A French Doctor Pioneers a Way to Correct Crooked Spines
Betsy Garrett of Hodgenville, Ky. grew up as a poised, self-assured youngster who always stood and sat up straight. But a little more than three years ago, when she was 10, Betsy was given a health exam at her elementary school, and nurse Virginia Stewart noticed that one of Betsy's shoulders was higher than the other. From the girl's protruding shoulder blades, Stewart recognized that Betsy had a dangerous spinal deformity that could one day require major corrective surgery.
Her condition is called scoliosis, and it is not altogether rare. One in every 10 youngsters has some abnormal curvature of the spine. It is a defect that tends to run in families and affects school-age girls more than boys. In about a fifth of the cases, the children are born with the condition or develop it as a result of another disease, such as polio or muscular dystrophy. But for no apparent reason, in the large majority of instances scoliosis develops in otherwise healthy children, usually between the ages of 10 and 15.
Most scoliosis cases are mild. The more serious ones often can be treated through exercise, electrical stimulation or by wearing body braces. But in one out of 1,000 cases, the spinal curvature becomes so severe that it distorts the rib cage and impedes the growth and function of the heart and lungs. Physicians and parents cannot simply assume that the child "will grow out of it," warns Dr. Kenton D. Leather-man, 72, director of a spine center named for him at Louisville's Norton and Kosair Children's Hospitals. "Scoliosis patients have died of heart and lung failure."
Today 18 states require scoliosis screening in schools. A number of other school districts have voluntary programs with nurses or gym teachers checking students' spines. "With early diagnosis, surgery can be avoided in many cases," says Leatherman, who is also a professor of orthopedic surgery at the University of Louisville. But for Betsy Garrett, even prompt diagnosis could not stave off three years of discomfort that included experimental surgery developed in France.
When Betsy first came to Leatherman in 1981, he hoped that the simplest treatment would suffice. He recommended postural exercises for Betsy to do at home. "Unfortunately," she admits, "I didn't do them regularly." Her spine curvature worsened.
Back at the hospital, Betsy was fitted for a Milwaukee brace, a girdle-like device that went from her hips up to her chin, topped off with a neck ring. She cheerfully agreed to the contraption until she tried to pick an object off the floor—and failed. But after physical therapists showed her how to move—and after she saw other children in braces—"her whole attitude changed," says her mother, Andrea. "She was fine."
With her bulky brace on, Betsy could no longer fit into her size 3 clothes. She acquired a loose-fitting wardrobe: Jogging suits with baggy drawstring trousers proved especially adaptable. "Betsy was fantastic in accepting her situation," recalls nurse Virginia Stewart. "It's traumatic for a young girl to have to wear a Milwaukee brace. Her body image is so important at that age." Her teachers asked her schoolmates not to stare, and everyone cooperated. "My friends are kind of protective," says Betsy. "They wouldn't let anyone say anything about it."
For two years the brace was a fact of Betsy's life, night and day. It came off for a few hours each week only to enable her to bathe, to put on a dress for Sunday services at the First Baptist Church or to attend school dances. Yet Leatherman decided the brace was not accomplishing enough for Betsy to avoid eventual surgery.
There are currently several surgical options for scoliosis, most involving the permanent implantation of steel rods in the patient's back to straighten and support the deformed spine. The newest variation was developed by French spine surgeon Yves Cotrel, 60, and uses a complicated series of hooks together with a pair of cross-braced rods. The Cotrel technique has one obvious advantage over the other methods. After most types of spine surgery, patients must be encased in a body cast or brace for as long as six months. In contrast, the Cotrel variation provides such strong support along the spine that the cast is dispensed with and the patient can be up and walking four days following surgery.
After 135 successful operations in France, Dr. Cotrel, a longtime friend of Leatherman, demonstrated his technique in Louisville last September. In November Cotrel returned to Louisville to operate on a new group of patients—including Betsy Garrett.
Her parents agreed to the surgery, and Betsy herself was remarkably calm about it, considering that she had undergone chest surgery only nine months earlier. At that time she had a steel plate inserted to expand her chest cavity so that her heart and lungs would have more room to grow (the plate was surgically removed in February). Still, she approached her new operation with no sense of dread, her mother says. "She seemed to feel, 'Oh, good, I finally get to throw my brace away.' "
Early on the morning of November 21, Cotrel and Leatherman meticulously studied full-length X rays of Betsy's spine to determine the placement of the hooks and rods. "It's a matter of where the hooks go and which hook will do what," Leatherman explained. Betsy was anesthetized at 7:44 a.m., and the tedious, four-hour operation began, during which her spinal cord was monitored against damage. Leatherman observed but did not participate in the surgery. At one point chips were removed from Betsy's pelvic bone and sprinkled on the spine so that it would fuse solidly. "Betsy will be able to bend and even do gymnastics," Leatherman cheerfully predicted. "Even when the spine is fused, patients can bend and put their fingers to their toes."
In the end, all of the doctors' hopes were borne out. Just three days after surgery, Betsy took her first steps, beginning with a walker and then unaided. Only 10 days later her parents drove her the 50 miles to Hodgenville and their antique-filled home, where without help Betsy climbed the stairs to her room with its four-poster bed. By January 10 she was back in class at LaRue County Junior High, and exercising at home to Carol Hensel records.
Today her life is normal. She swims at an indoor pool, plays the flute in the school band, practices the piano, and makes cookies for her sisters, Anna, 11, and Sally, 7. After school she visits, her parents, Eric and Andrea, at the family-owned furniture store, and joins friends for movies in nearby Elizabeth-town. One thing about Betsy has changed: She is noticeably taller. Before surgery she was 5'4". By the time of her 14th birthday on February 22, Betsy, standing straight, noted gleefully, "I grew two inches in just two months."
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