Personalized Spinal Implants: Nikki’s Story

Four. That’s the number of days it took for Nikki Clark to return home following scoliosis surgery at CHOC Children’s Hospital. Dr. Afshin Aminian, an internationally-recognized expert in pediatric orthopaedics and medical director of the CHOC Children’s Orthopaedic Institute, performed the surgery using the latest techniques and technology to minimize pain and yield the best outcome for his teen patient.

A customized approach to care

Nikki was among the first patients at CHOC to benefit from personalized spinal implants. Based on detailed measurements and perioperative planning, customized rods were created to the precise length and shape of Nikki’s spine. The goals of this approach are better alignment and accurate correction of the patient’s spine. Customized implants and patient-specific rods decrease surgical time. In addition, they have the potential to improve recovery time and minimize future problems related to scoliosis.

scoliosis surgery
X-rays of Nikki’s spine, before and after receiving custom spine implants during scoliosis surgery.

“Our specialists have fine-tuned the most innovative, effective treatments for scoliosis, with a focus on maximizing each patient’s ability to function, grow and enjoy quality of life,” says Dr. Aminian. “Most of our patients are active teens, who are eager to return to their sports and activities. We want to do everything we can to help them do that.”

Making the jump

A swimmer and competitive water polo player, Nikki was thrilled to hear Dr. Aminian’s approach to care. Less than a year after being diagnosed, she decided to pursue surgery rather than wait. Her focus:  being ready for the upcoming season.

“I knew my life was going to get busy and really wanted to make sure I could play water polo during my junior and senior years. I wasn’t afraid of the surgery or the pain. I was more worried about not being able to play,” explains Nikki.

The morning of her surgery, Nikki began feeling anxious; not scared, as she pointed out to the child life specialist who came to check on her in pre-op. “I knew I had the best doctor, at the best hospital in California, and was ready to get the surgery over and done,” recalls Nikki.

A few hours after surgery, Nikki was surprised she wasn’t experiencing as much pain as she anticipated. The next day, a physical therapist helped her sit up for the first time. “It felt so good to finally be able to move,” says Nikki, who also enjoyed ordering milk shakes from CHOC’s room service menu. The chocolate banana one was her favorite.

scoliosis surgery
After scoliosis surgery to receive personalized spinal implants, Nikki was surprised she wasn’t experiencing as much pain as she anticipated.

She continued to follow all the guidelines, including getting out of bed to walk. Her physical therapist and nurses were among her biggest cheerleaders, praising her for quickly reaching the milestones required for her to go home. On Nikki’s fourth day at CHOC, Dr. Aminian proudly announced she was going home.

Nikki’s recovery at home continued to progress at a record pace. A month later, she returned to school. Two months later, she was back as a junior life guard in Newport Beach. The determined athlete surprised everyone by finishing the “monster mile,” which includes running a mile and swimming a mile. By the end of summer, she had also completed eight jumps off the pier.

scoliosis surgery
Nikki loves being outdoors, and quickly returned to her active lifestyle after scoliosis surgery.

Back in competitive water polo, Nikki proudly shows off her surgical scar. She’s been approached by other players, who have scoliosis. She encourages them to “make the jump.”  “You’re strong and in great shape. You can handle surgery,” she tells them.

Learn about scoliosis services at CHOC now.

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Living with Scoliosis: Ellie’s Story

Ellie was a typical seventh grade student who enjoyed playing volleyball when, during a routine physical, her pediatrician noticed that one shoulder appeared to be a little higher than the other. Her mom was told to keep an eye on it, but since it was minor, not to worry. A few months later, minor back pain after a growth spurt lead her mom to discover a curve in Ellie’s back.  Another trip to the pediatrician soon followed.

Initially Ellie and her mom Gail thought the back pain might be due to carrying a heavy backpack around school every day. But Ellie’s pediatrician diagnosed her with scoliosis, and referred her to Dr. Afshin Aminian, director of the Orthopaedic Institute at CHOC Children’s.

scoliosis
Dr. Afshin Aminian, director of the Orthopaedic Institute at CHOC Children’s

“I wasn’t exactly happy about my diagnosis at the time,” says Ellie. “I was upset because I thought it would affect my daily life and I wouldn’t be able to do all the things I was used to doing, like playing volleyball, but Dr. Aminian helped me along the way and I grew into wearing my brace.”

