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Montefiore in the News

July 2, 2012

Terry D. Amaral, MD, Highlights Advantages and Implications of Pedicle Screw Scoliosis Surgery, for Pediatric Patients, at National Conference

Terry, D. Amaral, MD Vishal Sarwahi, MD

New York City, NY(July 02, 2012) - Orthopaedic Surgeons at Montefiore Medical Center, have shown over 90% accuracy in placing pedicle screws and nearly 100% success rate in correcting scoliosis in pediatric patients, using cutting-edge pedicle screw scoliosis surgery. Terry D. Amaral, MD, Chief, Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Montefiore Medical Center, Assistant Professor of Surgery, Albert Einstein College of Medicine of Yeshiva University, presented  the findings from a 5 year study in a research paper entitled “Burying One’s Head in the Sand: Are We Underestimating the Significance of Pedicle Screw Misplacement?” Dr. Amaral presented the paper last month to hundreds of experts at the 2012 Pediatric Orthopaedic Society of North America Annual Conference.

Scoliosis is an abnormal curving of the spine; typically a three-dimensional deformity, with the spine shaped like an "S" or "C." Scoliosis affects over 100,000 children each year and can result in back pain, decreased lung and heart function, fatigue, uneven hips or shoulders and decreased mobility. Montefiore’s top class team of scoliosis physicians are dedicated to correcting all types of spinal deformities, treating patients from around the globe with various types of spinal curvature.

“Montefiore was one of the first hospitals in the world to perform the pedicle screw procedure in the thoracic spine, rather than hooks, for better correction and stabilization of the vertebrae during surgery,” said Dr. Amaral, who performs the procedure on pediatric patients ranging from  two years to 18 years old. “In our hands the accuracy of screw insertion is 90% - amongst the highest anywhere - and the procedure to correct scoliosis itself is nearly 99% safe and 99% successful. While this procedure is known to produce the best outcomes for patients, our research shows that more needs to be done to ensure the  efficacy and safety of the surgery as it continues to gain popularity amongst physicians worldwide.”

From the 1960s until quite recently, the Harrington System was the gold standard for scoliosis surgery.
This involves attaching a stainless steel rod to the spine with two hooks, one in the vertebra at the top of the curve and one in the vertebra at the bottom of the curve, the spine is then stretched to straighten the curve and the rod is used to immobilize it. The patient typically wears a back brace for four to six months. 

Limitations with the Harrington System, including implant breakage, have led to pedicle screw placement being the preferred procedure for many experienced practitioners. Pedicle screw placement, which Dr. Amaral has been performing for the past five years, is recognized as a cutting-edge procedure in scoliosis surgery because for the first time doctors can correct deformity in all three planes. The procedure entails screws being placed in the pedicle area of the vertebrae. The pedicle is a small stem-like structure that connects the front of the spine to the back of the spine and acts as a side wall of the bony spinal canal that protects the spinal cord and nerve roots, in the lumbar region. Pedicle screws are fixated to the spine very carefully so as not to touch the sensitive cord or roots, with two rods which correct the alignment. High-tech equipment such as the navigation system, which allows surgeons to place a pedicle screw accurately in the pedicle by visualizing its placement in real time on a virtual screen, can be used to improve the safety of the surgery, especially for difficult cases.

While results have shown that pedicle screw placement produces the best outcomes for patients, reducing curvature by up to 90% in severe cases and involving a much shorter recovery time compared to the Harrington System, some doctors are concerned about misplacement of the screws which could, in the worst case, lead to paralysis or death. Currently, there are no standard protocols for imaging to ensure that screws have not been misplaced and so, in some instances, misplacement will not be detected until several days after the procedure.

“It is imperative that surgeons have immediate access to imaging devices at the time of procedure so that we can confirm the accuracy of screw placement, ensuring that we minimize the risk and provide the best quality outcomes for our patients,” said Vishal Sarwahi, MD, Chief, Scoliosis Surgery, Department of  Orthopaedic Surgery, Montefiore Medical Center, Associate Professor of Clinical Surgery, Department of Surgery, Einstein, who performs nearly 100 scoliosis operations each year.

Dr. Sarwahi is one of the foremost scoliosis surgeons in the region and Montefiore is the only center in the tri-state area utilizing pedicle screws in minimally invasive surgery, pioneered specifically for adolescent scoliosis. Both Dr. Amaral and Dr. Sarwahi are involved in a number of research projects, one of which is in collaboration with the musculoskeletal radiology department, to reduce the risk of pedicle screw scoliosis surgery and increase the safety of the technique and technology so that more patients can benefit from this treatment. Dr. Amaral has been the Chief of Pediatric Orthopaedic Surgery since 2007.  He is an active participant in medical education, both in the medical school and orthopaedic residency program. He is actively involved in career counseling for medical students and has gained national recognition for his humanitarian work.

Dr. Amaral and Dr. Sarwahi attended the Pediatric Orthopaedic Society of North America Annual Conference along with several Montefiore clinicians and hundreds of Pediatric Orthopaedic Surgeons from across the nation and around the world. The annual conference includes didactic educational sessions, covering clinical and research topics, multidisciplinary symposia and research presentations, with the goal of prompting a better understanding of current concepts in common pediatric orthopaedic problems.