Provider News

Adolescent Idiopathic Scoliosis: A Q&A With Dr. Jennifer Bauer, Including Algorithm and Case Studies

August 2, 2023

Dr. Jennifer Bauer is chief of spine surgery at Seattle Children’s. She is a committee member of leading international and national pediatric spine societies and study groups and an editor and reviewer for scientific journals.

Q: When should a child with scoliosis see a specialist?

Dr. Bauer: Kids with a thoracic or lumbar rib hump on an Adams forward bend who have a scoliometer reading of 3 to 5 degrees should be rechecked in six months by their PCP. For a scoliometer reading over 5 degrees, we recommend ordering a two-view standing PA/LAT spine radiograph. If it shows a Cobb angle over 20 degrees for any age child or over 10 degrees in a child under 10 years old, we recommend referral to Seattle Children’s. If they don’t meet those thresholds, we advise a follow-up X-ray in 6 months and referring to Orthopedics if any increase in curvature is seen.

We recently developed an algorithm for scoliosis that offers guidance on how to assess the pediatric spine and when to refer to orthopedics.

Q: How important is early bracing for AIS patients?

Bracing can prevent curve progression and the subsequent need for surgery and should be considered early. We sometimes see new patients who have waited too long to come in and have missed the chance for early bracing. We hope the new algorithm for scoliosis will help these kids find us sooner.

New research suggests that the youngest, most flexible curves may even have long-term correction rather than just preventing progression when starting a brace early.

We have an on-site orthotist team that is here daily and meets with patients in back-to-back visits with their other providers. They are experts in custom-fitting and helping patients be comfortable in their brace, with a workshop here inside our clinic to make same-day changes.

Q: As a pediatric spine specialist, what do you want PCPs to know about AIS?

AIS is the most common type of scoliosis, affecting about 1% to 3% of kids ages 10 to 18. It’s important to understand that AIS is a 3-D deformity. There are many intricacies and aspects to doing a good AIS surgery. Kids, older teens, and even young adults will get the best diagnosis and treatment options from a high-volume team that works only with pediatric patients, all day, every day. We see routine cases and complex cases every day.

Because we’re on the cutting edge of pediatric spine surgery at Seattle Children’s, we offer AIS patients options that are not commonly found elsewhere (see these three AIS surgery case studies). One example is limited spinal fusion, where for many children we can operate on just a portion of the curve to leave as many levels free for growth and movement as possible. Vertebral body tethering (VBT), or nonfusion surgery, is another option we offer. With VBT, a rope or tether is placed via incisions in the chest or abdomen and holds one side of the curve to allow the other to continue to grow out of the curve; it’s designed for a very specific patient group to help them outgrow their scoliosis without needing a spinal fusion. It requires special training and isn’t commonly offered in adult settings.

Another procedure we offer here that adult providers typically won’t is halo gravity traction as a precursor procedure for the most complex, largest curves.

Learn more: AIS surgery case studies by Dr. Bauer and Dr. Burt Yaszay, Seattle Children’s Spine Program

Q: What does halo gravity traction do?

Halo gravity traction is for very severe spine deformities. In a minor surgery, the device is attached around the patient’s head and uses a pulley system with weights to slowly stretch the spine over the course of several weeks. It makes the subsequent spinal surgery we do safer and helps the spine get straighter than it would otherwise get, with a less risky approach needed during surgery. While in the traction, patients can still walk around, play games and keep up with their school work.

Q: How do kids cope with surgery?

We know spine surgery can sound scary to families, so we often connect patients and parents who are interested in talking with other families who have already gone through it for peer support. It can really help with anxiety and stress. There are lots of little but important steps we take to make the surgery a good experience for the pediatric patient. During surgery, we’re very cognizant of the incision closure; we do a very particular closure, with no stitches to cut out or staples to remove later that might be uncomfortable for the patient. We use the latest postoperative protocols so patients advance much faster after surgery and go home sooner.

Being part of a children’s hospital, we also have all the ancillary and support services that help patients and families feel well-supported, like Child Life services to help with comfort and coping and Guest Services for out-of-town families. While in the hospital, patients may receive visits from age-appropriate music or art therapy, therapy pets or our video game consultant. And we connect patients to any other Seattle Children’s specialists they may need during the course of their AIS treatment such as pulmonology, cardiology, etc.

Q: Kids with AIS, especially older teens, are often referred to adult providers because of their age. What is the rationale for pediatric care?

I think there’s a misconception that we at Seattle Children’s only do the most complex surgeries, and since many AIS surgeries are more standard surgeries, that young adults or teens with AIS are equally served at an adult center. However, it’s important for AIS patients to see a specialist who’s knowledgeable and experienced in all the approaches to AIS, not just spinal fusion, and can offer deep experience in all available treatments, from bracing, to Schroth PT, to surgery.

I like to point out that when kids have spine surgery, one of the most important members of the surgical team is the pediatric anesthesiologist. At Seattle Children’s we have a group of dedicated spine anesthesiologists who are the only ones who do our spine surgeries. Together with our Spine Program surgeons, scrub techs and nurses, they do over 200 pediatric spine surgeries every year.

Q: Are there options at Seattle Children’s for kids who live far away?

Yes. We have telemedicine licenses to see out-of-state patients in the WWAMI region. After surgery, assuming no complications, we can do all their follow-up via telemedicine, with X-rays done in their home town and sent to us for monitoring.

Q: How do you stay current on AIS?

Our surgeons are part of national and international research and clinical trials on the spine. Dr. Yaszay and I sit on key committees for leading spine research societies (Scoliosis Research Society, Pediatric Orthopedic Society of North America and International Congress of Early Onset Scoliosis). We participate in every leading pediatric spinal study group (Harms Study Group, Pediatric Spine Study Group and FOX Study Group) and present our work at national and international conferences. We help design the highly specialized rods and screws used in spinal surgeries. We bring all this knowledge back to our patients, leading to safer surgeries, lower rates of complication and kids able to return home sooner.