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A Nice Bit of Surgical Engineering

By John Kelly
Monday, December 22, 2008

Laurel Blakemore insists that she does not spend her free time staring at people's backs. Only occasionally will she catch herself scrutinizing the ladder of vertebra that climbs from hips to neck -- at the beach, say, where the spine is unabashedly exposed.

Of course, you couldn't blame her if she wasn't able to resist the urge. She is an orthopedic surgeon at Children's National Medical Center, where she treats hundreds of kids each year for scoliosis.

"We don't exactly know what causes it," Dr. Blakemore said of scoliosis, an abnormal curvature of the spine. Neuromuscular ailments such as myasthenia gravis and cerebral palsy can contribute, but 2 percent of the population has idiopathic scoliosis, a seemingly random twisting of the backbone.

"You can't really prevent it if it's going to happen," Dr. Blakemore said. "It is not caused by backpacks. It's not caused by having to carry a heavy load. You can't control it with chiropractic treatment or with physical therapy."

Treatment usually starts with a back brace, but that's not foolproof. When the spine starts to get about 50 degrees off kilter, Dr. Blakemore starts considering surgery.

That's where Patrick Formhals, a 15-year-old from Oak Hill, found himself. He'd worn a brace for a year to keep his scoliosis from getting worse, but in the summer the decision was made to operate.

"If you catch it before the curve is too terrible, the spine is pretty flexible," Dr. Blakemore said.

The procedure sounds a bit like pinioning a Slinky in place. "You have to expose the spine from the back," Dr. Blakemore explained. "Just the part you want to operate on." Then the surgeon fixes rods to the bones.

Patrick had two foot-long titanium rods inserted in his back, held in place by 20 screws fastened to his pedicles, the short, rounded bumps that protrude from the vertebrae.

"It's all done by eye," Dr. Blakemore said. "Basically, you try to get as close to straight as possible without the spinal column or nerves getting angry at you."

Ah, the spinal column, the body's vital information superhighway. During the operation, the patient's nerves and muscles are monitored to make sure they're suffering no ill effects from the construction going on around them. "It's a fairly delicate operation, even though you're working on big bones and putting screws in," the doctor said.

The screws and the rods are part of Patrick now, the reason he gained nearly two inches from the procedure. Dr. Blakemore assured him that despite the metal that girds his spine, he shouldn't have any problems going through metal detectors.

Said Patrick: "I won't set anything off."

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