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LI teen's severe scoliosis straightened out with high-tech surgery at Cohen
Marissa was facing a lifetime of pain. But thanks to the advanced approach to scoliosis surgery at Cohen Children's Medical Center, the lacrosse player is back in the game
While packing for a family vacation in July 2021, Lori Martiny noticed something alarming about her daughter, Marissa's spine. “I saw her in a tank top and did a double take,” she recalls. “Her right shoulder blade was sticking out while the left side was flat. Also, her right shoulder was higher than her left.”
Marissa’s pediatrician had noticed she had slightly uneven shoulders at her check-up the year before. The doctor asked her to touch her toes, then recommended they make an appointment to get an X-ray. Lori had intended to follow up, but with Covid-19 in full swing, additional doctor visits got put on the back burner. Besides, Marissa, 13 at the time, seemed fine, despite a full schedule of physical activity. The Holtsville teen played lacrosse on her school team, and was taking tap, jazz and lyrical dance classes.
But now, a year and a growth spurt later, Martiny was shocked at the change in her daughter’s appearance. She asked Marissa to bend over and touch her toes, as the pediatrician had. “One side of her back was now bulging,” says Martiny.
Marissa had no idea that something might be wrong. “I was taking three dance classes a week, so a little pain seemed normal,” she says.
It wasn’t. An X-ray revealed Marissa had scoliosis. Her spine had an abnormal side-to-side curve — and it was severe.
The search for a surgeon
The abnormal curve that defines scoliosis is most often diagnosed in adolescents. While it can occur with certain neuromuscular conditions (such as cerebral palsy and muscular dystrophy), it manifests most often in children as idiopathic scoliosis — meaning its cause is unknown.
Mild curves usually don’t require treatment, though doctors generally recommend regular checkups to monitor the spine. In some cases, kids may need to wear a special scoliosis brace to keep a curve from getting worse as they grow. Neither approach would be enough for Marissa. The bump Martiny saw in her daughter’s back was from her ribs protruding on one side of her body — the pronounced curvature of her spine had forced them to grow asymmetrically. Scoliosis surgery was her only option.
The consultations were frightening. One doctor told Martiny that after surgery, Marissa would never be able to touch her toes or tie her shoes again. Lacrosse and dance were a passion for the young girl, Martiny says. “I didn’t know how she’d ever be able to give up doing what she loved.”
Things changed, though, when the Martiny family met with Vishal Sarwahi, MD, chief of the Billie and George Ross Center for Pediatric Orthopaedics at Cohen Children’s Medical Center. “Dr. Sarwahi took the time to really answer Marissa’s questions, which no one else had done,” Martiny says.
They were barely out of Dr. Sarwahi’s office when Marissa turned to her mom and said she wanted him to do her surgery. Martiny wasn’t surprised: “We both knew he was the one.”
Preparing for scoliosis surgery
To correct her curve, Marissa would need spinal fusion surgery, the most common surgical treatment for scoliosis. The procedure is recommended when the spinal curve is greater than 45 degrees. Marissa’s curvature was S-shaped: The curve in the upper section measured 73 degrees, and the lower was 68 degrees.
Such an extreme curvature of the spine can lead to significant pain and put pressure on the lungs, which, over time, can compromise lung function, says Dr. Sarwahi.
Without treatment, Marissa would become breathless with routine activities or even at rest. And increasing back pain would limit her ability to run, dance or play.
What is spinal fusion surgery?
In spinal fusion surgery, two or more of the spine’s vertebrae are joined together permanently. Pieces of bone or a bonelike material are placed between the vertebrae, and then metal rods and screws are implanted to hold that section of the spine straight. Just as when a broken bone naturally heals, the vertebrae and bone tissue eventually fuse, or grow together, into one solid bone.
The spine is made up of 33 individual vertebrae stacked one on top of the other. “In this type of scoliosis surgery, there isn’t much room for error,” he explains. “We have to navigate a small channel that connects the back of the spine to the front, and then put in screws from the back, which means we can’t see the front.” The area is crowded with essential tissue — any damage could cause paralysis, so every move must be meticulous and accurate.
