Understanding Scoliosis in Children and Teens

Podcast Transcript

Dr. Richard So, MD:

Welcome to Little Health, a Cleveland Clinic Children's podcast that helps navigate the complexities of child health one chapter at a time. In each session, we'll explore a specific area of pediatric care and feature a new host with specialized expertise. We'll address parental concerns, answer questions, and offer guidance on raising healthy, happy children. Now, here's today's host.

Dr. David Gurd, MD:

When you're at the pool or helping your child get dressed, you might notice one shoulder sitting up higher than the other, or a curve in the spine that you hadn't noticed before. I'm Dr. David Gurd, an orthopedic surgeon and the head of pediatric spine deformity surgery at Cleveland Clinic Children's Hospital. Today, we're talking about scoliosis. We'll explain why these curves happen, how we monitor them, and the modern treatments available to help your child. Joining me today is my colleague, Dr. Kevin Serdahely. He's a pediatric orthopedic surgeon at Cleveland Clinic Children's Hospital, who specializes in spinal deformities. Welcome to Little Health, Dr. Serdahely.

Dr. Kevin Serdahely, MD:

Hey, thanks for having me on.

Dr. David Gurd, MD:

Please tell us a little bit about yourself.

Dr. Kevin Serdahely, MD:

Like you mentioned, I'm a, a pediatric orthopedic surgeon here at Cleveland Clinic Children's. Uh, I have a specialty interest, uh, in scoliosis and pediatric spine deformities. Um, I did a fellowship, uh, in, in pediatric orthopedics and spine deformities at Vanderbilt before I came here and, uh, have been in practice here at Cleveland Clinic for a while now. And, uh, happy to be here. Excited to talk about scoliosis.

Dr. David Gurd, MD:

Well, thank you for joining us. So let's start with this. Just understanding what exactly scoliosis is. For a parent who has never heard this term, how would you explain scoliosis?

Dr. Kevin Serdahely, MD:

Sure. So I think the easiest way to start thinking about it is to bring it down to the most, uh, basic descriptions, which is a curvature of the spine. And you can see that both when you're looking at the back, but also when you see x-rays as well. Uh, we see curvature at really sometimes one level, sometimes multiple levels of the spine. What it actually is, when you really dig down into it is, is rotation of the spine that leads to curvature of the spine as well, and that's why when you're leaning forwards, you can see the ribs up on one side or the shoulders out of balance, uh, with the curves as well. So simplest, easiest description of it is spine curvature that is abnormal.

Dr. David Gurd, MD:

What causes the scoliosis? Is it heavy backpacks, poor posture? Is it sports that they play?

Dr. Kevin Serdahely, MD:

It's another good question. So the cause of scoliosis is varied, but the most common reason is that it is idiopathic, meaning that we don't actually have one specific underlying cause for it. We think it's multifactorial. There's a genetic component, although there's no specific genes necessarily identified, but we know it tends to run in families. We definitely know it's related to growth. We'll talk about that, uh, probably a little bit later as, as how we monitor, but we know it's related to growth, potentially the growth plates around the spine. Uh, it's not caused by things like a heavy backpack or sports or activities or what your child is or is not doing, um, which I think is an important point. There's also subcategories of scoliosis, uh, that do have different causes for children who have cerebral palsy or other neuromuscular conditions or muscular dystrophies. Uh, while it's kind of one in the same condition of scoliosis, uh, there's sort of an underlying cause for those reasons with muscular imbalance, things like that, uh, that we don't necessarily see as a cause for the children who have idiopathic scoliosis.

Dr. David Gurd, MD:

So you mentioned the growth spurt. Why is my child's growth spurt the most critical window for treatment?

Dr. Kevin Serdahely, MD:

That's a great question. The growth spurt is the most important time window because it, uh, is when we see the curves change. These curves change, uh, when kids are growing the fastest. We call it the peak growth velocity. Uh, and we see that happen right around the time of puberty for both boys and girls. Um, and that's when we see these curves actually develop and then that's when we see them take off as well. It's also our window of time where we can really impact scoliosis with treatments, ma- whether that's bracing or various growth-friendly surgeries or, you know, even eventually the, uh, spinal fusion surgeries, um, although our goal is that we can try to treat it during that peak growth velocity window during the growth spurts, so to speak, and maybe stop us from having to do a spine surgery down the road.

