Shriners Children’s Scoliosis Research Looks for Breakthroughs with AI

During Spinal Cord Injury Awareness Month, Shriners Children's, a nationwide leader in pediatric spinal cord injury rehabilitation, is raising awareness about a common condition to watch for in children who sustain a spinal cord injury (SCI). They often also develop scoliosis, which, in some cases, requires special care.

When she was just an infant, Rae Anne's family received a difficult diagnosis for their daughter. A second opinion at the Shriners Children's Chicago location confirmed her neurological issues were caused by transverse myelitis, a type of pediatric spinal cord injury caused by inflammation damaging the cord. She later developed scoliosis, an abnormal curve in the spine, which can have a major impact in a child's life. Her experience of scoliosis after an SCI is a common occurrence. Researchers at Shriners Children's found that up to 96% of children who had an SCI before age 5 developed scoliosis.

"Children with SCI before their adolescent growth spurt almost always develop scoliosis, regardless of the level of injury. Younger patients are at higher risk for scoliosis because they have a lot of growth remaining. We typically see curves developing during periods of rapid growth, particularly from ages 10 to 16," said John Ghazi, M.D., pediatric orthopedic surgeon at Shriners Children's Chicago. "The type of scoliosis that occurs in individuals with spinal cord injury is called neuromuscular scoliosis. As the name implies, it is the result of a disorder of the nervous system or muscle."

Dr. Ghazi said the treatment approach varies based on the child's individual curve and curve progression. Larger spine curves can make it harder to sit in a wheelchair comfortably. It can cause pain and even affect a child's lungs. "The reason that scoliosis can lead to respiratory issues is that a thoracic spinal curvature decreases the space available for the lungs in the chest, and the deformity of the chest wall weakens the mechanical forces necessary to ventilate the lungs properly," he said.

Families concerned about scoliosis should speak with their child's doctor. They may be referred or decide to make an appointment with the specialized scoliosis teams at Shriners Children's, where three locations, Chicago, Philadelphia and Northern California, specialize in pediatric spinal cord injuries and scoliosis.

Smaller curves may be managed with close observation and optimization of positioning in a wheelchair. Moderate curves are sometimes treated with a brace. "It is important for these braces to be well-padded and fitted appropriately to avoid excessive pressure on the skin, particularly in areas that lack sensation," Ghazi said.

In more severe cases, doctors typically recommend surgery to stabilize the spine and keep the curve from growing worse. The most common type of surgery for patients with an SCI who develop scoliosis is posterior spinal fusion. The surgery at Shriners Children's can be customized for a child who uses a wheelchair. Purnendu Gupta, M.D., is chief of staff at Shriners Children's Chicago. He explained that spine surgeons attach big screws at the bottom of the spine and into the pelvic bones for support, "like the pylons you put in the ground to support a skyscraper," he said. "What happens is kids cannot sit square in a wheelchair unless you give them some support … I always explain to families that for a tall structure to stand you have to anchor it into the ground."

Ghazi said surgery also allows doctors to significantly correct the spine curve using rods, which may give a wheelchair user better positioning and comfort as they attend school and pursue their dreams.

This material originally appeared in the SCI Informer, a pediatric spinal cord injury support publication from Shriners Children's Chicago. Learn more about our pediatric spinal cord injury care .