MedStar Health DocTalk
Comprehensive, relevant and insightful conversations about health and medicine happen here… on MedStar Health Doc Talk. Join us for real conversations with physician experts from around the largest healthcare system in the Maryland-DC region.
MedStar Health DocTalk
Scoliosis with Dr. Zan Naseer
In the latest episode of MedStar Health DocTalk, orthopedic surgeon Zan Nasser, MD, who specializes in spine surgery, discusses the facts and fiction of scoliosis. From understanding the basics of curvature of the spine, to treatment options, patients, parents, and healthcare professionals alike, this podcast has something for everyone.
Contrary to popular belief, scoliosis isn't solely a teenage affliction nor is it caused by poor posture. In fact, scoliosis can develop in individuals of any age, and its severity varies significantly from person to person.
Bracing is often the first line of defense for children with mild to moderate curves, and it plays a crucial role in preventing the curvature from worsening. But when does bracing start, and what happens if treatment isn’t pursued. Dr. Naseer has details the issues surrounding bracing for pediatric patients and for adults… with practical advice for parents on how to manage bracing routines.
Dr. Naseer delves into the more complex aspects of scoliosis management, including surgery.
Listeners will also learn about the importance of early diagnosis and regular monitoring.
With expert insights from Dr. Zan Naseer, listeners are empowered to understand scoliosis better and to navigate its challenges with confidence. Tune in to gain a deeper understanding of scoliosis, its management, and how to support those living with it. Don't miss out on this enlightening conversation that could change lives!
For more information on Dr. Naseer, go to medstarhealth.org/naseer, or to make an appointment, call 410-248-8054.
If you would like to share feedback on this podcast, or suggest a topic for another episode of DocTalk, email Debra Schindler at debra.schindler@medstar.net.
For more episodes of MedStar Health DocTalk, go to medstarhealth.org/doctalk.
Comprehensive, relevant and insightful conversations about health and medicine happen here when MedStar Health DocTalk These are real conversations with physician experts from around the largest healthcare system in the Maryland D.C. region. Many of us hear the word scoliosis and picture a severe curvature of the spine or back brace worn all the way up to the chin. The fact is, scoliosis can be mild without symptoms and worsen with time. It can form in people of any age, is different for everyone diagnosed with it, and no, it is not caused by poor posture. there are a lot of misconceptions about curvatures of the spine. In Today's episode of MedStar Health Dog Talk, we're going to break it down fact from fiction about scoliosis with MedStar Health orthopedic surgeon Dr. Zan Naseer who specializes in complex and minimally invasive adult spine surgery, as well as pediatric spine deformity and scoliosis. I'm your host, Debra Schindler. Dr. Naseer thank you for being with us here today on doctalk.
>> Dr. Zan Naseer:Thanks for having me.
>> Debra Schindler:The first record of scoliosis dates back to ancient Greece, when Hippocrates wrote about it. Scoliosis actually means crooked. It's been centuries then that curvature of the spine has been studied and understood, misunderstood. What do we know about it now? How do you explain what scoliosis actually is?
>> Dr. Zan Naseer:Yeah, it's actually interesting that you bring that up because the field of orthopedics actually started with fixing children with deformities. The word orthopedic actually means straight child. So children with leg length deformities or, you know, scoliosis or curvatures of their spine. That's kind of the origin of where orthopedic actual specialty started was treating pediatric patients. And there are multiple different types of scoliosis, and we'll talk about those during this podcast. But the ones that we commonly think about the scoliosis that we commonly think about is the scoliosis and the teenager with a big S shaped curve and they have to wear a brace for several hours a day. And, you know, we can see this child with uneven shoulders. And, you know, classically, you know, back in the day when we went to school, they would have us bend forward and they would evaluate our spine and, you know, everyone will be sent to the nurse's office and get checked. And, you know, so that, that's the adolescent idiopathic scoliosis that we traditionally know of. There are many different types of scoliosis, but, today we'll talk about adolescent idiopathic scoliosis, how to diagnose it, and, you know, what patients and families can expect.
>> Debra Schindler:When you say idiopathic, that means not having a cause.
