What Would Happen | Page 26

ORTHOPEDICS INSTITUTE STRAIGHT AHEAD THE LONG SEARCH FOR THE GENETICS OF IDIOPATHIC SCOLIOSIS Specialists at the Center for Gait and Movement Analysis use state-of-the-art instruments — like advanced video recording techniques and 3D motion capture technology — to analyze a patient’s body movement and muscle activity while walking. ORTHOPEDICS INSTITUTE Researchers like Nancy Hadley-Miller, M.D., noticed long ago that scoliosis runs in families. A strong family history could sometimes even predict the severity of a case. A NEW TWIST “You get two parents with scoliosis, usually their child is going to have a more severe case,” Dr. Hadley-Miller says. “But that’s just anecdotal. There’s a big difference between anecdote and science.” SHARPENING AN OLD SURGERY WITH NEW TECHNOLOGY And Dr. Hadley-Miller wasn’t satisfied with anecdote. As far back as 1988, she began looking closer at the families she treated: “This guy has a 60-degree curve, his sisters have 20, 25-degree curves. Why?” For an explanation of Van Ness tibial rotationplasty, ask the guy who got one. It’s the question to which Dr. Hadley-Miller has devoted her career and it carries huge implications, especially in pediatrics, where a 10-degree curve in a 10-year old might become a 50-degree curve later on. Or it might not. “The idea is to save as much of the limb as possible,” says Garrison Hayes, 16, who underwent the procedure at 6 years old. An accurate way to predict the severity of scoliosis could help doctors decide not only whether to treat, but how to treat and when. Dr. HadleyMiller’s lab at Children’s Hospital Colorado, in partnership with the University of Colorado School of Medicine, is one of just two National Institutes of Health-funded scoliosis labs in the nation — the other one, at Washington University in St. Louis, is a close collaborator. Doctors removed the cancerous section of bone from his leg, rotated the remaining leg, and reattached it with the foot reversed, functioning like a knee. “You keep all the blood Dr. Hadley-Miller’s latest discovery is a damaging variant in the HSPG2 gene. “If there was one gene for scoliosis, I probably would have found it a long time ago,” Dr. Hadley-Miller says. “This situation is a lot more complex than we first thought.” NANCY HADLEYMILLER, M.D. 24 “I thought we’d have this figured out by 2000,” she jokes. “You really have to enjoy the process.” It’s not a new procedure. “I did my first one about 30 years ago,” says Travis Heare, M.D., a patient favorite with a big cowboy mustache and an easygoing Texas drawl, who performed Garrison’s operation a decade ago. “But we’ve refined it a whole lot.” Dr. Heare refines by constantly evaluating Garrison and patients like him using Children’s Hospital Colorado’s Center for Gait and Movement Analysis. While not exclusive to people with scoliosis, it bears out in scoliosis patients enough to be significant. It’s not a cure, but it is a clue. Rather, Dr. Hadley-Miller and a cast of international collaborators as far flung as France and Japan are working to isolate a panel of several genes, which, considered together, might have some predictive merit. But there’s a long road ahead. vessels and nerves and muscle — apparently, if you just take out the bone, everything else still works. I don’t know how they figure this stuff out.” TRAVIS HEARE, M.D. One of just a handful of high-tech gait labs in the nation, the CGMA employs ultrasensitive kinetic sensors, motion-capture technology, and electromyography to compile a detailed picture of exactly how patients walk and move. In Garrison’s case, the Van Ness procedure fused muscles from both his calf and thigh, and Dr. Heare wanted to see exactly which of those muscles were firing in Garrison’s stride. “We found he was mostly using his calf muscles, so we did a lot of training, figuring out how to use those quads, and he’s actually gotten a lot stronger as a result.” Such findings affect not only Garrison, a serious athlete with Paralympic aspirations, but also treatment decisions ranging from surgical technique to rehab to physical therapy — decisions that influence treatment costs, outcomes, and patient quality of life. For patients who get the Van Ness procedure, the outlook is better and better. And Garrison? He’s added six inches to his vertical jump in the last year. 25