“Growing rods” for scoliosis help straighten tiny patient’s spine

By Maureen Gilmer, IU Health senior writer, mgilmer1@iuhealth.org

Selena VillaGomez-Diaz was just about 2 months old when her dad, Angel Diaz, noticed an unusual curve in her tiny back.

“She was leaning to one side all the time, even when she lay down or when we picked her up,” he said. “She was always slouched over to one side.”

As the curve in her spine continued to worsen, Angel and his wife, Jessica, sought answers from the Riley Children’s Health orthopedic team, specifically orthopedic surgeon Dr. Tyler Christman, who specializes in scoliosis treatment.

Signs of scoliosis include leaning to one side, uneven shoulders, a shoulder or hip sticking out, and ribs protruding on one side. While scoliosis occurs most often during the growth spurt just before puberty, infantile scoliosis can develop in the first six months of life.

Now 5 years old, Selena has undergone multiple interventions in an attempt to straighten her spine, most recently surgical implanting of growing rods by Dr. Christman.

“Her surgery is unique in that she is exceptionally small, and her curve is extreme,” the surgeon said.

In fact, Selena is the smallest patient to have this surgery at Riley. She’s not the youngest, Dr. Christman said, noting he had performed the same operation on a 2-year-old. But at just under 28 pounds, she is the tiniest.

Born with a chromosomal abnormality and kidney problems, Selena has always been small, but placement of a feeding tube enabled her to gain enough weight to have the surgery, her parents said.

Angel Diaz holds up X-rays of his daughter taken before the surgery, which show a significant curve.

“It’s like a question mark going on there in her back,” he said, as his agitated daughter was comforted by her big brother and best friend, Alexander, at Riley.

“He wanted a brother,” the children’s mother said, “but he is very protective of her.”

There was no question that young Selena needed the surgery, despite her age and size, Dr. Christman said.

She was initially fitted with body casts as a baby, then moved to a brace, but her scoliosis continued to progress, he said.

“She started to develop more of a kyphotic deformity,” he explained.

Kyphoscoliosis is a more aggressive form of scoliosis, which can lead to organs being affected.

“That’s one of the main reasons I felt she needed a surgery of this magnitude at such a young age,” Dr. Christman said, “because we know that when scoliosis progresses, particularly above 80 to 100 degrees, there does start to be compromising of cardiopulmonary function.”

Selena’s curve was already at 100 degrees or more (among the most serious he’s seen), so allowing it to continue could have a significant impact on her quality of life and her heart and lung function, he said.

Casting can be a particularly effective treatment for infantile scoliosis, but eventually patients can age out of that option. The spine becomes more rigid and less amenable to casting as children get older. Those children would graduate to a brace, and some, like Selena, need to have growing rods.

Selena was discharged from Riley last week, a few days after her surgery, but she will return this week for a wound check, then come back in three months, when Dr. Christman will begin lengthening the MAGEC (Magnetic Expansion Control) rod in her spine.

“This type of construct is really a bridging technique to allow the spine to be controlled and supported and to prevent additional progression while the patient continues to grow,” Dr. Christman explained.

“All children who have these growing rod constructs eventually will require a more definitive fusion where we remove the magnetic rod and place additional screws and a more adolescent-type construct,” he added.

The growing rods allow kids to age, mature and get taller before a more permanent surgery is done.

“If I were to fuse them at 5 years old, and that portion of the spine no longer grew, there would not be space for an adult heart and lungs.”

Selena still has a long way to go, Dr. Christman said, and may require additional procedures, including a new set of growing rods.

The rods he placed, which will allow for 3 centimeters (approximately 1.18 inches) of growth, are the smallest that the manufacturer makes. The surgeon expects to adjust Selena’s growing rods by about 3 millimeters (a fraction of an inch) every four to six months.

Dr. Christman, whose primary focus is on scoliosis patients, said Riley has a “fantastic, multidisciplinary team” to care for patients with spine deformities.

“We have tremendous resources and expertise at Riley that allow me to do this type of surgery,” he said. “Without the knowledge, expertise and support of the spine team, including the anesthesia team, our pain team, the nursing staff, the operating room staff, as well as the physical therapists, this type of surgery, this complexity of surgery would not be possible with the same success rates that we have.”

Photos by Mike Dickbernd, IU Health visual journalist, mdickbernd@iuhealth.org