>> Dr. Zan Naseer:Exactly. Yeah. The term idiopathic generally means that there isn't a confirmed reason why it happens. There isn't any data out there in the literature that explains why the condition happens. So for adolescent idiopathic scoliosis, we know that it happens. We know that there are correlations to certain things, like genetics, family history. there are some theories that it may be developmental as a child is getting older, that there's a propensity to have a curve or develop a curve, but we don't really know what the definitive sources. And in reality, there might be, you know, three or four different reasons why this type of curvature develops.
>> Debra Schindler:But sometimes there is a reason. You, you do know why it develops. What would those causes be?
>> Dr. Zan Naseer:Yeah, it's a good question. So there. There have been some studies on identical twins, and there is definitely a genetic component to this. So, you know, patients that come to the office, I ask every single one of them is their. A family history. And most of the time, you know, children have a family history. Their mother had it, their grandmother had, or their father had it. Someone in their family had scoliosis. So there definitely is a genetic component to it.
>> Debra Schindler:So if it happens in one twin, does it always happen in the other? That was interesting that you raised that.
>> Dr. Zan Naseer:Yeah, most of the time it does. and most of the time, if a child has scoliosis, the mother or the grandmother usually had it. Whether it was treated surgically or not, that's. That's a different story. But there definitely is a genetic component to it.
>> Debra Schindler:Well, I know I'm going back a lot of years, but when I was in school, I remember students having the brace on that held their. Their head way up and their neck was very straight. And then it seemed like they had that on for years, and then they would get that off, and they still sat with the same posture in their head up like a meerkat poked up. Is that still, a course of treatment for scoliosis in pediatric patients?
>> Dr. Zan Naseer:It is, and it's actually one of the kind of the first line, most conservative things that we try. you know, the braces have changed a lot. back in the day, there used to be very bulky braces that exactly like you described, what go all the way up to the neck. We still use braces. a lot of the braces that we use are custom fitted. You know, patients are measured and then the mold. The, braces are molded and custom fitted to the patient. Individualized. But yes, braces are still a kind of a gold standard of treatment, typically in curves that haven't progressed to the level where they need surgical intervention. And we periodically, you know, prescribe these braces to patients.
>> Debra Schindler:And do they wear them 24 7?
>> Dr. Zan Naseer:Not 24 7.
>> Debra Schindler:Not to bed, not to sleep in?
>> Dr. Zan Naseer:Well, it depends. yeah, it depends. So, you know, let's say hypothetically, there is a child with a 30 degree curve, and we want to treat them conservatively with the brace. They're still growing. There's still a propensity for the curve to progress. I'll initially try a brace. there are different types of braces, depending on how big the braces is and how restricted the child is, determines how many hours the brace should be worn. The most common type of brace is called the Boston brace. It's a brace that goes up to kind of the mid chest, all the way down to the hips. That's a brace that, in the literature has shown to be effective if worn for 13 hours at a minimum. Typically for my patients, I tell them to split the day into thirds. So eight hour blocks. And, you know, there is a big social element to this. You know, a lot of children. Absolutely, yeah. Let alone children, like adults, don't want to wear a brace either in public. You know, they don't want people to see them in that type of condition. And with children, children, you know, the social element is a key thing that we have to understand when we treat them. So I tell families, patients, parents that just split the day up into thirds, make it eight hour periods. Out of those three periods of the day, you should try to wear for two of those three periods. So 16 hours out of the day. So whether it's eight hours while you're at school, put a hoodie over the brace so that no one can see it, or if you don't want to wear at school, then you wear it right after you as soon as you come home, and then you wear throughout the night. And, it really depends on the child's, you know, activity level, if they play sports, if they don't, if they can't wear the brace while they're playing sports, or if they just want to sleep comfortably without the brace on. But at a minimum, it typically needs to be worn for 13 hours to actually be effective.
>> Debra Schindler:How old does a child have to be before you go with the brace option?
