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Johns Hopkins Pediatric

A New Approach to Preserving Spine Mobility in Middle-aged Adults

Two x-ray images show spine curvature indicating scoliosis


As one of the top programs in the country treating complex pediatric and adult spine deformity, Johns Hopkins is a leader in developing new surgical approaches for the most challenging cases.

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“These middle-aged patients tend to be more active. Some of them have young children or manual jobs. We need to find ways to preserve their spine motion segments.” —Khaled Kebaish

Khaled Kebaish, chief of orthopaedic spine surgery, has developed a new way to treat kyphosis and scoliosis in adults in their 30s to 50s. “These middle-aged patients tend to be more active,” says Kebaish. “Some of them have young children or manual jobs. We need to find ways to preserve their spine motion segments.”

Typically, long thoracolumbar fusions extend to the sacrum, providing maximal stability but reducing flexibility that allows the bending and twisting necessary for many activities. “Limiting their spine motion, especially lumbosacral motion, can have a significant impact on their ability to perform their job, to exercise and to be active,” says Kebaish.

In carefully selected patients, Kebaish has pioneered a new technique to correct deformity while preserving lumbosacral motion. He explains: “Instead of going, for example, from T3 to the sacrum, I would go from T3 to L4 and temporarily brace that distal level by applying instrumentation to hold the spine internally for three to six months. What this allows us to do is to achieve the correction we need and give it support while the spine heals. Then, in about three months, we go back and remove the extra fixation device.” The approach has been successful in the initial dozen patients who have had this procedure.

One key to the success of this shorter fusion technique is the availability at Johns Hopkins of a bone health clinic, the Metabolic Bone and Osteoporosis Center. There, experts in endocrinology, nutrition, geriatrics and physical therapy use a team approach to optimize the bone health of patients who might not otherwise be candidates for Kebaish’s method. Clearly, this procedure adds additional biomechanical stress to the spinal column,” he says. “Candidates have to have a healthy spine at the lumbosacral spinal segments. When patients come to us with osteopenia or osteoporosis, we collaborate quite a bit with the bone health clinic. They’ve been a great help to these patients and enabled us to treat patients who would not otherwise be good candidates for the procedure.”

In addition, patients treated with Kebaish’s technique require specialized postoperative rehabilitation that is available at Johns Hopkins. “We work with our physical therapists and rehab group to tailor patients’ activity to what the procedure allows,” says Kebaish. “There is some limitation early on because we need to limit motion until healing occurs. Patients do require more specialized physical therapy and rehab to get back to, hopefully, a higher level of activity than they had before surgery. We work closely with them on that.”

By offering this specialized multidisciplinary expertise, along with advanced surgical technique, Johns Hopkins is leading the way toward better outcomes for middle-aged adults with spine deformity.

Learn more about our research here.

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