Shriners Hospitals for Children � Chicago performs more pediatric spinal surgeries than any other hospital in the state of Illinois. Common conditions include:

� Scoliosis
� Kyphosis
� Spondylosis
� Spondylolisthesis

Scoliosis
Scoliosis affects two of every 100 children. Most scoliosis (called idiopathic, because the cause is generally unknown) occurs in young adolescents, especially girls. Most curves do not progress and can be followed with observation. Children whose curvature is likely to progress include those who:

� Have curves greater than 20 degrees
� Are skeletally immature
� Are girls who have not yet started to menstruate

If there is a significant risk of progression, patients should be followed every four months. For children who are skeletally immature and have curves somewhere between 25 and 40 degrees, bracing can keep the curve from worsening. Bracing will not reduce the curve, but has been shown to be effective in preventing progression in 75% of patients, if the brace is worn for 16 to 18 hours per day. Skeletally immature children with curves of 40 to 45 degrees or greater and skeletally mature children with curves greater than 50 degrees are candidates for surgery.

Surgery for Scoliosis
Scoliosis can be surgically addressed by implanting rods alongside the spine to straighten it, fusing together some of the vertebrae. These surgeries are constantly growing in sophistication; new rod systems yield increasingly good corrections of spinal curves. Neurological monitoring systems, cell savers, and autologous blood donation make spine surgery safer than ever. Mobilizing young people soon after surgery helps to get your child home more quickly. Casting or bracing after surgery is rarely necessary anymore.

Vertical Expandable Prosthetic Titanium Rib
The cases of much rarer congenital curvatures present unusual problems. Fusing the spine keeps it from growing. In the case of adolescents, this is hardly problematic; most of these patients are at or near their full spinal height. For children born with scoliosis or developing the deformity soon after birth, rodding, and the resulting fusion, will only exacerbate the problem of thoracic (chest) insufficiency.

A new procedure offers an original way to enlarge the chest without fusing the spine. The new Vertical Expandable Prosthetic Titanium Rib (VEPTR) uses titanium implants to gradually push the ribs apart to expand the chest. The implants can be placed between the ribs; can be angled between the ribs and the outside of the spine; can even be braced between a rib and the top of the pelvic bone, depending upon the three-dimensional angles needed to open up the chest cavity and straighten the spine. VEPTR implants can telescope, sliding open like a curtain rod to fit a window. As the child grows, small incisions allow the surgeon to expand the rods and keep the chest growing, providing space for the heart and lungs.