Dr. Jason Lowenstein Delivers Scoliosis Lecture at Industry Expert Symposium

Dr. James C. Wittig, Chairman of Orthopedic Surgery at Morristown Medical Center, recently released a recorded lecture by Dr. Jason Lowenstein of The Advanced Spine Center. The lecture, entitled “Pediatric Orthopedics for the Primary Care Practitioner” was given at Morristown Medical Center’s Annual Pediatric Orthopedics Course.

The annual symposium invites industry leaders in orthopedics to impart advanced concepts from their area of expertise to other practitioners in their respective niches. As Chief of Morristown Medical Center’s Scoliosis & Spinal Deformity Program, Dr. Lowenstein is uniquely suited to impart such wisdom.

As Dr. Wittig writes, “[Dr. Jason Lowenstein] is a top surgeon well known for the correction of the most complex scoliosis and spinal curvatures in both children and adults.”

In addition, Morristown Orthopedics, where Dr. Lowenstein operates, performed over 11,000 orthopedic surgery procedures in 2019, receiving 5-star ratings from healthgrades in all recorded areas of critique. Furthermore, in recognition of this outstanding achievement, Us News and World Report ranked Morristown Medical Center as the number 34 hospital in the country for orthopedics. With over 6,100 hospitals in the country, this secures Dr. Lowenstein’s position among the elite orthopedic surgeons in the United States. In fact, Morristown Medical Center has been rated as the number 1 hospital in all of New Jersey!

Meet Dr. Jason Lowenstein

Dr. Jason Lowenstein studied neuroscience at the University of Pennsylvania, where he graduated magna cum laude as a Dean’s List Scholar. Subsequently, he went on to receive his medical degree from the prestigious University of Pittsburgh School of Medicine, a top 10 orthopedics institute. At the University of Pittsburgh, Dr. Lowenstein worked in the Department of Orthopaedic Surgery’s Growth and Development laboratory, where he conducted gene therapy research to advance the treatment of musculoskeletal disorders.

After completing his surgical residency at New York-Presbyterian Hospital / Columbia University Medical Center, Dr. Jason Lowenstein accepted a fellowship in spine surgery at Emory Spine Center in Atlanta Georgia. Currently, Dr. Lowenstein serves as co-partner of The Advanced Spine Center and Chief of the Scoliosis & Spinal Deformity Program at Morristown Medical Center where he serves as a regional referral source for exceptionally complicated cases involving all manner of spinal deformities.

The following passages in this article highlight key talking points from Dr. Lowenstein’s recent lecture entitled “Pediatric Orthopedics for the Primary Care Physician.”

 

 

What is Scoliosis?

Doctors define scoliosis as any kind of deviation in the natural S-shaped curve of the spine. These deformations are typically mild, however, there are certain situations that are severe enough to warrant surgical intervention. Generally, if an individual acquires a curvature deviating more than 10 degrees from “normal”, a doctor will suggest monitoring or treatment. In cases in which the curve deviates by more than 40 degrees, the patient may be a candidate for corrective surgery.

Furthermore, your doctor may diagnose you with one of the five following subtypes of scoliosis:

• Idiopathic: Over 80% of scoliosis cases are idiopathic. Idiopathic simply means that the cause of the condition is unknown.
• Congenital: This type of scoliosis is present at birth. In other words, the curve develops while the fetus is still in the womb. This subtype of scoliosis affects roughly 1 in 10,000 newborns.
• Neuromuscular: The second most common form of scoliosis. This form of the condition is associated with muscular or neurological disorders such as spina bifida, cerebral palsy, and spinal cord injuries.
• Syndromic: Syndromic scoliosis develops as part of a pre-existing syndrome such as trisomy 21. Doctors define a syndrome as a condition that has a group of symptoms that consistently occur together.
• Degenerative: Doctors sometimes call this adult-onset scoliosis. Degenerative scoliosis is the result of the wear and tear that occurs on the discs and joints of the spine.

Diagnosing Scoliosis

Usually, your doctor will begin his or her formal scoliosis diagnosis with an office evaluation. Here the doctor will conduct a series of questions and tests that will serve as guidelines for the treatment plans that they will ultimately recommend. While the experience will vary from case to case, many doctors employ a similar approach. Your doctor may explore the following avenues during your evaluation:

• Age: How old is the patient? More specifically, what is his or her bone age? In other words, how much spinal growth is remaining and what are the odds that the curve in question may progress further?
• Type of Scoliosis: Are there any reasons to believe that the cause is not idiopathic scoliosis?
• Curve Progression: Is the curve becoming worse? Has the parent of the child noticed any big changes over a period of time? The answers to these questions will ultimately affect the aggressiveness of the treatment options your doctor will suggest.
• Age at Diagnosis: What was the age of the patient when they were diagnosed with scoliosis? Furthermore, what treatments have they received up until now?

