Tag Archive for: Kelly

Boy with scoliosis during rehabilitation

Children’s National first-use of anterior vertebral body tethering system for idiopathic scoliosis

Boy with scoliosis during rehabilitation

On Monday, Feb. 1, 2021, Children’s National Hospital performed the first anterior vertebral body tethering procedure for a child in the Washington, D.C., area. The device is a recently approved option for treating children with idiopathic scoliosis, the most common type of scoliosis. It allows for gradual correction of a spinal deformity through the natural growth of the spine, leading to improvements in spinal alignment while maintaining spinal flexibility.

In August 2019, the U.S. Food and Drug Administration (FDA) approved the first spinal tether system for pediatric patients called The Tether – Vertebral Body Tethering System. This device is attached to the spine during a minimally invasive thorascopic procedure performed by a multidisciplinary medical team, which includes orthopaedic surgery, thoracic surgery and anesthesia.

“This promising technology may help maintain the flexibility of the spine as it grows straighter over time,” says Matthew Oetgen, M.D., chief of Orthopaedics at Children’s National. “Novel devices like The Tether offer additional treatment options for idiopathic scoliosis, which have the potential to improve pediatric surgical outcomes and quality of life for children and adolescents with significant spinal deformities.”

The procedure at Children’s National brought together some the region’s best pediatric orthopaedic and thoracic surgeons, including Dr. Oetgen, Shannon Kelly, M.D., associate chief of Orthopaedic Surgery, and Timothy Kane, M.D., chief of General and Thoracic Surgery.

“Children’s National can offer these types of procedures because the hospital is home to many talented pediatric surgeons across specialties, many of whom are experts in minimally invasive techniques for children,” says Dr. Kane. “We collaborate together, often, because we know that’s the best way to continually improve the care we provide to children and their families.”

Idiopathic scoliosis is the most common type of scoliosis and can occur in children between age 10 and 18 or until they are fully grown. Spinal fusion surgery is the most common treatment for children with the most severe spine curvatures and continues to be the “gold standard” for surgical treatment of this condition. It takes about 3 months for a child or adolescent to fully recover from the procedure. While spinal fusion produces excellent and reproducible outcomes, in certain patients with less severe deformities and significant skeletal growth remaining, vertebral body tethering may offer some benefits over spinal fusion. In clinical trials, the spinal tether was shown to shorten recovery time and increase range of motion. Early diagnosis is vital to dictate which treatment will be most beneficial.

little girl in wheelchair

A holistic and proactive approach to the management of the patients with cerebral palsy

little girl in wheelchair

The cerebral palsy program at Children’s National Hospital takes a comprehensive approach to meet children’s needs from infancy through young adulthood.

Though children with cerebral palsy (CP) often require significant rehabilitative and surgical support, most often each service is provided in the individual specialty itself. Patients and their families frequently experience a great deal of stress coordinating care, getting to appointments, keeping track of medications and managing treatments on their own.

However, the CP program at Children’s National Hospital, co-led by an orthopaedic surgeon, Sean Tabaie, M.D., and a pediatric rehabilitation specialist, Olga Morozova, M.D., working together and in collaboration with Shannon Kelly, M.D., (Orthopaedics) and Jeff Rabin, D.O., (Physical Medicine and Rehabilitation) has evolved into a truly comprehensive approach. The program is designed to meet the needs of these children from infancy through young adulthood with the goal of improving function and preventing musculoskeletal deformities and complications.

Providing children and their families with a single point of care coordination allows the care team to track and anticipate a multitude of potential challenges for each child as early as possible and intervene in smaller ways before they bring pain and long-term complications or require major surgical interventions. Key highlights of this collaborative program include:

  • Hip surveillance: Patients with CP are followed closely to identify hip pathology prior to serious subluxation or dislocation. Early identification allows for the use of medical or surgical interventions to prevent a minor issue from becoming a major one.
  • Serial casting for children with early signs of muscle contractures: Dr. Morozova uses agents to relax the muscles and Dr. Tabaie applies the cast in the operating room followed by continued weekly serial casting in the clinic. “Proper medical management and bracing at regular intervals can improve muscle function and prevent the need for larger surgeries and more intense rehabilitation later,” says Dr. Morozova.
  • Advanced coordination between physical therapy in the hospital and outpatient services in the region, building on the hospital’s partner agreement with the HSC Health Care System.
  • Single event multi-level surgeries (SEMLS): Ensuring that surgical procedures capture all surgical needs at one time by assessing the entire anatomy and scheduling multiple surgical or pharmaceutical interventions to occur in a single session.

The doctors point out that offering these services in one cohesive location and combining treatments into the same appointment or procedure date is something that many patients with CP and their families truly appreciate.

“I think families of children with CP will travel great distances if the care they receive is comprehensive and eliminates some of the back and forth travel they do now,” says Dr. Tabaie.

Today, the team sees close to 100 patients with CP per month and hopes to expand to reach as many families in the region and beyond who need them.

Dr. Tabaie says, “Our goal is to identify patients early and start managing them to help their quality of life today, prepare them to grow as healthily and in as little pain as possible and set them up to be as healthy as they can possibly be as adults, too.”

young girl sitting on a bed with a cast

Creating better casts

young girl sitting on a bed with a cast

Each year, millions of children in the U.S. come to hospital emergency departments with fractures. While broken bones are commonplace, the expertise to stabilize these injuries and cast them is not, says Children’s National Health System orthopedic surgeon Shannon Kelly, M.D.

Most fractures are casted by an on-call resident without the assistance of an orthopedist, she explains. Whether that resident applies a cast successfully depends largely on how well he or she learned this skill as an intern. While most current training models have interns take calls with residents, picking up casting skills through hands-on experience from their more senior peers, they can also pick up mistakes – which get repeated once they’re caring for patients independently as residents themselves, Kelly says.

Casting mistakes aren’t trivial, she adds. They can have serious consequences for patients. For example, a cast that’s not tight enough in the right places can leave bones vulnerable to shifting, a scenario that doctors call a loss in reduction, Kelly explains. If bones aren’t in the right position to heal, doctors must reposition them either in the operating room, often exposing patients to general anesthesia, or through painful, in-office procedures.

Conversely, casts that are too tight – particularly on a fresh fracture that’s prone to swelling – can damage tissues from loss of circulation. To avoid this latter problem, doctors often create a “bivalve” cast in which the two halves are split like a clamshell, leaving room for tissues to expand. But they must use extreme care when they cut open the cast with a saw to avoid cutting patients with the rotating blade or burning them with heat generated from its friction.

“Each year, thousands of children are harmed from improper casting and must go through additional procedures to fix the damage done,” Kelly says.

That’s why she and her colleagues are developing a better way to train interns before they start their orthopedics rotation. Starting this spring, the team will be directing a series of casting workshops to train interns on the proper casting technique.

The workshops will take advantage of models that allow interns to practice without harming patients. Some of these models have simulated bones that show up on an X-ray, allowing participants to evaluate whether they achieved a good reduction once they’re finished. Other models are made of wax that melts if the heat of a cast saw becomes too intense and show nicks if the blade makes contact. Learning proper technique using this tool can help spare human patients painful burns and cuts, Kelly says.

To broaden this effort beyond Children’s National, Kelly and her colleagues received a $1,000 microgrant from the Pediatric Orthopaedic Society of North America to create videos based on material from these workshops. These videos will help trainees at medical institutions across the country learn the same pivotal casting skills.

“A broken bone is difficult enough,” Kelly says. “We’re hoping to decrease the number of times that a child has to have an unnecessary procedure on top of that from a casting mistake that could have been avoided.”