Scoliosis Surgeon Puts his Patients on the Straight and Narrow
In early September, if you had asked 14-year-old Victoria Prisco how she was doing, she would have answered, in typical teenage fashion, “Fine.” There’s nothing remarkable about that, unless you consider the fact that just four weeks earlier, Victoria underwent a six-hour surgery to straighten out a severely curved spine. Victoria had scoliosis, a condition that caused her spine to curve in a progressively more severe “c” shape. But less than a month after orthopedic spine surgeon Laurence Mermelstein, MD, performed an operation at Good Samaritan Hospital to correct the condition, Victoria was, in every possible way, fine.
“I have to say Dr. Mermelstein – I can never thank him enough,” said Victoria’s mother, Nunzia Agozzino. “He is an amazing doctor. The surgery went 100% well and when he showed me X-rays ten days after surgery, her spine is completely straight.”
A sophomore at Massapequa High School, Victoria was 10 when her pediatrician noticed a slight curve in her spine and referred her to a specialist. That doctor prescribed an orthotic brace which Victoria wore nearly around-the-clock for the next three years.
“The goal of bracing is to prevent the curve from progressing and hopefully avoid surgery,” Dr. Mermelstein explained. To do this, bracing is recommended before the patient has reached what is called skeletal maturity.
Unfortunately, in Victoria’s case, bracing did not work as anticipated. Her curve had progressed to beyond 50 degrees, which is the benchmark for surgical correction.
When doctors started talking about surgery, Mrs. Agozzino sought several opinions, including those of pediatric spine surgeons in New York City. But when she and Victoria met Dr. Mermelstein, they knew they had found the right surgeon.
“We first saw him in June, and we immediately scheduled her surgery for August,” she said. “I just knew that this was the right thing to do and this was the right doctor to do it.”
In the more than two decades since he began his career, Dr. Mermelstein has operated on hundreds of children and has witnessed significant progress in surgical techniques and post-operative recovery.
“Nowadays with modern techniques and the protocol we’ve honed for pain management and mobilization at Good Sam, kids bounce back very quickly,” he said. “By two weeks out it looks like they never even had surgery.”
The children’s resilience belies the serious nature of the surgery. The procedure involves making a thin incision down the spinal column, and strategically fusing vertebrae together. Special screws are used as anchors in the vertebrae. Once the spine is corrected to a straightened position, the screws are anchored to rigid rods made of titanium or cobalt chrome, a remarkably strong metal that is tissue-friendly.
“Bone grows around it and through it,” Dr. Mermelstein explained. “Once the fusion is mature, we can leave the hardware in there forever – there is no reason to take it out.”
By carefully selecting which vertebrae to fuse, Dr. Mermelstein ensured that Victoria’s spine will still bend and flex enough to provide her with full mobility and very few, if any, limitations. Victoria underwent a “selective thoracic fusion” which, when carefully performed, can correct the spinal deformity while still allowing normal motion in the lower (lumbar) spine.
Scoliosis is relatively common in the United States, with up to three million new diagnoses each year. The majority of those affected are girls. While it seems to run in families, the cause of the condition remains largely unknown. Fortunately, most cases are not as severe as Victoria’s; only 30 percent of patients require bracing, and 10 percent progress to the point that surgery is needed.
Dr. Mermelstein believes that Good Samaritan provides an excellent environment for his scoliosis patients to recover from surgery, for a variety of reasons. As a result, Dr. Mermelstein says his patients’ complication rates are close to zero.
“Good Samaritan has a pediatric intensive care unit to take care of kids in the immediate post-op period, when it is important to monitor neurological function, check surgical wounds for swelling, and monitor breathing and blood pressure,” he said. “But at the same time, the hospital is very user friendly for families. It’s not overwhelming for these kids who, for the most part, have never been in the hospital before.”
Good Samaritan’s staff, from nurses to pediatric intensivists and physical therapists, all play a crucial role in helping children recover.
“They do a good job of pain control and mobilization,” Dr. Mermelstein noted. “Early mobilization in the ICU at Good Sam takes patients to the next level. The staff gets them out of bed the next day, makes sure they receive physical therapy, and walks the halls with them.”
Victoria’s surgery was on a Friday, and she was back home on Tuesday.
“The hospital was amazing...the nurses and everybody that took care of her,” Mrs. Agozzino said. “They were so caring, so compassionate, so on top of everything she needed. I didn’t know that the hospital had this type of care for children. That department was top of the line. There are amazing people working there.”
If you suspect your child has scoliosis:
Dr. Mermelstein advises early intervention if scoliosis is suspected.
“I recommend that kids get checked sooner rather than later, since the curve is probably not going to go away by waiting,” he said.
Most of the time, surgery is not necessary, and doctors have a toolbox of other treatments that they will exhaust before considering surgery. These include new custom braces that work better than in the past, as well as new physical therapy regimens.
If surgery is indicated, Dr. Mermelstein says doing it earlier is better than waiting.
“Doing it before the child graduates high school and enters college is preferred,” he said.
Left untreated, severe scoliosis will eventually cause medical issues.
“Individuals begin to have pulmonary problems, they may be unable to take a deep breath, and they can start to get an obvious deformity along with back pain. Not the least of these issues is the cosmetic concern,” Dr. Mermelstein noted.