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.
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“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.
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