After assessing these items, the next step usually involves a physical examination of the patient. At this stage, your doctor will look for any asymmetries that indicate the magnitude of your scoliotic curves. For example, your doctor will examine the symmetry of the waistline, shoulders, torso, hips, etc. Additionally, your doctor may use the Adam’s forward bending test to determine if there is any asymmetry in the ribs or lumbar spinal muscles. Any atypical crease lines in the waist or humps in the ribs will be noted.

Ruling out Scoliosis

Sometimes, the patient doesn’t have scoliosis. Part of the diagnostic journey is ruling out other conditions that the patient might have. For example, if the spine (when viewed from the side) contains atypical thoracic or lumbar curves, the child likely has another form of spinal deformity (such as kyphosis or lordosis) instead of scoliosis.

Evidence of neurological symptoms is another important factor to consider. Doctors will perform a neurologic examination to assess for these exact factors. Your doctor will examine superficial abdominal reflexes, Hoffman’s reflex, the motor strength of the bilateral upper and lower extremities, and more. If the patient does in fact have scoliosis, all of these factors should function as they normally would. Conversely, this means that if abnormalities show up here, the underlying condition may not be scoliosis.

And, of course, if your doctor expects scoliosis, then he or she will want to secure radiographic confirmation as well. Your doctor will likely use x-ray imaging to measure the curvature of the spine by assigning Cobb angles. Usually, advanced imaging techniques such as MRIs and CT scans are only utilized in cases in which scoliosis is not the suspected culprit.

Treatment Options for Adolescent Idiopathic Scoliosis

The vast majority of scoliosis cases do not require surgery to be treated effectively. Generally speaking, your doctor will adhere to the following guidelines:

• If the abnormal curvature is less than 40 degrees, then the patient should be observed/braced.
• Curves between 40 and 50 degrees, unfortunately, fall into a gray area. Whether your child needs surgery will depend on a number of factors including their day-to-day functioning and pain levels.
• Over 50 degrees, the patient ideally needs to undergo some form of corrective surgery.

Bracing Goals for Scoliosis

Scoliosis braces endeavor to limit the progression of abnormal curvature as the adolescent approaches skeletal maturity. Braces do not “fix” existing curvature, but rather attempt to prevent further damage from occurring into adulthood. As such, these interventions can also be used until a child with severe scoliosis is deemed old enough to undergo surgery.

Physical Therapy & Schroth Method

Physical therapy is also an excellent treatment modality for patients who wish to manage scoliosis-related discomfort.

However, for physical therapy to be effective, the right exercises must be performed in precisely the right manner. With scoliosis, your doctor should employ a three-dimensional approach in order to elongate the trunk and correct spinal imbalance. The goal should be to develop the inner muscles of the rib cage while altering the alignment of the upper trunk. In the end, “good” physical therapy should aim to stabilize curve magnitude while simultaneously reducing pain and improving muscle strength and endurance.

Physical therapy does not necessarily stop curve progression, however. More often than not, PT is used as a supplemental form of treatment to alleviate some of the harsher symptoms of scoliosis. That said, studies show that patients find physical therapy to improve their appearance, perception, and quality of life. This is true even though significant effects are not observable on the actual curvature itself.

Scoliosis Surgery

First and foremost, the goal of scoliosis surgery is to correct the deformity by fusing the least number of motion segments possible. Furthermore, the procedure should improve coronal and sagittal balance while simultaneously decompressing the spinal cord and nearby nerve roots. For best results, your surgeon should perform the surgery when the patient is young, ideally while the segments of the spine are still flexible. As we age, these segments become more rigid and difficult to correct. Likewise, adults must also contend with unrelated bone problems (such as osteoporosis, which softens the bones and is also much more cumbersome to fix).

More recently, doctors have been taking advantage of a new surgical technique called vertebral body tethering (VBT). This technique serves as an alternative to fusion and instead employs screws that anchor to a flexible cable in the spine. Doctors invented this innovative method of treatment in order to correct scoliotic curves while also maintaining the natural flexibility of the spine. (Patients typically lose a measure of spinal mobility during the fusion process) VBT has recently received FDA-approved through an important exemption. Your institution must seek board approval in order to become VBT certified. Morristown Medical Center is currently enrolled in this exciting program and doctors such as Jason Lowenstein have been successfully implementing this technique for quite some time now.

A Bright Future

Scoliosis is a fairly common and extremely treatable condition. With early detection techniques, doctors are achieving better and better correction results all the time.

Dr. Lowenstein has successfully performed thousands of complex surgical procedures to correct scoliosis. He has also implemented non-surgical treatment methods, such as bracing and pain management, with overwhelming success. As one of the top doctors in the country for scoliosis correction, there is no one more qualified that you should trust.