Advanced pediatric spine care: Q&A with a pediatric orthopedic surgeon

Health & Wellness |


Spine qa puryear

Aki S. Puryear, MD, one of our expert pediatric orthopedic spine surgeons at Riley Children's Health, shares what makes the difference in providing leading edge spine care.

The orthopedics program at Riley Children’s Health is Indiana’s only nationally ranked pediatric orthopedics program. Aki S. Puryear, MD, pediatric orthopedic spine surgeon at Riley Children’s and George J. Garceau Professor of Pediatric Orthopedic Surgery at Indiana University School of Medicine, provides details on the leading-edge spine program at Riley Children’s.

How are the pediatric orthopedic surgeons at Riley Children’s uniquely qualified to care for children with spine disorders?

Dr. Puryear: We are fortunate to have three fellowship-trained pediatric orthopedic spine surgeons experienced in consultation, diagnosis and treatment of the full range of conditions, including scoliosis and spinal deformity. As pediatric orthopedic surgeons treating infants and children of all ages, we are skilled at managing the needs of the growing child. Our surgical techniques include use of the growing spine constructs such as the MAGEC rod to reduce the need for spinal fusion and preserve spine motion—both of which contribute to better patient outcomes.

My colleagues, Dan Drake, MD, and Tyler Christman, DO, MS, are pediatric orthopedic spine surgeons at Riley Children’s and also faculty members at IU School of Medicine. In addition to engaging in research that translates to clinical care, we are actively involved in well-regarded surgical performance and study groups such as the Pediatric Spine Study Group and Setting Scoliosis Straight.

What is the age range of your patients and what conditions does the team treat?

Dr. Puryear: We treat infants, children, adolescents and young adults up to about age 21. We care for patients with a wide range of spine conditions, including all types of scoliosis, kyphosis and spondylolysis/spondylolisthesis. Our team also sees children with cervical spine disease, whether it be instability or myelopathy. One aspect of our program that’s unique is our monthly multidisciplinary spine conference where we review all of our operative cases and some nonoperative cases.

What types of advanced treatment options and technologies are available at Riley Children’s to treat spine conditions?

Dr. Puryear: Our orthopedic spine surgeons perform all available surgical options. For deformity surgery, spinal fusion is the primary surgical treatment. For scoliosis, I mentioned the MAGEC rod, which is an innovative surgical technique that allows for greater spine motion. It’s also important to note that Riley Children’s is one of the few facilities regionally to provide casting for infantile or early-onset scoliosis.

In terms of advanced technologies, we use O-arm, which is similar to a CT scan, for image guidance in placing implants intraoperatively in a more precise way.

We also have the benefit of EOS imaging, which offers a complete picture from the head all the way down to the lower leg, allowing for imaging of anterior-posterior and lateral at the same time. The benefit of EOS is that we’re able to obtain these images with up to four times less radiation than traditional methods. We were the first in the state to use EOS and are among the few nationwide with these machines.

We also offer all casting options, including nonsurgical casting and bracing. In cooperation with our team of skilled therapists, we provide various kinds of physical therapy and even yoga and forms of manipulative therapy for patients as part of a comprehensive treatment plan.

How do Riley orthopedic surgeons collaborate with other teams of pediatric specialists?

Dr. Puryear: In addition to our pediatric spine surgeons, our multidisciplinary team includes experts in anesthesia, pain management, radiology, nursing, plastic surgery, nutrition, and physical medicine and rehabilitation. Not every child with scoliosis or a spine disorder needs multidisciplinary treatment. But for patients with co-occurring conditions, such as spina bifida, seizure disorders or pulmonary embolism, we collaborate with our colleagues in other specialties at Riley Children's.

We discuss all surgical cases at our monthly spine conference to determine the type of expert oversight and treatment that’s required for patients with special needs. Working together, our goal is to ensure every patient is adequately prepared for surgery and achieves the best possible outcome.

If you are a provider, you can easily refer a patient for comprehensive pediatric orthopedic spine care. Learn more about our specialists and how to refer a patient.

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