Dr. David Gurd, MD:

We mentioned that, that sports are not creating the scoliosis, but should I be worried about my child playing sports if they have scoliosis?

Dr. Kevin Serdahely, MD:

That's a super common question. I think we both get that all the time in clinic. I think it's an important point that kids who have scoliosis can still participate in sports, um, encourage them to participate in anything they want to. We don't want this to, you know, slow down their life or the things that they want to be doing or the things that they enjoy doing, uh, sports being a big one there. When we're in treatment, uh, particularly timing around surgeries and things, then sometimes we'll make some modifications to activities, at least, you know, in the postoperative recovery windows. But broadly speaking, uh, we still want kids playing their sports, being active, trying to live normal lives, so to speak.

Dr. David Gurd, MD:

So just to make sure I fully understand, having a curved spine does not make my child more at risk.

Dr. Kevin Serdahely, MD:

You got it.

Dr. David Gurd, MD:

So I am a little bit older than you, Kevin. <laugh> Back in the day, the schools would frequently do scolly checks, gather all the kids together. If my child's school does not do spinal checks, what are red flags that I can look for at home?

Dr. Kevin Serdahely, MD:

So that ha- I think that has kind of fallen out of favor in schools, is my understanding. Um, that, that's not really ... Some, some people still do with sports physicals at school, but for the most part, I don't think it's, it's routinely checked anymore. One thing I, I will say is a lot of pediatricians are still checking that. And so, uh, at your well child visit every year, always a good idea to just bring that up with the pediatrician, make sure that we're doing that forward bend test, looking for any abnormal curvatures, but that's also something you can kind of keep an eye out for at home. Um, I think you touched on this right at the top of the episode. The things that most people pick up on, uh, as the first sign of this are things like a shoulder imbalance that you didn't notice before, that's a pretty common one, or some asymmetry in the back, especially when your kids are leaning forward to pick something up and you're, you're looking at them from the kitchen and you're like, "Boy, I, I, you know, looks a little bit off there. I didn't, I didn't see something like that before." Um, those are all reasons to e- you know, head into the pediatrician or, or get in to see one of us, um, because the reality is a lot of these things weren't present, uh, when they were younger kids and then as they're getting towards their growth spurts or their teenage years, uh, around that puberty time window we talked about, it's when we do start to see some of those things pop up.

Dr. David Gurd, MD:

So you mentioned the forward bend test. What, what exactly is that? As a parent, what would I be looking for?

Dr. Kevin Serdahely, MD:

So we call it the Adams Forward Bend Test. I don't actually know who Dr. Adams is. Usually these things are named after somebody from a while ago, but, uh, it's basically keeping your legs straight, leaning forward and trying to touch your toes, and then looking from the back to see if there's any asymmetry in the spine. Uh, we talked a little bit earlier about how scoliosis is a rotational problem of the vertebra. Uh, so with that test, what you see is one side of the back higher than the other side of the back. The reason we see that is that in the upper back, the ribs are connected to the spine. So when the spine is rotated, one on top of the next, it pushes the ribs backwards on one side and forwards on the other side. So what we actually see with that test is the rib height.

We use that as a, as a tool to say, uh, it looks like you might have some rotation in your spine there, you may have some scoliosis. And, uh, I don't know how much, how often people use this, uh, nowadays, but there's also something called a scoliometer, uh, that was certainly used in the past, uh, uh, in school screenings and things where it was basically a fancy level, uh, that you'd plop on the, uh, kids' backs when they would lean forward and they could give you some angle measurements off of that and, and could provide some information as, "Hey, should we send you over to see one of the spine doctors?"

Dr. David Gurd, MD:

And everybody has that level on their phone.

Dr. Kevin Serdahely, MD:

Everybody that's true, yes.

Dr. David Gurd, MD :

If you, if you want to check your child at home, have them bend forward-

Dr. Kevin Serdahely, MD:

That is true.

Dr. David Gurd, MD:

... set the level on your phone and- [You got it.] ... you can place it on the back and see.

Dr. Kevin Serdahely, MD:

Absolutely.

Dr. David Gurd, MD:

So next step. So say my child has scoliosis, the curve has progressed, and we're now discussing, you know, utilizing a brace to help prevent the scoliosis from getting worse. How does one talk to a preteen about wearing a brace without affecting their self-esteem?

