My 13-year old daughter has a severe scoliosis. Bracing won’t be enough. She’s going to have a spinal fusion. I understand they use metal rods to hold the spine together until the bone graft fuses. The rods are left in and aren’t removed later. Will there be any problems years from now from the metal in these rods?

A very good question and one that hasn’t been addressed until recently.

Several studies have been done that show elevated levels of metals in the blood of patients with metal-on-metal total hip replacements. This led scientists to wonder about toxic levels of metals in children undergoing spinal fusion with rods, screws, and/or hooks.

A recent study from the Children’s Hospital in Boston showed elevated levels of nickel and chromium after spinal fusion. The metals were seen early after the operation and remained elevated even years later.

It’s not clear if the metals are actually toxic to the body. It’s possible that long-term exposure can lead to a depressed immune system. Any time the immune system is affected, other problems such as cancer can occur.

More studies are needed to answer your question fully. For now nothing will change in terms of the use of metal rods and implants for spinal fusion or joint replacement.

My 11-year old daughter was diagnosed with spondylolisthesis of the L5 vertebra. Will this heal if she stops gymnastics?

The answer to this question depends on several things. The first is the type of spondylolisthesis present. Spondylolisthesis means there is a gap between the main body of the L5 vertebra and the spinous process and facet joints.

There are four types of spondylolisthesis. Each type is different depending on the type
of defect present. Cause of defect is also important. Some types only require careful watching. There are often no symptoms and the child isn’t involved in any sports or activities that can make it worse.

Other types can be treated with activity restriction, physical therapy, and spinal bracing. Surgery may be needed when neurologic symptoms don’t go away with this type of conservative treatment. Surgery is also indicted when the spine is unstable.

Imaging studies such as X-rays, CT scans, SPECT, and MRIs may be needed to find out exactly where the damage is and how much damage is present. Once the extent of the defect is known, then treatment can be decided on.

My 13-year old daughter has spondylolysis. They say it’s usually caused by trauma or overuse in athletics. She hasn’t done anything like this. Could it be hereditary? Several other family members have this problem, too.

Some individuals may be genetically predisposed to develop spondylolysis. Spondylolysis is a defect in the vertebral bone. There is a gap between the main body of the vertebra and the back half.

Usually very active children or teens involved in athletics start to have symptoms. A smaller number of individuals develop problems without an activity or injury. The risk of a spondylolysis becoming a spondylolisthesis goes up in children with any other kind of defect in the bone.

Spondylolisthesis occurs when the defective vertebra slips forward over the normal bone below it.

There is one type of spondylolysis and spondylolisthesis that is more likely to be hereditary. About one-fourth of all cases (26 percent) have a family history of the same condition. First-degree relatives (parents, children, siblings) report this condition.

My son had a spine X-ray looking for scoliosis. They found something called spondylolisthesis instead. Now they want to do a CT scan. What more can that show us?

When a problem shows up that wasn’t known about or suspected, it’s called an incidental finding. Defects in the spine like spondylolisthesis are often found this way. Spondylolisthesis is the separation of the vertebral body in the spine from the back half where the spinal joints are located.

The vertebral body slips forward over the vertebra below it. Problems can occur from stretch pressure on the discs and spinal nerves in that area.

X-rays are used to look at overall spinal alignment. Scoliosis and spondylolisthesis can be seen on an X-ray. Other defects in the area may show up on X-ray. CT scans shows the bone structure more clearly in a slice-by-slice fashion.

This helps the doctor see how much of the bone is disrupted and to what extent. Any other bony changes are also seen on CT scan. This helps the physician in planning treatment. Other imaging studies such as single-photon emission computed tomography (SPECT) and MRI can be useful.

SPECT shows if there are any tumors or fractures. MRI may be done when neurologic symptoms are present.

My three-year old daughter had a brachial plexus injury at birth. She’s had physical therapy and is slowly getting better but she still can’t lift her arm over her head. Will this ever improve?

You didn’t say if she has had any surgery or just the physical therapy. Surgery is often advised when the child with a brachial plexus palsy doesn’t have full use of the arm. Doctors differ as to how soon that should be done. Most agree it should be at least evaluated by age 12 months.

Researchers at the Brachial Plexus Injury Center in Pittsburgh made a recent discovery. Ten children with brachial plexus palsy couldn’t raise their arms out to the side past 90 degrees.

Surgery was done and they found a second nerve called the axillary nerve was the problem. Scarring and muscle tightness had trapped the nerve. Releasing the nerve restored motion for eight of the 10 children.

Perhaps your child has a secondary problem. Has she been seen by an orthopedic surgeon or neurology specialist? It sounds like now would be a good time for some close follow-up.

My niece was just born last month. There was a difficult delivery and they say she has Erb’s palsy. What is this and what should we expect?