Day of surgery
On November 19, 2021, Marissa checked into Cohen Children’s for surgery. Dr. Sarwahi would perform the procedure in an orthopedic operating room specially equipped for spine surgery like hers — with machines hung from the ceiling to give doctors more space to work and a big screen on which they could project top-to-bottom scans of the spine.
Dr. Sarwahi would need to fuse 14 of Marissa's vertebrae. Once she was prepped and ready, Dr. Sarwahi and his team made an incision in her back and began the delicate procedure.
High-tech solutions improve accuracy, recovery time
To minimize the risk of complications, surgeons at Cohen Children’s employ a state-of-the-art CT scanner and navigation system called AIRO®. This technology creates a 3D model of the spine, which helps surgeons implant screws more accurately. It can also provide high-quality CT scans on demand. “That allows us to verify — in real-time — that spinal hardware is placed in the right location, so we can perform any revision needed before we close the incision,” explains Dr. Sarwahi. The technology also allows him to adjust the amount of radiation used in imaging, so patients are exposed to less radiation than they would be with standard CT scans. “That’s important for a growing child,” he adds.
Since the AIRO first debuted at Cohen Children’s three years ago, Dr. Sarwahi has refined the surgical technique used with this system to shorten the operation time. “Decreasing the duration of surgery means there’s less anesthesia, less blood loss, less chance of infection, a faster recovery and a shorter hospital stay,” he says. He published his approach in The Spine Journal.
Chidubem Iloabachie, MD, breaks down the most common causes and how to handle each.
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Dr. Sarwahi and his team aligned Marissa’s vertebrae and placed the rod and screws. Then he turned his attention to her ribs. Because of the severe curvature of her spine, five of the ribs on her right side were no longer rounded like a hilltop, but instead formed a V shape, like a sharp mountain peak. That’s what created the hump when she bent over. To remedy that problem, Dr. Sarwahi removed a small piece from each of the affected ribs, and then shaved them down so they no longer protruded. Within about three weeks, the ribs would heal back into a normal alignment.
Scoliosis surgery recovery
To help with post-surgery pain, Dr. Sarwahi injected a small dose of morphine into Marissa’s spine. This approach is part of Cohen Children’s innovative Rapid Recovery Protocol, which has reduced the hospital’s opioid use by a full 80%.
“The majority of scoliosis patients in the country get a patient-controlled analgesia [PCA] pump that delivers opioids, usually one or two milligrams per hour. Over 24 hours that can be as much as 50 milligrams of opioids,” says Dr. Sarwahi.
“We are a zero-PCA hospital — one of very few in the world.”
This protocol actually provides better pain control, Dr. Sarwahi says. What’s more, it helps patients get out of bed and into physical therapy sooner — and go home faster. Dr. Sarwahi published a paper on the approach in the journal Spine in 2021.
Marissa felt better fast: On a one to 10 pain scale, she was never higher than a three, she says.
“Two days after surgery I was up and walking,” she recalls. And on day four, she headed home.
One of the biggest concerns for patients is whether they’ll be able to resume their activities after scoliosis surgery. Like with Marissa's family, Dr. Sarwahi assures patients that, “Ninety-five percent of the time, once I do a spinal fusion, whatever the patient could do before surgery, they can do afterward.”
Though it can take a year for the vertebrae to fully fuse after surgery, some patients may be able to safely get back to their activities sooner; Marissa returned to school in January 2022, six weeks after surgery, and was cleared to dance after a month of physical therapy. And when lacrosse season began in March, she picked up her stick.
Martiny is beyond grateful for the care Dr. Sarwahi provided her daughter — and the entire family. “This was the most difficult thing my husband and I ever had to deal with,” she says. “All the time Dr. Sarwahi spent with us at the hospital and on the phone when I had questions, and the way he and his team helped us through the entire process, was a blessing.”
Since the surgery, Marissa has learned to adapt certain movements to accommodate the inflexible section of her back, but that hasn’t stopped her from living her best teenage life without pain or restrictions. “I still zipline and love going on rollercoasters and carnival rides,” she says. She continues to dance and looks forward to the spring when lacrosse season starts. Oh, and yes — she can still touch her toes.
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