Dr. Kevin Serdahely, MD:

Sure. So the bracing is always, or not always, but can be kind of a, a challenging, uh, subject, uh, especially with, you know, that time of life as you're getting towards puberty in middle school and high school typically and, you know, the, the social impacts that come along with that. So, you know, the way, the way I like to approach it is to kind of talk about what our end goal is here with it, you know, because it is annoying to wear, that's sort of the reality of it, but, uh, what we're trying to avoid is a major surgery down the road. And so we have this time window where we can make a really big impact and potentially even save somebody from having a, a really big surgery. And so, you know, as best as we can, sort of reiterating the importance of that, there's also some consideration on types of braces as well, and, and there's some variety there.

There are full-time braces that we're ideally wearing as much time as possible, but I think all of us would say at least 18 hours a day if we could. Um, and then there's also nighttime braces. And, and there's some nuance to, you know, what curve types might, might be the best, uh, for that because, you know, despite the fact that we lump all scoliosis kind of together for the sake of, uh, talking about it on a podcast like this, because it makes it a little bit easier to understand, there is a lot of nuance to even specific subtypes of scoliosis within idiopathic scoliosis where one curve type might respond better to a nighttime brace, whereas another one might respond better to a, what we call a full-time brace where you're wearing it both at daytime and nighttime. Obviously, the nighttime brace, I find people tend to like a little bit more because they're not wearing it at school, I think at least partially because of those social factors.

Dr. David Gurd, MD:

So if you found like psychologically it is really affecting, let's say a 12-year-old female, you'd consider moving to a nighttime brace to make their life a bit easier?

Dr. Kevin Serdahely, MD:

Um, I think it depends. I think it's a very individual discussion. I think if the reality is that, that patient is not going to wear the brace, if the difference is not wearing the brace or wearing the full-time brace less than 16 hours per day, then I will acquiesce, I guess is the right word, uh, so that we're doing something with the nighttime brace. I personally tend to lean towards more of the full-time brace. Um, although again, that's, that's, you know, certainly up for discussion and there's papers, uh, showing that both are effective. Uh, I think there's a little bit more literature out there or at least more long-term literature out there, uh, behind full-time bracing, which is why I tend to lean that direction. But I certainly have lots of families and patients where we get together in clinic and we decide, "Hey, I think the nighttime brace is probably the best route forwards for us."

Dr. David Gurd, MD:

Yeah, so sometimes some compromise.

Dr. Kevin Serdahely, MD:

Yeah.

Dr. David Gurd, MD:

So speaking about braces, there's this new thing called 3D printed custom braces. What are they and how do they help correct the curve?

Dr. Kevin Serdahely, MD:

Sure. Uh, so that's one of these cool new things that's come along with technology as, as many things have in medicine. The, the idea with these is, uh, I feel like I'm harping on this a lot, but, you know, scoliosis being a rotational or a three-dimensional deformity, it's very easy for me to show families and patients an X-ray, looking from back to front and say, "Here's your curvature. It looks like an S." And what we want to do is have the brace kind of push and support and keep it from getting worse as you grow. But the reality is, it is a three-dimensional problem. And so if we're only trying to correct things in two dimensions on really the front view X-ray, we may be missing an opportunity to impact to the curve. And so that's where spine surgeons and the bracing companies have developed braces that correct things in three dimensions.

The idea with this is actually three dimensional molding, although there, there certainly may be some 3D printed braces, uh, uh, if there's not, I'm sure somebody's working on it. But, uh, the idea is, uh, three dimensional molding where we're working on correcting rotation and the lateral view beyond just correcting the coronal view or that straight on S shape. And, and I think that's been quite effective, uh, at least in the, the early literature that's come out with it over the last few years, it does seem to be making an impact, uh, with the three dimensional considerations.

Dr. David Gurd, MD:

So what about like wearable sensors and mobile apps? Can that help kids stay compliant with their brace treatment?

Dr. Kevin Serdahely, MD:

I think so. Um, I think it's definitely growing in popularity, you know, more and more frequently when I talk to various spine surgeons around the country, I think more and more people are, are using the, uh, sensor technology. It's a bit of a delicate subject from the standpoint of, you know, I think in general, people don't like feeling like they're being watched, so to speak. <laugh> But that being said, you know, I think it's a really good tool as long as everybody's on the same page with it because, uh, it re- it lets us get a very realistic sense of how often the brace is being worn. Um, we've talked about this before, uh, especially for, you know, those full-time braces. We know that less than about 16 hours a day, you might as well not be wearing it because it's not gonna do anything. And so rather than, you know, when, when we come in and we say, "Well, I don't know, it might be, if you think it might be 16, 18 hours a day, we have, we, you know, it's, we don't have a stop clock on, but we think we're getting that much in."