>> Dr. Zan Naseer:It's a great question. So you Know, this really comes into a discussion about the nuance of scoliosis. And so before I talk about that management aspect, you know, really the diagnosis of scoliosis is made when the curve of the spine has exceeded 10 degrees. And at, you know, at a degree level of 10 to 25 degrees, we actually don't even need to brace. We actually monitor children conservatively with serial X rays to see if they progress or not. and I guess the most important thing to consider is curves progress when children have growth left. So if a child is going through puberty or if they're growing and they're having growth spurts, and that's typically between the 10 to 15 age range in boys and girls, when they're growing and they have a curve, the curve is going to worsen as they get taller as they grow. So if a curve gets to 20 degrees, that's usually our indication to start the bracing, regardless of what the age is. You know, if they're 13 and, they still have a lot of growth left, we're definitely going to put them in a brace. If they're 15 and they still have some growth left, we're going to put them in a brace. We typically don't do bracing if imaging shows that they've done growing. So typically on X rays, we can see their growth plates and we can determine whether or not they have bony growth left. And if they don't have any bony growth left, if they're not going to get taller, then usually the curve usually does not progress. So therefore they don't need a brace.
>> Debra Schindler:So if parents hear that bracing is an option for that child, do you think that that's probably good news? Because the next step would be probably surgical, and that's not something people really want to. That's very daunting.
>> Dr. Zan Naseer:Yeah, no, definitely. It, it's a daunic diagnosis to have to hear from a doctor. But there are great management strategies. And yes, if a surgeon or physician says bracing is an option, that's actually great news. The goal of bracing is not to reverse the curve. That's a common question I get is, will the brace straighten out my spine? So what the brace actually does is, it improves the curvature a little bit. But the goal of the brace is to prevent the curve from getting worse. So, you know, if the curve is a 20 degree curve and we brace you until skeletal maturity, you know, until your X rays show that you're not growing anymore and your curve stays at 20 degrees, that's the best news we could have, you know, you're likely unlikely to progress. Actually you're not going to get worse as you get older. So really the goal and the expectation of the braces, if we can freeze you in time, if we can freeze your curve in time, and if it doesn't get worse, that's, you know, that's a real win there.
>> Debra Schindler:I see you're not really trying to reverse what you're trying to create a guide for the spine to grow in.
>> Dr. Zan Naseer:Yeah. You're trying to contain the spine and you're trying to essentially prevent it from worsening in the direction that it's going to worsen as, as you grow skeletally. So, for example, the treatment after a brace is typically surgery if the curve is getting worse. The guidelines for surgical intervention are usually implemented when the curve reaches a degrees, a, degree of curvature, 50 degrees or more. Because the research suggests that once a curve has gotten to 50 degrees, then it's likely going to progress, you know, up to one degree per year as the child gets older. So, you know, in that case, surgery is recommended. So if we can start a child with bracing at a curvature of 25 degrees and prevent it from getting to that 50 degree curvature range, then that's actually ideal, and that's a success with bracing beginning.
>> Debra Schindler:I mentioned that every case is different, and maybe this is not a fair question to ask, but how long does a child normally have to wear a brace?
>> Dr. Zan Naseer:Yep. The goal of the bracing is to prevent progression of the curve. And the biggest thing that affects that propensity to actually worsen is how much time you have left for growth to happen. So if a child is prepubescent, hasn't really had their growth spurt, then there's a high likelihood that that curve is going to get worse as they have their growth spurts, because as they get taller, as they get bigger, the curve actually gets worse. So typically we treat patients in a brace and we periodically, serially get X rays every six months or every year. And we evaluate certain aspects of their skeletal system to see how much growth they, they have left. And when those growth plates seem to be fused and are connected and are no longer growing, that's when we usually stop thebrace.
>> Debra Schindler:So, so it's years, but we're talking about years.
>> Dr. Zan Naseer:Y. Sometimes it's years. Yeah.
>> Debra Schindler:So do you ever get parents or a child who says, I don't want to do this for years and I don't want to get serial X rays for years and wear this for years and, and let's just do the surgery.
>> Dr. Zan Naseer:They don't go to the surgery right away, but they will say that they don't want to wear the brace. And you know, I tell them, you know, this is a medical condition that we are dealing with now. You know, it's, it's, it's about a 3% incidence in the country of all adolescent Sos. It's not uncommon. It is, it is there. And know I tell kids, if you have a hundred kids in your school, three of them, you know, may have scoliosis, they may be wearing a brace. But the goal is, you know, how do we fix this without having to do surgery. Now that's the goal of any surgeon in my opinion is how can we get people better without having to get to the option of doing surgery. And when you really, you know, pain out the risks of scoliosis if it goes untreated, you know, then patients and families will start to understand like maybe a brace is a good option. Maybe we should be complyingt with it for the next, you know, couple months to years. And you know, surgery, surgery is not a small ordeal, it's a big surgery. and we'll talk about, you know, we'll talk about surgery. But it is, it is a big surgery. But you know, children are resilient and there are patients and children, understandably so, that are not compliant with the bracing and you know, sometimes a curve will progress and when it does, that's when we recommend surgery.