Erb’s palsy is the result of an injury to a group of nerves in the neck and arm called the brachial plexus. The injury occurs before birth or during delivery. The position of the baby or use of forceps or vacuum extractor are the usual reasons for the injury.

Weakness of the muscles and even paralysis lead to loss of motion and function. In most cases the children recover in the first year. Severe problems may be treated with surgery during the first four months.

Any major loss of motion or function after nine months should be looked at more carefully. Often a team of doctors including the pediatrician, orthopedic surgeon, and neurologist work together to find the best treatment plan for each child.

My nephew lives in the New York City area. He broke his arm while out skate boarding. Now the school won’t let him back in. This seems like discrimination because he’s a “skate head.” What can we do about it?

According to a recent study from New York City up to half of all students with orthopedic injuries are refused attendance at school. Principals say there are safety concerns. They are afraid of the liability if the child falls or is injured further while at school.

The report cites overcrowding, rambunctious children, and narrow stairways as safety hazards for already injured students.

Your nephew’s activities as a skate boarder may have nothing to do with the school’s refusal to allow him back. If the school says it’s in the best interest of the child to stay home during recovery, then find out about home instruction. Each state has its own requirements and laws about this policy.

My sister had twin boys about a year ago. One of the boys had a nerve injury that keeps him from using his right arm and hand fully. I noticed I can lift his hand over his head but he can’t do it himself. Why not?

You are noticing the difference between passive motion (you lift his arm) and active motion (he lifts his arm). There are usually two main reasons for a problem like this. First the nerve damage may have left the muscles of the arm weak.

Second muscles that don’t move through the full range of motion can get tight or contracted. With limited use of the shoulder, the soft tissues around the shoulder can get contracted. The contracture can put pressure on the nerve in the area causing this weakness.

You’ve made an important observation. If you haven’t mentioned it to your sister, do so now. Encourage her to have the child evaluated or re-evaluated if he was seen some time ago.

My 10-year old son broke his leg playing football. He had to have surgery and is now in a cast with crutches. What’s the best way to make sure he doesn’t miss too much school?

First check with his orthopedic surgeon to see if there’s any medical reason he should stay home. If not, make an appointment with the school principal, vice-principal, or counselor. Find out what obstacles your child will have to overcome going from class to class to keep his schedule.

Since he can manage with crutches, ask for special permission so that he can leave each classroom five minutes early. This will help him get from room to room without crowding or pushing in the hallways. Ask for a “helper.” This person can be a friend, another student, or staff member. The helper can carry any books, projects, or backpacks.

If there’s a medical reason he must miss school, make arrangements to pick up his assignments. This can be done every day, every other day, or once a week. It depends on the teachers’ classroom and work schedule. Short-term home instruction or tutoring is also an option.

My 9-year old son has wing bones that stick out quite a bit. I don’t notice this in my 7-year old daughter. What causes it?

The “wing bone” in humans is also called the scapula. You may be seeing what’s frequently called scapular winging. This occurs when the inner border of the scapula moves away from the trunk. The presence of scapular winging on both sides suggests a muscle imbalance or weakness.

This is not uncommon in young children, especially boys. It often goes away as the muscles, bones, and joints mature and develop. Scapular winging only on one side may be caused by muscle injury or nerve damage. Single-sided scapular winging should be examined by a medical doctor.

My 3-year old daughter sits with her legs twisted out to the side in a position called ‘W’ sitting. The pediatrician has told us to discourage this. What difference does it make?

The W-sit position describes the shape the legs make in the sitting position. The knees are turned in and the bottom rests between the two feet. The opposite position is called Indian or tailor-sitting. This alternate position turns the hips and knees out with the ankles crossed in front.

In young children, the hipbones and joint are still unformed with rubbery cartilage in the hip socket. The top of the thighbone (femur) fits into the hip socket to form the hip joint. The hip is more likely to dislocate if the femur is twisted at the top.

This slight twist is called torsion. A torsion forward is an anteversion. A twist in the opposite direction is called retroversion. Sitting for long periods of time in the W-sit position can cause anteversion. In some children, this can lead to hip dislocation.

My 17-year old son is on a high school water polo team. Several of the players have developed osteochondritis dissecans (OCD). How can we prevent this in our child?

Overuse of the arm or leg with repeated tissue trauma is the suspected cause of this condition in athletes. The constant pinching of cartilage between two bones may lead to the breakdown of the cartilage. The cartilage may separate from the bone and even break off.

Loose fragments of cartilage in a joint cause pain, swelling, and loss of motion. Doctors advise treatment at the earliest sign of this condition. In children under age 12, adequate rest is needed for healing. Older teens may need surgery to remove any torn tissue.

There isn’t any sure formula for prevention of OCD. Over training in competitive sports puts high stress on joints. Finding the right training for each sport and each athlete is a start.