It's a, it's an objective measure. We can look at the sensor data and say, "Well, let, here it is. You know, here's how long you are in it. " And it wa- you know, I think as long as you approach it with the right, uh, mind space and attitude and, and relationship with the family and the patient, I actually think it's a really good tool. It has definitely been shown to increase brace compliance as well.

Dr. David Gurd, MD:

So as we kind of work towards the, the surgical portion of this, I think one question I would have if it were my child would be like early on, they're 10 or 11, they have scoliosis, like what's the likelihood that this is gonna go on to surgery? Do most kids need surgery for this?

Dr. Kevin Serdahely, MD:

That's a good question. So I guess, uh, we'll dive into that in a second, but I guess we should maybe chat about what our goals of bracing are too. We talked a lot about bracing, but, um, I think maybe we should clarify what our end goal is with a brace. When we put people in braces, our goal is not to straighten out the spine with the brace. Our goal is to keep it from progressing or getting worse to a, that magical threshold degree where, hey, all of a sudden we think it's probably worthwhile doing surgery so that you don't have problems later in life related to your scoliosis. And so we have some various cutoffs, uh, where we start thinking about bracing and kids who are still growing. You know, I think most of us say maybe around 15 to 20 degrees with growth remaining, we start thinking about doing bracing so we can try to keep those curves from getting out to like 45, 50 degrees.

But the goal of bracing is not that we're going to be able to brace the spine back straight again. The goal is that we're going to be able to maintain a smaller curve so that it doesn't reach the point where we would recommend surgery or have a curve that's going to cause you problems down the road.

Dr. David Gurd, MD:

Do most kids who have scoliosis go on to need surgery?

Dr. Kevin Serdahely, MD:

We're actually pretty effective with bracing. Uh, it does a pretty good job. And so we are able to avoid surgeries in a good number of cases, uh, as long as we're compliant with bracewear, even in curves that are decent size with lots of growth remaining, uh, you know, we can be, uh, pretty effective with it. Now, some curves, uh, don't respond to bracing or some people just can't tolerate wearing the brace and we see progression, we see progression for a variety of reasons. But, but to answer your question, you know, broadly speaking, there's a fairly good chance that if we catch it early on and we brace effectively, that we can avoid a surgery.

Dr. David Gurd, MD:

Which is wonderful, yes. So then speaking of surgery, are there new innovations that are occurring with surgery? Could you tell us about things like vertebral body tethering?

Dr. Kevin Serdahely, MD:

Absolutely. So I think there's a pretty exciting area for scoliosis treatment. Um, it, it's probably, I would say the fastest moving or fastest developing area, uh, in scoliosis treatment. And the idea behind some of these newer surgical treatments is that we are trying to do something earlier on to prevent the curve from progressing to the point where you would need a spinal fusion surgery, uh, when you're a little bit older. And this is where, you know, we touched on our goals with bracing was to prevent curves from getting worse. Most of the new, uh, the newer surgeries like vertebral body tethering are actually a chance that we have to try to straighten the spine, actually make the curve straighter while kids are still growing. We'll say most of these newer, uh, surgeries are growth dependent. So it's something that needs to be done while there is still enough growing left because they require that growth to basically help with the correction.

So something like vertebral body tethering, uh, being probably one of the most common nowadays and, and one of the most talked about areas of, of growth-friendly scoliosis surgery, uh, that's a surgery where, uh, we place screws into the front of the spine and the vertebral bodies in front of the spinal cord and, uh, we connect those screws along the convex side of the curve or the bowed side of the curve and we connect the screws with a taut tether for, that's where that's where the name came from. And we pull it tight, we secure it into place with, uh, screw heads in each of the screws, and then as the kids grow, the concept is similar to how we try to impact growth around growth plates in like legs for angular deformities, that it changes the forces at the growth plates such that the spine actually grows straighter as the kids grow.