>> Debra Schindler:Why do you think scoliosis is more common in girls, adolescent to girls than boys?
>> Dr. Zan Naseer:Yeah, that's a good question. Also. I think that's also part of the reason why it's idiopathic. We don't know but there is a 10 to 1 or 9 to 1, difference in male to female or female to male predominance. so yeah, females definitely get it. But it's not, it's not uncommon to see it in a boy. You know, I recently had a patient probably six months ago that I treated 14 year old boy, in middle school who had a curve that started to progress one from 45 to 55 degrees. So it's not uncommon. But yeah, I don't think we really know why it's it's a female predominance. there are some theories but again, you know, it can happen in anyone.
>> Debra Schindler:In the beginning of the intro I had mentioned that scoliosis can develop in people of any age, which was part of the research that I found. Has that been your experience as A spine surgeon, definitely.
>> Dr. Zan Naseer:You can have scoliosis in any range, starting from being an infant. You can have infantile scoliosis. there's a whole subcategory of scoliosis that develops in children under 10 years old. We call that early onset scoliosis. So it can be infantile, it can be juvenile.
>> Debra Schindler:Oh, my goodness.
>> Dr. Zan Naseer:And then it can be adolescent.
>> Debra Schindler:Is that treated when they're infants?
>> Dr. Zan Naseer:Yeah, it's a lot more complex. It is treated. you can imagine. You know, surgery for a scoliosis consists of doing a fusion. That's the gold standard, or where you fuse the spine. That's not really a good option in someone who's 4 years old because they still have a lot of growth to growth left. So there are different strategies, that we implement in the younger population. But I would say the other main category of scoliosis we see in our office all the time and that relates to adults with scoliosis. And the most common scoliosis you would see in an adult patient is something that we call degenerative scoliosis. Meaning as, as everyone gets older, you know, our bones wear out, our joints wear out. And as our bones and joints wear out in our spine, the spine becomes a little unstable and can start to curve towards one direction. And you develop a scoliosis usually in the lower part of your spine as you get older.
>> Debra Schindler:So that's not a case in adult scoliosis of having adolescent scoliosis that went untreated, Correct?
>> Dr. Zan Naseer:Yeah, that's, that's scoliosis that develops because of underlying degenerative pathology and issues.
>> Debra Schindler:Okay, so let's get to the diagnosis part. You mentioned checking. I remember the physical bend over, see if your hips are level. How might parents know I should take my child and have them checked out? Or how might an adult know I'm feeling some changes there in the spine? What might be a symptom or an indication that they should get seen?
>> Dr. Zan Naseer:That's a great question. So, you know, typically children that have a scoliosis or adolescent scoliosis usually don't have pain. this is usually a pain free type of condition. Really? The changes that happen have to do with posture, have to do with the shoulders, just like you mentioned, have to do with the, the hips being uneven. And most of the time, parents don't even notice. You know, these are things that the pediatrician will pick up during the normal pediatric physicals that the children have. nowadays there's some controversy whether or not there should be screening for all Children. You know, like we talked about back in the day when we were in elementary school, everyone would have this examination, in the nursees's office. But now there's a difference of opinion. but typically in my office I have patients that are referred to me by their pediatricians. Just because the pediatrician noticed an uneven shoulder or noticed u, on exam that the scapulara, the shoulder blade is a little protruded more than the other. but to, you know, I would say the most important way to diagnose someone is with, with E rays, you know, plain X rays front and a side view of the entire spine. And that's typically the initial way we diagnose patients.
>> Debra Schindler:Okay, so the laundry list is just for simplification. Uneven shoulders, one shoulder may be higher than the other. Uneven waist, waist may look uneven or off balance. One side of the pelvis is higher than the other. Prominent ribcge on one side. Do you see that often?
>> Dr. Zan Naseer:Hold the time.
>> Debra Schindler:when bending forward, one side of the ribcge may stick out more. and the head is not centered over the pelvis. That's a sign.