The curve in Ellie’s spine was less than fifty degrees, and non-operative treatment was recommended. She received a custom-fit brace that would apply pressure to the areas where the spine was exhibiting deformity, in order to reverse the curvature and prevent it from getting worse.

“It made me more self-conscious and it made the little everyday things people take for granted more challenging, such as tying my shoes. But I learned to adapt, and even more than adapt, prosper. Time gave me the gift of wisdom to deal with my scoliosis; scoliosis gave me the gift of knowing challenges are inevitable but my defeat is optional,” she says.

An example of a Boston Brace, like the one Ellie wore.
An example of a Boston Brace, like the one Ellie wore.

Wearing the brace practically around the clock took a few weeks to get used to. The first few nights she slept in a sleeping bag on her bedroom floor because it was more comfortable for her back.

At the time, Ellie and her mom wondered if she’d be teased for wearing a brace every day.

“I didn’t know what scoliosis was before my diagnosis. We visited with a family friend who has scoliosis and she gave me great ideas about what clothing to wear with my brace, and now you can’t even tell when I’m wearing it,” she says. “I saw that she was doing well after wearing her brace every day, so I always knew that I would be as dedicated as she was, and wear mine every day, too.”

Long tank tops that were soft and comfortable, loose-fitting shirts, and skirts became wardrobe staples as Ellie tried to camouflage her brace. Because of how far her brace comes down her back, shirts that are a bit longer in the back also helped, she says.

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Long tank tops are one way Ellie camouflaged her brace.

Hearing stories of other scoliosis patients who weren’t as regimented about wearing their braces reinforced for Ellie the importance of sticking to her brace regimen. She made special arrangements with her physical education teacher at school and her volleyball coach to change in private before class and practice because of her brace.

“Having scoliosis wasn’t Ellie’s first choice, but thanks to good support from her school, teammates and friends, she is thriving. Scoliosis just added a little complexity to things, and Ellie has mastered that very well,” says Gail, who helps Ellie tighten her brace after every time she puts it on and takes it off.

Thanks to Ellie’s dedication to wearing her brace every day, the curve in her spine drastically decreased, and she is now slowly able to decrease how often she needs to wear it, and in a few months, she will be brace-free.

“Scoliosis is 70 percent mental and 30 percent physical, so attitude is key,” Ellie says. “If you have a good attitude and are relentless in your bracing, you realize you sacrifice little for your future health.”

Ellie’s commitment to her care team’s plan was evident.

“Part of the reason Ellie’s bracing was so successful was due to her commitment to wearing her brace religiously, up to twenty two hours per day. She was disciplined and it paid off,” says Aminian.

Ellie’s hope for recently diagnosed scoliosis patients is that they would also prioritize their doctor’s orders over what other kids at school might tease them about.

“When I first got diagnosed and got my brace I was really scared and didn’t know what it would mean for me, but eventually you just get used to it, like braces. It’s uncomfortable at first, but every day it gets more normal,” she says. “It really works if you do it right, but you only get one shot at it. People shouldn’t worry too much about being teased but if they do, dealing with it makes you stronger in life.”

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Living with Scoliosis: Jessica’s Story

During a routine check for scoliosis during physical education class in seventh grade, a teacher noticed a slight curve in Jessica’s spine. A trip to her pediatrician soon followed. X-rays showed a thirty degree curve and since that was considered slight, follow-up imaging was recommended for a year later. By that time Jessica’s curve worsened by 15 degrees, and she was referred to Dr. Afshin Aminian, pediatric orthopaedic surgeon and director of the CHOC Children’s Orthopaedic Institute.

Bracing was initially recommended to try to prevent Jessica’s curve from getting worse.

“People my age don’t know that much about scoliosis even though it’s so common,” says Jessica. “I only had to wear my brace at night while I was sleeping, so no one ever really saw it or had the opportunity to tease me because of it, but they still asked questions, like was it comfortable or not.”

Although Jessica was vigilant about wearing her brace as instructed, her curve worsened by another twenty degrees, to nearly 70, and surgery was recommended. As a lifelong dancer, and a member of her high school’s competitive dance team, Jessica was initially worried that having surgery to correct this significant curve would affect her flexibility.

scoliosis
Jessica’s spine, before and after surgery.