It, it's kind of easy to think about it in so much as if you pull a tight tether on the convex side of a bow, it's gonna kind of pull it straighter. Conceptually, I think that makes the most sense as to how to think about it. There's, there's a little bit more to it with growth plates and things, but that's the general concept. And then as kids grow, the spine straightens out. There's actually some cases where it can even overcorrect a little bit, um, and, and, you know, at the beginning, I think we kind of thought we would consider that almost a failure in some ways. And I think, you know, we're kind of revising our opinion on that in so much as it means it's doing the job and, you know, if it, if it overcorrects too much, we can always go back in, uh, with a smaller procedure to release the tether.

And then there's, you know, there's a variety of other, uh, uh, similar, um, devices that have been developed that are similar concepts of some type of growth friendly thing to avoid ... Ba- basically our goal here being to avoid a fusion surgery in the future and maintain motion.

Dr. David Gurd, MD:

Excellent. Thank you. So with AI being so much of our life now, how is artificial intelligence being used to predict which curves will stay small and which ones are likely to progress?

Dr. Kevin Serdahely, MD:

You know, I was looking into this a little bit, uh, ahead of this episode, because I was curious. You know, I, I haven't personally seen a whole lot about AI with regards to curve progression prediction. Uh, so I did a little bit of searching ahead of time just to kind of see what's out there. And there are definitely some folks who have developed various AI models, um, particularly a few notable ones that have been done in Japan and they do seem to have some promising, uh, results there. That being said, you know, even outside of AI, uh, there's some pretty good classic papers and, and studies out there that I think we all use to help predict that progression as well. I actually even sometimes will bring up Dr. Sanders' paper in clinic sometimes. There's a, there's a nice chart in there that talks about, you know, risk for progression based on how big a curve is and how much growing a child has left to do from a hand x-ray.

Um, that's still what I use, you know, certainly as technology develops and as AI becomes more ubiquitous, as people develop new models from that standpoint, if somebody comes up with something better than that, I'll, I'll be the first one to jump on board with it, but certainly for me right now, I currently use the Sanders model using the, the bone age x-ray from a hand and, and we can kind of marry that to a curve size and, and get a sense of the percentage chance of progression. I think on that note, AI in general in management of pediatric spine deformities is an interesting topic beyond just curve progression predictions. You know, some of the other things that I've seen more recently, uh, being the patient specific, uh, rod contouring, that's one that I, I have seen sort of start to be developed where, uh, you look at x-rays ahead of time and, uh, this would be for a posterior spinal fusion surgery.

The, the AI system looks at the x-rays ahead of time and tries to, uh, basically make a, it's not 3D printed, but make a, for lack of a better word, 3D printed rod ahead of time to sort of limit the amount of bending of a rod that you have to do in surgery. That's getting in the weeds a little bit. So there's, there's certainly other factors that, at play here, uh, as well. So definitely will be interesting to see what, uh, sort of role that's gonna play moving forwards. I don't think any of us really know to what extent AI is gonna impact our, our practices as we move forward from here. And, uh, and I'm sure there will be useful tools that'll come up with it.

Dr. David Gurd, MD:

So we're told scoliosis shouldn't hurt, but my child complains of back fatigue. Is that normal and how can we manage it?

Dr. Kevin Serdahely, MD:

That's a good question. Um, you know, I, I think there's some evidence that people who have scoliosis may have perhaps a slightly higher risk for back pain. But that being said, you know, in general, uh, with or without scoliosis, lots of people have back pain or back fatigue issues. And so, you know, most of the time, it's usually not inherent to the scoliosis itself, although with bigger curves, sometimes the positioning that we do unconsciously just to balance the head over the pelvis to sit upright in a chair or balance your shoulders out if you happen to be looking in a mirror or, or thinking about it, those things can definitely be tiring. And so there is instances where I do think it plays a factor.

With that, some of the things that we can do are really, I think the number one thing for me is core strengthening. Uh, I think that is probably the best possible thing to do for scoliosis with regards to any pain symptoms or fatigue symptoms. Obviously, stretching, maintaining hamstring flexibility, uh, actually is, is a very useful tool with that as well. That's a problem in, in most teenagers, but certainly in somebody who also has scoliosis is probably a driving factor in, uh, developing some of these pain or fatigue symptoms. But I, I think for me, the number one thing is gonna be working on core strengthening both front and back.

