HJAR May/Jun 2020

HEALTHCARE JOURNAL OF ARKANSAS  I  MAY / JUN 2020 39 David B. Bumpass, MD Orthopaedic Spine Surgeon Arkansas Children’s Hospital Dr. David Bumpass is an orthopaedic spine surgeon at Arkansas Children’s Hospital (ACH). He specializes in treatment of a wide variety of complex spinal conditions, including scoliosis, kyphosis, neuromuscular deformities, and congenital deformities. After studies in health policy and economics at the University of Toronto as a Fulbright scholar, Dr. Bumpass graduated with honors from the University of Virginia School of Medicine, and then completed an orthopaedic surgery residency at Washington University in St. Louis. He continued his training as a spine surgery fellow at Washington University, completing an additional complex spine deformity fellowship under the mentorship of Dr. Lawrence Lenke, one of the world’s foremost spine surgeons. He has published research in numerous prestigious orthopaedic journals, focusing on outcomes of spinal deformity surgery and spine tumors, as well as on current health policy challenges facing orthopaedic surgery. The treatment for moderate AIS, which is curvatures between the ranges of 20- 45 degrees on x-ray measurements, is bracing. In 2013, the Bracing in Adolescent Idiopathic Scoliosis Trial (BRAIST) provided level 1 evidence of the effectiveness of a molded thoracolumbar brace to control curve progression and prevent the need for spinal fusion surgery. Braces are now molded using optical scanning technology and lightweight plastics, enabling the brace to often be worn under clothing and enable daily activities. Typically brace wear is recommended between 18-23 hours each day until the conclusion of growth. Surgery remains the mainstay of treatment for scoliosis curves greater than 50 degrees in magnitude. Spinal fusion techniques for scoliosis correction have continued to advance as the sophistication of spinal implants has dramatically changed over the past 20-30 years. While these remain major surgeries, a multidisciplinary care approach and use of recovery protocols has resulted in a typical post-operative stay of three days, and return to school within three weeks. This represents a remarkable change from several decades ago, when patients were often placed in a body cast and kept hospitalized for months after surgery. AIS patients are now able to return to most sports at a high level, even playing at the collegiate or professional level. Spinal tethering is a new non-fusion technique that can be used to treat some AISpatients.Aflexible fiber cord is attached using screws to the outer convex portion of the spinal curvature through minimally invasive thoracoscopy. This restrains the growth on the outer portion of the curve and allows the inner concave portion of the spine to catch up, thereby straightening the spine. The FDA recently approved this procedure via the humanitarian device exemption pathway. Research continues to identify which patients are best suited for this procedure rather than a fusion, but it does represent a potential alternative over spinal fusion in select patients. Treating Other Forms of Scoliosis Congenital, neuromuscular, and syndromic scoliosis patients are often more complex, as they can have other associated medical issues that require a complex care team of spine surgeons, anesthesiologists, geneticists, neurologists, pulmonologists, and critical care physicians to provide optimal care. As these patients often require surgery at a young age, it is imperative to maintain as much growth as possible. Corrective surgery and spinal implants must allow for growth, rather than simply fusing the spine. The development of magnetic growing rods is an exciting advancement. Previously, young scoliosis patients had to be brought to surgery every six months for lengthening of rods attached to the spine in order to elongate the torso and permit appropriate lung development. The magnetic rods have a small magnetic motor inside of the rod. The lengthening is performed with an external magnetic drive in the surgeon’s office, and is completed in about five minutes with no anesthesia and no discomfort to the patient. Use of these rods saves patients from numerous trips to surgery during childhood and enables them to remain in school and in their activities more consistently. Other technological advances that have made dramatic changes in how pediatric spine surgery is performed include spinal navigation. A specialized CT scanner is used during surgery to acquire imaging of the spine, and the surgeon’s instruments are thenprojectedonto computermonitors showing the exact position and trajectory of the implants being placed into the vertebrae. Navigation helps to avoid injury to the spinal cord and critical vascular structures that surround the spine. Three- dimensional printing has also proven to be a very valuable technology. Spine surgeons can print full-size spinal models of complex deformities using a patient’s preoperative CT scan. The surgeon can then study the model for planning, and review the model with patients and families so that they can better understand the deformity being treated. Scoliosis can be a devastating disease if untreated; however, the current advances inbothnon-surgical andsurgical treatment are enabling children with scoliosis to lead fulfilling and active lives. n