curvature of his own spine did not play into his treatment of these images.

Art has often been solace and catharsis for an artist’s own infirmity. Artists such as Van Gogh have used the canvas to express the inner turmoil of their psychological despair, yet have found ways to soften their own mortal terror with images of amazing loveliness and gratitude. Toulouse-Lautrec may have designed his elongated and motive figures to reflect his ambivalence about his painful dwarfism, yet his artwork is alive and vivid. Freda Kahlo is famous for the stark images of pain which reflected her own physical sufferings, yet her art is as colorful as carnival in its tonal composition.

Scoliosis has often arisen as the inner image of the artist’s psyche and is also depicted in a wide range of emotive settings. Scoliosis is featured by classical artists in ultra realistic images of twisted and crippled old age, or images of snakes curved along the ground. But in another famous work, Rubens’ “Three Graces”, one of the deities with her back directly to the viewer has an unmistakable rib and hip prominence. For all her scoliosis, she is as lithe and beautiful as her straighter sisters.

Rubens' "The Three Graces". The Grace with her back to the viewer has an unmistakable curve.

In 2007, the AAAOS held an Orthopaedic art competition to celebrate its 75th anniversary. Although all aspects of orthopaedic care are represented, spine and scoliosis make up a significant percentage. They range from architectural forms exploring the masterful design of the spine to figure drawings and paintings of the scoliotic form. One of the most arresting and stark artworks I have ever seen is that by Laura Ferguson of a solitary figure wrapped around herself with her curved spine exposed to the canvas. The earthiness and honesty of that artwork are especially moving. Elsewhere in the collection is a crystal “caduceus” made up of a scoliotic spine that is both uplifting and jovial.

In searching images for this essay, I happened on thousands of images of artwork by people affected by scoliosis, some professional artists, some simply folks using art as a form of expression. Along with paintings, sculptures and fractal images are scores of poems and essays, some of which are searing and bleak, others defiant and uplifting. The artwork itself ranges from painful horror fantasies to graceful and beautiful figure pieces that blend the curvature of the spine into the gentle natural line of the seated or lying human body. Some of the art is funny and high-spirited. Some artists have posted x-ray images as a statement that even the curved spine is a wondrous work of art in itself. One particularly striking image has the curved spine lit by brightly colored lights coursing down its length, as if to express the energy that that emanates from even the curved spine. It brings to mind Whitman’s famous words, “I sing the body electric…”

Our local artist’s work is neither tortured nor despairing. It is fun and clever, a sense of peace and wonder purveying. I wonder if the very act of making such art serves as catharsis for the multitude of artists I encountered on the web. I certainly hope that those artists find some peace through their expression.
I heartily recommend browsing the scoliosis artwork on the web. As a doctor with a keen interest in spine and in the development of children, and more important, as a human being with what I hope is a high degree of empathy, I was profoundly moved and changed by the images I saw and the words that I read.

Monday, January 9, 2012

Why a Pediatric Spine Specialist?

There is an old saying that every pediatric practitioner knows by heart.  It is practically engraved on our foreheads the moment we choose a pediatric specialty.

“A child is not simply a small adult”

This maxim is based on a number of differences between the child and the adult.  The most obvious is the potential for growth.  A child is continuously growing up to the ages of thirteen to fifteen in girls and sixteen to eighteen in boys, and sometimes beyond.  The growth is dependent on specialized centers in the skeleton and in other parts of the bodies which cause the cells to duplicate and then to reform in an enlarged or lengthened shape.  The spine is no exception, having a very complex growth system for every bone in the vertebral column.

Other differences are less obvious.  The bones (and other organs) are constantly reshaping and what we term remodeling.  In other words, the shape of a young child’s leg bone may be quite different than the same bone in the same child when she is older and may be more different still when she is a grown woman.  This allows the bones to take on different functions that the child needs at different ages, whether it is learning to walk at one year old or fine tuning a soccer free kick at fifteen.

The least obvious but probably most important is the psychological difference between a child and an adult.  The child as she grows is becoming aware of the world about her for the first time.  She is taking new challenges and partaking new experiences that she will assimilate into her ‘adult’ view of the world.  But until adulthood (and often beyond) that development of character is a work in progress.  One can never anticipate the child’s or the adolescent’s response to a given problem.

So why has the medical community developed specific pediatric specialists that work with and specialize in treating children exclusively?  It is because our training allows us to accommodate for the surprises that the child will hand us during the course of her care.  Pediatric specialists are particularly good at hitting curveballs.

We also have knowledge and experience in anticipating the changes that a child will undergo in the course of her life.  Our treatments are often geared not only towards the ‘here and now’ but also towards the future.

But this experience and expertise is developed, as with anything, only by specialized training and long practice.  One can’t dabble in pediatric treatment – treating fifteen year olds at one moment and eighty year olds at the next.  The differences in the treatment, the approach and the care are far too great to allow any sort of smooth transition. 

Now turn the question around.  Why did I choose Pediatric Spine?  I completed a pediatric orthopaedic fellowship and have a practice that is exclusively children.  Although I treat all problems, well over half of my practice is devoted to the care of pediatric spinal conditions.  I find the problems compelling, challenging and extraordinarily rewarding.  The spine is the central support of the child and problems in it cause central problems in a child’s life – whether these are issues with school or work or issues with the more complex social world of the growing child.

In the pediatric spine, we never are doing salvage work.  We never are settling for accepting pain or accepting a status quo that is unacceptable to the patient.  And because of the unique nature of the pediatric spine our range of treatments are far greater and more effective than those for the adult population – I will write much more on these topics as this blog develops.

So why did I choose to specialize in the pediatric spine?  It is expressly because children are not just small adults.   With every overreaction and moment of drama, they bring moments of serenity and composure and boundless energy that make treating them an n endless source of challenge and joy.