Dr. David Gurd, MD:

Yeah, super important. I would agree 100%. The two biggest reasons I think we see back pain is from deconditioning and tightness, and you covered both. Flexibility is super important, core strengthening, super important. So once my child finishes growing, they've had scoliosis, the, the scoliosis never made it to a significant magnitude, and now they're done growing. Does the risk of curve worsening vanish, or could it still progress in adulthood?

Dr. Kevin Serdahely, MD:

Yeah, that's, uh, you know, I think we get that question a lot. This gets to sort of, I, I think you mentioned, you know, if it's, let's say it didn't reach a magnitude for surgery, and our sort of magic numbers, so to speak, I think for most of us are like 45 or 50 degrees of curvature. And we have that cutoff because we know that if the curve is over that number after skeletal maturity, it is likely that it's going to get worse over time. Um, I think most, most people will say it by about one degree per year on average. It can be faster or slower than that, but about one degree, uh, per year on average, which I know doesn't sound like a whole lot. Uh, but if you think about it, if you have a 55 degree curve at 16, and 40 years down the road, that means that's a 95 degree curve, and you're in your 50s.

You're still, you know, wanting to be living a healthy, productive age, working, doing all those things. And so, you know, a, a 95 degree curve at that age is a, is a big surgical problem, not nearly as healthy to withstand a large surgery like that. And so it's something that we can kind of impact early on. And, and that's where we have sort of, that's where, where some of these cutoff numbers, uh, that, that we talk about patients with, um, come from. Underneath that number, it, it's less likely to progress overall, uh, over a lifetime. Now, uh, are there instances? Uh, sure. There's, there's certainly possibility that there could be some progression over time, but, you know, if we're looking at like a 30 degree curve at skeletal maturity, it's pretty unlikely that that would progress significantly down the road later in life.

Dr. David Gurd, MD:

Perfect. Thank you. What is scoliosis specific exercise? And is that an option rather than surgery or bracing?

Dr. Kevin Serdahely, MD:

So scoliosis specific exercises, um, I think most commonly refers to scoliosis specific physical therapy. Uh, we have a name for that called Schroth Physical Therapy. I have a lot of families come in, uh, that have, you know, received a diagnosis of scoliosis, uh, from their pediatrician and have done some research ahead of time and they'll come in and say, "Hey, you know, we were reading about physical therapy options for this and, and this Schroth physical therapy." And Schroth physical therapy is really the conglomerate of the scoliosis specific exercises and programs. Now, it's great. It does a great job of not only some of the things we talked about before with building up your core strength, you know, limiting back pain, maintaining flexibility, uh, keeping you active in sports, all those things, and it may not necessarily impact the curve per se. I think that's a little bit debatable for smaller curves, but, but may not impact the curve per se.

Uh, it definitely has been shown to impact quality of life and, and perception of appearance, one's own self-appearance. I think there's a great role for it. I actually send a lot of patients to scoliosis specific physical therapy. In some instances, it's not the best option and we have people do exercises at home, um, but, you know, I think that kind of hearkens back to what we've talked about before of your core exercises, your flexibility exercises. I think the best core exercises for me, when we talk about core exercises, I'm talking and thinking about things like planks, leg flutter kicks, Supermans with your back, not so much like crunches and those types of like ab exercises per se. I find the other ones to be a little bit more beneficial, balance exercises, things like that. And then, uh, again, I think we harp on this a lot in pediatric orthopedics, uh, hamstring flexibility.

Um, I know you like to say the Achilles tendon is the root of all evil- [Root of all evil.] in pediatric orthopedics. Uh, I would, I would maybe add the hamstrings to that, at least from a pain standpoint for people who come in with variety of pain, whether it's leg pain, back pain, um, any of those things. I, I, I certainly think the hamstrings play a huge role in that.

Dr. David Gurd, MD:

Absolutely. So I've noticed that my daughter's right shoulder seems to be elevated and I'm looking to find a doctor. What is the difference between a general orthopedic surgeon and a pediatric spine specialist?

Dr. Kevin Serdahely, MD:

So I'll get in the weeds on training, I guess, a little bit here. So, uh, general orthopedic surgeons, um, uh, all of us do an orthopedic surgery, uh, residency. And that's after you finish medical school, you become a doctor and you go to residency for five years, and you get trained in all sorts of orthopedic surgery, joint replacements, rotator cuff tears, ACL surgeries, broken bones, pediatric conditions, uh, but you see a little bit of everything and, uh, and you're learning how to do everything and, and how to manage all these conditions. And then once you've completed that residency, uh, you can decide to do some additional subspecialty training. And so for those of us that are pediatric orthopedic surgeons, we've done an additional year of fellowship training specifically focusing on orthopedic surgery for children. Many pediatric orthopedic surgeons, uh, see all sorts of things from spine deformities like scoliosis to broken bones to hip dysplasia, um, and I think a lot of us, you know, see and manage any orthopedic condition for kids, but we also have some subspecialty interests as well, um, and that's where some of us like to focus on things like scoliosis as well.

