Advanced procedures and implants.
Improving the quality of a child’s life, and sometimes saving it, pediatric surgeons are on the front lines of advanced care.
In a world of emerging technologies and rapid advancements, Children’s pediatric surgeons strive to provide the most up-to-date procedures. They also work to use less-invasive techniques, decrease post-operative pain, and shorten recovery. But even more important, they want kids to feel better, and go home with improved function and quality of life.
Surgeons at Children’s see some of the most difficult cases, from operating on a heart the size of a walnut, to utilizing the advanced “pull-through” procedure for anorectal malformation and colorectal disorders. Recognizing that a multidisciplinary approach is effective when caring for complex conditions, they work with the patient’s other caregivers to share information and develop a treatment plan that’s best for the child.
The only pediatric hospital between Los Angeles and the Bay Area, Children’s offers many specialized services and alternative options not available elsewhere in Central California. The following procedures show how Children’s surgeons use cutting-edge techniques, state-of-the-art devices, and their own expertise to provide the best outcomes for their young patients.
Already the first in Central California to perform the Vertical Expandable Prosthetic Titanium Rib (VEPTR) technique, Children’s Orthopaedic Surgery Department has added two more cutting-edge interventions to treat children with severe scoliosis. The new Shilla and Internal Traction techniques build upon the department’s alternative options for young patients who don’t respond to conventional management.
“We have the best options available with modern technology that we can tailor to each patient,” said Dr. Michael Elliott, who specializes in scoliosis and spinal deformity and is one of five pediatric orthopaedic surgeons at Children’s.
The Shilla is a new dual-rod technique that can be more stable and have fewer complications than the traditional single-rod approach for spinal correction. Surgeons implant a pair of rods that hold the most curved portion of the center of the spine straight and fused. Ends of the rods are not fused, but held in place with growing screws, allowing the spine to lengthen as the child grows. With other techniques patients had to return every six months for adjustments, but with the Schilla they don’t have to come back for two years.
Internal Traction is used for curves of 100 degrees or more and is completed in two stages. The first surgery implants a rod that partially straightens the spine. A week later, a second operation inserts double rods allowing further improvement, gaining about an 80-degree total correction. This gradual approach is safer for the patient and results in shorter hospitalization.
In addition to Shilla and Internal Traction, Dr. Elliott also performed Children’s first VEPTR titanium rib technique. The titanium rib treats early onset of scoliosis and thoracic insufficiency syndrome (TIS). TIS is a congenital condition causing severe deformities of the chest, spine, and ribs that prevents normal breathing and lung growth. The titanium rib - a curved metal rod attached to ribs near the spine - helps straighten the spine and separate ribs so the lungs can fill with adequate air to breathe. The length of the device can be adjusted as the patient grows.
“These procedures are very complex and should be done at a children’s hospital such as ours that specializes in spinal surgery,” said Dr. Elliott.
Up to 4 percent of children age 10 to 16 in the U.S. have adolescent idiopathic scoliosis (AIS); the majority of those affected are girls.
Bone anchored hearing.
In the U.S., up to three out of every 1,000 children are born deaf or hard of hearing, and more lose their hearing later in childhood. Hearing is vital to a child’s early speech and language growth, and hearing devices can be key to a child’s development.
The type of hearing loss a child has determines what kind of hearing device is most appropriate. Bone Anchored Hearing, or BAHA, is a surgical alternative when traditional “in the ear” or “behind the ear” devices are not effective. The amazing device directly stimulates the inner ear through the bone.
“The BAHA is appropriate for those who have conductive hearing loss, mixed hearing loss, or single-sided deafness,” said Dr. Jairo Torres, a surgeon in Children’s ear, nose and throat division. “We learn speech by the feedback we hear. If a child has one normal ear, usually their speech is fine, but if not, this can help.”
Bone conduction transmits sound directly through the jaw and skull, bypassing the outer and middle ear. Conventional hearing aids rely on air conduction and won’t work if the middle ear isn’t functioning. The BAHA is designed to bypass the outer and middle ear altogether.
The short, outpatient procedure is done under general anesthesia for children age 5 and up. It involves surgically implanting a titanium screw into the skull and leaves a small abutment exposed outside the skin. After the titanium attachment has had three to six months to integrate with the bone, the sound processor, or hearing device, is snapped onto the abutment. The surgeon may also implant a “back-up” titanium post in case the initial receptor fails or becomes damaged.
The child’s hair grows over the abutment, concealing the device. The surgery is easily reversible, but Dr. Torres said few people choose that option because, “the sound quality is so great.”