Bruno Braga, M.D. Answers Questions On: Pediatric Spinal Surgery

It depends on the surgery. In the brain it actually can be a plus that it is still developing. Let’s say there’s a tumor in an area of the brain that is responsible for language. In an adult, if you take that tumor out and the adult loses the language, he might not ever get that back. But in a child, since the language area is still developing, the child would be likely to recover full language function.

In the spine it’s more complicated. Sometimes we need to add screws or rods to make the spine more stable, and if you leave those instruments in a growing spine, it can cause scoliosis or other growth problems. So our options are fewer when we’re treating certain spinal fractures; where in an adult we would just put screws in and never worry about it, in kids we may have to go back surgically later, to remove the instruments so that the spine doesn’t fuse asymmetrically.

In some cases there’s been a fracture to a vertebra in the spine, and that makes the spine unstable, so we use rods and screws to anchor the spine until the bone fuses – to immobilize it, just like a cast for a broken arm. But because the bones of the spine have disks in between them, you have to immobilize several vertebrae at once to allow the fractured bone to fuse. 

In congenital malformations, sometimes the bone just develops abnormally, and it compresses the spinal cord or the brain stem. So we have to decompress that area, and then re-set the bones so that they will still be stable, but in a normal position.

Today we often work with smaller implants. Where in some cases we once would have had to immobilize several vertebrae to treat a particular fracture, now we can use shorter instruments. So for example, in some cervical fractures we previously would have fused the head to the neck; now we only have to fuse the neck. So the child will be able to move his head without having to move his whole trunk.

Also, now we do some operations as minimally invasive procedures, so that instead of large incisions we are working through an incision just about the size of my thumb. That means the child will be much more comfortable after the surgery, and his overall recovery time will be much faster.