That being said, all of us that are pediatric orthopedic surgeons have done that year of fellowship focusing on pediatrics, doing a substantial amount of training in pediatric spine deformity, uh, and that's where you and I and our partners, you know, take care of these kids with scoliosis, whereas, you know, somebody who did a joint replacement surgery fellowship is focusing on doing joint replacements in adults. And then we don't really cross over. I don't do joint replacement surgeries, they don't do scoliosis surgeries. Um, you probably wouldn't want either of us doing the opposite <laugh>. So that's, that's the difference there. It's, it's really just the training coming up and then now our focus is in practice.

Dr. David Gurd, MD:

So your focus of practice really is more on the child's spine?

Dr. Kevin Serdahely, MD:

Correct. Yes. Uh, that's my favorite thing to take care of is pediatric spine deformities.

Dr. David Gurd, MD:

Perfect. So we hear about getting multiple x-rays and the concern for radiation. Does your facility use a low dose radiation for frequent x-rays that will be needed as we follow along the course of scoliosis?

Dr. Kevin Serdahely, MD:

We do. We do have a, uh, low dose radiation x-ray system. I'd like to hopefully expand the use across multiple locations as well, hopefully, um, in the future, but, uh, we definitely have it and use it. Um, and I think it's a really important point because for those who have scoliosis and especially for those who have early onset scoliosis or develop scoliosis in very young in childhood, even as young as infants sometimes, those kids are gonna be getting a lot of x-rays over their childhood and their lifetime. And so trying to limit the amount of radiation that we do, I think is very important. And, and I think we're all very conscientious of that, including the, the radiology techs and the radiology departments as well. So they do everything in their power to limit radiation exposure. I think one thing I do is I limit the number of times that I'm doing lateral view x-rays, um, other than the, maybe the first time I see a child and then if we're getting closer, if we're seeing progression that I wasn't expecting, or say we're getting closer to maybe needing to talk about surgery, then we'll, we'll go back and, and repeat some lateral views, but sticking to just that single PA view as we're following along with bracing and things, I think is a nice strategy to help limit some of the radiation.

And then as we get into instrumentation for surgeries, things like that, I, I think we probably don't have time to get into all of that stuff today, but sometimes we're using CT scans and things for that as well. So I, I do think it's a really important point to consider, you know, minimizing radiation for these kids.

Dr. David Gurd, MD:

Yeah, I love that. At every stage of the care, trying to minimize the risks.

Dr. Kevin Serdahely, MD:

Absolutely.

Dr. David Gurd, MD:

Well, Dr. Serdahely, thank you so much. All the information that you've given us has been wonderful. Really appreciate your time.

Dr. Kevin Serdahely, MD:

Thank you for having me. This is wonderful. This is my favorite thing to talk about. So, uh, I'm, I'm always happy to sit down and chat about scoliosis. If, uh, if anybody has any concerns, you know, you notice, like we talked about some of those, uh, findings in your own child or the pediatrician mentioned something to you at your next appointment, please, uh, give us a call, come see us. Even if you think it's really minor, you know, we're, we're happy to see anybody. If there's any concern for curve, um, you know, I, I, I think, uh, we see this day in and day out. Even if it's, you know, the x-ray ends up looking straight, I'd still rather know. I think it lets everybody sleep a little bit better at night too.

Dr. David Gurd, MD:

Excellent. Thank you so much. Really appreciate your time. With early intervention and modern treatment, our goal is to make scoliosis just a small part of your child's story. To schedule an appointment with Dr. Serdahely or another pediatric orthopedic specialist at Cleveland Clinic Children's, call 216.444.2606. That's 216.444.2606.

Dr. Richard So, MD:

Thanks for listening to Little Health. We hope you enjoyed this episode. To keep the little health tips coming, subscribe wherever you get your podcasts or visit clevelandclinicchildrens.org/littlehealth.