Newsletter Articles:
• BIG STEPS Welcomes New Addition to the Team
• Fisher Centres CHEO’s First Line
• Sounding the Alarm on Childhood Obesity
• CIBC Commits $125,000 to CHEO Foundation’s BIG STEPS Campaign
• Making a Difference One Spine at a Time
Making a Difference One Spine at a Time
Imagine having a baby born with a musculoskeletal disorder of the spine. And imagine in the first five years of her life, she endured several traditional surgeries in the hopes of treating her disorder, only to have them be unsuccessful, leaving her tiny frame in a permanently curved position. Five years ago, this was Fatima Nasser’s story. She was born with scoliosis, in which there is a sideways curvature of the spine, and after her initial surgeries, doctors were running out of options to help her.
Enter Dr. Paul Moroz and Dr. James Jarvis, both orthopedic spine surgeons at the CHEO, who performed the first Vertical Expandable Prosthetic Titanium Rib (VEPTR™) instrumentation procedure on five year old Fatima in June, 2005. She was the first child in Ontario to benefit from this surgical procedure and CHEO was thrilled to host this medical first and eager to pave the way for future VEPTR surgeries. Prior to this, children requiring this kind of surgery were sent to Boston
or Texas.
The VEPTR is extremely successful in children with early onset scoliosis, which usually starts before 5 years of age, as it allows for expansion of the growing ribs at each end of the abnormally curved spine and corrects the deformity. After the first major operation to insert the VEPTR, Fatima was required to undergo periodic, minor surgeries to expand the VEPTR device to accommodate for her growth. Today, Fatima is nine years old. “She’s doing wonderfully well,” says her surgeon, Dr. Moroz. “Her last adjustment was in January 2010 and I’m very pleased with her progress to date. When Fatima stops growing, around the age of 12 to 14 years, we will do a final operation to partially fuse her corrected spinal deformity.”
VEPTR has proven to be a very successful surgical tool that will continue to change the lives of children diagnosed with early on-set scoliosis. Dr. Moroz, who trained at the Harvard Medical School in Boston, had previously been part of a team of specialists who performed the VEPTR procedure. When he arrived at CHEO in the summer of 2003 his goal was to create a specialized program that would become a Centre of Excellence for VEPTR surgeries at CHEO, but lack of funding has stalled his vision.
“The cost of the VEPTR implant alone is about $35,000 per surgery. This is approximately three times what a regular spinal implant costs, however a regular implant will not provide the same exceptional results as the VEPTR does in an early onset scoliosis,” explains Moroz. The regular implants are fine for scoliosis seen in teenagers but they cannot be used in the rarer, early onset children.
“In principle, I have a budget that allows me to perform up to three VEPTR surgeries per year at CHEO, but I have at least twice that many children per year that need one,” says Moroz. “I am able to do their surgery, but the funds must come from ‘elsewhere’ in the hospital and this strains other programs”.
According to Dr. Moroz, three percent of the population will suffer from scoliosis severe enough that they need to be seen by a scoliosis doctor and of this three percent only about 15 to 20 percent may actually need surgery.
Scoliosis can be genetically inherited or appear as a result of a syndrome, or children can be born with congenital abnormalities in their spines causing scoliosis. The more prevalent teenage scoliosis is mostly seen in girls, with five girls for every boy being diagnosed with significant scoliosis.
Last year Dr. Moroz performed six VEPTR surgeries at CHEO. “Because we are a tertiary pediatric centre we receive children from all over. From Nunavut to Thunder Bay to Western Quebec,” explains Moroz. “The demand outstrips the supply.”
Dr. Moroz would like to be able to perform VEPTR surgeries on a regular basis without worrying about the financial burden to the hospital. “It’s very frustrating,” says Moroz. “You want to develop a centre of excellence, but you need stable funding to do that.”
This is where the BIG STEPS campaign literally steps in to address this growing void. From the $25 million dollar campaign goal, BIG STEPS will invest $10 million to add, upgrade and integrate new devices and systems that will greatly enhance our ability to provide optimal care for kids. With the support of the BIG STEPS campaign, sustained funding for a VEPTR Centre of Excellence can one day be a reality.
For now Dr. Moroz will continue to fight for his vision. Making a difference in the life of Fatima and children like her -- one spine at a time.