“It’s very common for children or adolescent patients to be hesitant or even fearful when they first hear they need surgery,” says Dr. Aminian. “We encourage all of our patients to ask a lot of questions so they really feel like they are involved in their care team. We remind them that the team of orthopaedic surgeons at CHOC uses the very latest methods in a setting that’s specially designed for kids and teens, so they are in the best hands possible.”

Jessica’s surgery was ultimately set for winter break during her sophomore year of high school.

“All of my nurses were so impressed that I was up and walking the next day, but after I went home it was harder than I thought to move around” she said.

At a check-up with Dr. Aminian a few weeks later, Jessica was healing so well that she was able to return to school three weeks after surgery, as opposed to the three month break she had expected. Thanks to her flexibility as a dancer prior to surgery, she could even touch her toes at her follow up appointment, to the surprise of her care team.

Getting back into the groove of a full school day did not come without challenges. To protect her spine as it continued to heal, Jessica had to adjust to sitting for longer periods of time, something she slowly worked up to before returning to school. She also brought a small pillow to school to make her desk more comfortable, and made arrangements with teachers to keep textbooks in class so she didn’t have to carry them around.

“For an active person like me, not being able to bend, twist or lift anything for three months was hard, but in the end it made me thankful because my recovery was temporary, and overall I am really healthy,” she says.

Jessica knew she wanted to document her recovery phase, so she asked her mom to film some footage while she was in the hospital. That eventually morphed into a series of YouTube videos educating others on scoliosis, recovery tips, and sharing her own journey with the condition. When she was diagnosed, she knew others who had scoliosis, but no one’s curve was as severe as her own, so some peer-to-peer questions were left unanswered.

scoliosis
After her own successful scoliosis surgery, Jessica now imparts wisdom on other teens suffering from scoliosis.

“I want other scoliosis patients to know that it’s going to be hard, and you will have times when you can’t do something, but I promise it will get easier if you just go at your own pace and follow your doctor’s guidelines,” she says. “I love getting messages from people that watch my videos, thanking me for helping to calm their nerves before surgery.”

Filming these videos and helping other patients has helped to fill the void that dancing left. After losing one year of practice time due to surgery and recovery, Jessica decided not to go back to dancing.

“I’m busy in different ways now,” says Jessica. “Dancing provided great memories for me, but I’m on to a new chapter now.”

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Children and Fractures – What Every Parent Should Know

Young wrists, forearms and elbows are vulnerable to injury. Did you know up to 30 percent of all childhood fractures involve the growth plate? Growth plate fractures require prompt treatment to avoid surgery or life-long deformity.

Few kids grow up without breaking something. Prompt, expert care of fractures, especially those involving a bone’s growth plate, ensures childhood misadventures don’t linger into adulthood. CHOC Children’s Fracture Clinic offers rapid access to specialized fracture care. Patients are usually evaluated and treated within three to five days of injury, well within the narrow treatment window recommended by the American Academy of Orthopaedic Surgeons. Afshin Aminian, M.D., medical director of the CHOC Children’s Orthopaedic Institute, explains what every parent should know about growth plate fractures.

Q. Why do children’s fractures need to be treated so quickly?

Dr. Aminian: Growth plates, located near the ends of long bones, help regulate and determine a bone’s eventual shape in adulthood. However, growth plates are very soft and vulnerable to fracture. They also heal very quickly, which gives us a very short window to do minor, non-surgical manipulations to set broken bones correctly. Ideally, a growth plate fracture should be set within a week of injury. After that, surgery is necessary to prevent a life-long deformity.

Q. What are the main causes of growth plate fractures you commonly see? 

Afshin Aminian, M.D., Medical Director, CHOC Children’s Orthopaedic Institute

Dr. Aminian: An estimated one-third of growth plate injuries occur during competitive sports such as football, basketball or gymnastics. Monkey bars, skateboards, snowboards and “heelies” (roller shoes) are also very rough on young wrists, arms and elbows. Wrist guards provide some protection, but more importantly, children should always wear a helmet when engaging in those activities. I always tell my patients that it is much easier to fix a broken arm than a broken head.

 

For more information about the CHOC Children’s Fracture Clinic, please visit www.choc.org/orthopaedics.

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