I am a Consultant Spine Surgeon with a specialist interest in paediatric spinal deformity. My private practice is at the Portland Hospital for Women and Children and my National Health Service practice is at the Oxford University Hospital. I've been in practice for over 10 years and one of my main interests is the treatment of early onset scoliosis (a condition which involves a curvature of the spine), in particular the magnetic growing rods that have revolutionised the treatment of children with the condition.
One of the great things about working at the Portland Hospital is the multidisciplinary nature of the service. I am part of a team of experts that deals very frequently with children who have complex spinal conditions, and a lot of those children will also have other medical problems. From my paediatric colleagues down to the nursing staff, we've got a very capable theatre team with a state-of-the-art facility that we use to treat these children.
We've also got a physiotherapist team and a children’s rehab team. We have a child psychologist as well; as you can imagine, some of these children are very ill and it is daunting coming into hospital to be treated for these complex conditions. I think we are extremely lucky to have the total service that we offer at the Portland Hospital. I think it is one of the only purpose-built children’s facilities in the UK that speciﬁcally deals with children’s problems, not just in spinal surgery, but across the whole range of medical specialties.
Throughout treatment there are interactions with the various members of the team before surgery, during surgery, in the anaesthetic room, after the surgery and all the way through to discharge. That’s the sort of environment that needs to be encouraged, that parents and families will expect to be the norm in terms of future care pathways. What we are trying to provide is the ‘one-stop shop’ where children and their parents see different members of the team in as short a time period as possible, and then all those members of the team are in constant communication about the child’s care. By so doing, we aim to optimise each child’s treatment and also make it fun for them while they are in the hospital environment.
Parents can stay overnight and we also encourage the children to engage with each other while they are on the ward. There are playroom facilities and common rooms where families can get together, socialise and exchange experiences about their treatment. It’s about trying to make the hospital a home away from home, so that both the child and their parents feel relaxed. As the Portland Hospital is in central London, families will often go sightseeing or shopping when the children have recovered from surgery and are well enough to go outside, which is a good experience for them as well.
In years gone by, the mainstay of treatment for scoliosis for children who failed conservative therapy, such as bracing, was surgery. Older children, above the age of 10, and younger children with severe curves would have what we call a definitive spinal fusion. The difficulty with that was, if you fuse the spine at a very early age, then a child will have a short trunk and may run into problems with their respiratory function later in life.
Treatment then progressed to what we call the growing rod systems. The principle was that you would insert these rods into the backs of these children to try and control the spinal curve, while at the same time you would lengthen these rods on a regular basis to keep up with growth. So you would allow those children to maintain their trunk growth, but also controlling their spinal curvatures. However, the big drawback was, to do that successfully, these children required repeated surgery; in some cases, if the rods were inserted very early, for instance at the age of six, such children would have undergone between 10 and 20 operations by the time they were ready to have definitive surgery at the age of 12. As you can imagine, that is terrifying for any child and a huge burden on the family.
In the past five to six years, the introduction of magnetic growing rods has meant that the surgical episodes for treatment of scoliosis in very young children have diminished considerably. There is one operation to insert the rod, with subsequent lengthening carried out remotely with a machine that allows the rods to be lengthened in clinic without the need for surgery. In this way, we can keep up with the growth of the child, lengthen the rods and control the curve without having to perform repetitive surgeries. All round, it's generally better for those children and their families and it is such an advancement on the treatment that had gone on beforehand. A lot of the pioneering work around the magnetic growing rods took place in the UK and I'm proud to have been a part of that process.
I think the future will see the proliferation of non-invasive growing rod technology. The next stage is to develop intelligent growing rod systems that ‘talk’ to each other so that we can determine the expected growth of the child to improve the accuracy of the lengthening process and better control the spinal deformities as well.
There also other different growing rod systems, which we can also offer those at HCA UK. There is the Schiller growing rod system, which again is a modification of the non-invasive growing rod technology; essentially, it's a telescopic growing rod system that requires one operation to insert the rods, and then the system grows with the child over a number of years.
From a non-operative point of view, physiotherapy has previously been used as a way of trying to control the spinal curvature, but there is a new method called the Schroth Method, which combines physical exercises with breathing exercises. It is a physiotherapy method that also takes into account the effect that the spinal curvature may have on the respiratory system, whereas conventional physiotherapy focuses on the trunk muscles’ core stability. This Schroth Method is starting to gain traction in the United States and I think it will do so here in the UK.
Also, there are new bracing techniques that we offer at the Portland, which not only help to control the curve, but also provide the ability for in-brace correction. In effect, they are active braces that facilitate correction as well.