What has been the traditional way to treat scoliosis in kids?
Dr. Flood: Traditionally, we monitor the children until they get to about 25 to 30 degrees and if they have significant growth remaining and have a risk for progression, then we would brace that child. For children who continue to progress despite being in a brace, we would offer them surgery to prevent or stop the progression.
How does the spine typically curve?
Dr. Flood: It's typically a curve to the right side of the upper back so if they were to bend forward and touch their toes, and you look at them from behind, you would see that their back is a little higher on the right side.
How does that interfere with their ability to move and flexibility?
Dr. Flood: Scoliosis is typically not a painful condition, so sometimes it becomes quite advanced before it comes to the clinic, or before it's noticed by a school nurse during a screening exam or pediatrician during a visit or a school physical. It doesn't necessarily always limit their flexibility when they're young, but if the curve progresses, it can have profound affects on their heart and lung functions.
When you first saw Matthew, how severe was his scoliosis and what treatment approach did you think needed to be taken?
Dr. Flood: Matthew came to me with an approximately 50 degree curve in the upper part of his back. He's a very tall boy -- very active basketball player. He wasn't having symptoms, but his mother noticed over the last year that his shoulders were different -- one was higher than the other. When she saw him bending over, she saw a hump on the right side of his rib cage in the back there -- she became concerned. And then she saw her pediatrician and the pediatrician referred him to my office.
How would a doctor have traditionally approached a case like this?
Dr. Flood: Well, for a child with a 50 degree curve -- we would do surgery on that child to stabilize his spine and prevent progression. Certainly, we try to correct the deformity as well. In Matthew's case, prior to using stem cells, he would have had a typical fusion where we put either hooks and rods or screws and rods in his back to correct the deformity. Then we would take bone from his pelvis bone -- called the iliac crest -- and put it along his natural spine to create a spinal fusion so that the spine fuses together and the curve doesn't continue to progress. The problem with taking the bone from the iliac crest is that it is a significant source of pain -- sometimes even permanent pain. It requires another incision, the potential risk for infection and that bone is gone forever. You cannot go back to that site, in the event that he would need additional surgery in the future.
What are stem cells allowing you to do for scoliosis patients?
Dr. Flood: Stem cells are cells in the body found in several areas that are uncommitted cells. They have not differentiated into a muscle cell or a bone cell. They are cells waiting to become committed, so to speak. The stem cell market is, I would say, is not a fully mature market, but there are many companies out there with stem cell products. Prior to today, there have not been companies with a point of care product where you could harvest the patient's stem cells and apply them with a clinical application. Now, there are companies available that will allow you to harvest the stem cells, process the stem cells and replant them back into patient for different reasons.
What would you do with the stem cells in this case?
Dr. Flood: Rather than making a separate incision -- a good size incision over the iliac crest -- and harvesting the bone. Instead, through a small puncture wound, I can harvest the bone marrow, process that bone marrow and then I have a sample -- an aliquot if you will -- of stem cells that I can use with bone from the bone bank and use that to create a solid fusion for the patient.
What will those stem cells do for patients like Matthew?
Dr. Flood: Those stem cells are going to create the fusion for Matthew's back. So the instrumentation -- the screws and the rods -- will correct his deformity, but that's not the final answer. The second stage of scoliosis surgery is to create the fusion and that is what a stem cell will do. It will create a solid fusion with less morbidity because you do not have to take it from the iliac crest. They will create a solid fusion in hopefully a quicker period of time than if it was from his own iliac crest.
How does the recovery time of this new procedure compare to other methods?
Dr. Flood: The recovery time is not much different except that they don't have the pain at the iliac crest, but they still have significant pain from the large incision on their back that was used to create the deformity. This will lead to a solid fusion for Matthew and that's our goal. Once his fusion is solid, he can return to his normal activities. He's a very active basketball player. He's 14 and over 6' 2" so basketball is extremely important to him.
How important is this breakthrough in terms of how you treat patients with scoliosis?
Dr. Flood: I think it's critical for the future of spine surgery and that you can use stem cells rather than take it from their own iliac crest. You can use simply the bone from the bone bank, but there is going to be a certain percentage of people who do not go on to a solid fusion because it's just dry brittle bone. It doesn't have the factors that you need to promote the fusion in it.
How did the stem cell treatment work for Matthew?
Dr. Flood: Matthew has done extremely well. He's very motivated. The surgery took about four hours. After surgery, he got up out of bed on post-op day one, dangled his legs over the side of the bed and continued to progress from there. He's done extremely well.
Are you typically seeing patients have the same positive results?
Dr. Flood: Yes. I do think not having to take the bone from the iliac crest makes a difference in the morbidity right after surgery. I use it routinely on all my patients. I discuss the risks and benefits with the parents. These stem cells are immune protective; there is no rejection. They're the patients own stem cells; they're not embryonic stem cells. So there is a very high acceptance rate of them and I have not seen a case yet where the fusion did not become solid.
And it's a more holistic approach to the healing process?
Dr. Flood: Exactly right. It's a perfect word for it -- holistic is a good word because it's from the patient himself or herself, so it's the patients own stem cells. They're just waiting to become a bone cell or a ligament cell or muscle cell. So we can take the patient's own cells and use them to their advantage.
Is there a good chance Matthew's scoliosis will not be a problem for him as he reaches adulthood?
Dr. Flood: Matthew is now three months after surgery. There is no evidence of any complication and his fusion appears to be consolidating nicely. We're gradually returning him to normal activities. He can return to basketball probably in another six months. He is very satisfied. His family is very satisfied with his outcome and I am also.
Is there anything else you would like to add?
Dr. Flood: I think there are other applications for stem cells, whether it is for degenerative conditions of the knee or the spine. We will, in the future, be taking the stem cells not from the iliac crest, but also from the patient's fat. There are more mesenchymal stem cells -- the stem cells we use for the fusion -- in the fat, than there actually are in the iliac crest. So we can take 20 to 30 cc's of fat -- which is not very much fat -- and then harvest that, process it, and get it back to the patient. Then you don't have the morbidity from sticking a large needle into the pelvis to harvest the bone marrow and most patients won't mind losing 20 to 30 cc's of fat.
If you would like more information, please contact:
Mark Flood, DO