>> Dr. Zan Naseer:H. Yeah. These are all correct. You see varying degrees of all of these things, you know, depending on how severe the curve gets. So scoliosis, if you can imagine looking at a patient directly straight on is a curvature of the spine, but it's actually a 3D deformity. So you get a curvature in the front view where the spine may become an S, but you can also get a change in their alignment from the side view when you look at them from the side. But more importantly, you get a rotational deformity where the spine actually spins on itself. And it's that rotational deformity of the spine that causes the ribs to protrude that can cause, you know, the pelvisis, change in orientation. so you know, it's a combination of all those three deformities that really can manifest as uneven shoulders, hip issues, and the head not being centered over the body.
>> Debra Schindler:If you find that the curve is less than 25% and maybe doesn't need treatment, does that mean they just live with that curve and there are no real repercussions to that?
>> Dr. Zan Naseer:Yeah, so, you know, if a child comes in with a curve of less than 25 degrees, I typically get X rays every six months just to make sure that it's not progressing up until they reach skeletal maturity. and once they've reached maturity, let's say they're 18 years old and they're no longer growing and they have a 20 degree curve. The research suggests that if the curves are less than 30 degrees that they very rarely, if at all, ever progress. And with that amount of curve, you can live a normal healthy life without any restriction.
>> Debra Schindler:And there's no other health impacts.
>> Dr. Zan Naseer:There's no other health impacts.
>> Debra Schindler:Wow.
>> Dr. Zan Naseer:If the curves are greater than 50, then they typically progress. So if a child is 18 years or older and their curve is 55 degrees, then know we have a very real conversation with them regarding what they can, you know, expect in 30 years. In 30 years, their curve may be 80 degrees. It mightess, it might progress 30 degrees from the initial 50 degree diagnosis. And you know, when we start getting to 80, 90, 100 degrees of curvature, that's when you really start having systemic issues. You know, you can have difficulty breathing, the space for the lung gets really narrow, the lung may not develop properly. So that's, you know, the initiative to treat these early is so that those manifestations don't arise. And also, you know, children actually do very well after this type of surgery. They're very resilient. They stay in the hospital for three to four days and, you know, they go back to normal sports and activity without issue most of the time.
>> Debra Schindler:What's spinal manipulation?
>> Dr. Zan Naseer:Well, it depends. Spinal manipulation in the traditional sense, may consist of chirop, chiropractic stuff where they do adjustments. there are current techniques in physical therapy called stroth therapy, where this is a therapy that's very specific to scoliosis. And there's some good literature that it may help slow down the progression, of disease, of curvature. But in reality, you know, if there is a curve that's 20 degrees or more, I think it makes sense for parents and for children to be evaluated by a spine surgeon, by an orthopedic or neurosurgical spine surgeon that actually deals and operates on patients with this issue.
>> Debra Schindler:Do you ever refer your patients for physical therapyct?
>> Dr. Zan Naseer:I do, yeah. You know, specifically straw therapy. It's a specific type of therapy. And I will if, you know, if the, curve is small, you know, less than 25 degrees, or if even if they're bracing and it's, you know, within the 25 to 30 degree range, I think it's not a bad idea. I don't think it causes any harm. You don't burn any bridges. And I think it's something that can actually affect their, and improve their posture.
>> Debra Schindler:Okay, let's talk about surgery. What has been the long term prognosis for kids who have spine surgery, are they going to need additional surgeries as adults? Are they going to always have back issues?
>> Dr. Zan Naseer:Typically not. You know, it's, u. Again, it's a very nuanced conversation when it comes to what type of surgery is being recommended and, how many levels of the spine are going to be included in the surgery. So, traditionally, the gold standard of scoliosis surgery is what we call a fusion surgery, where we essentially put in screws and rods into the spine and lock that area of the spine. And over the first three months after surgery, that area fuses together and becomes one solid piece of bone. And, theoretically, if you think about it, if you fuse the spine, then the spine is not going to curve anymore. It's going to stay rigid in that position. Now, it really depends on what area of the spine is curved. You know, if the thoracic spine, which is the spine in the upper part, in the chest area, if that area of the spine is the area that's curved, typically you can do a, what we call a selective thoracic fusion, where you're not doing anything to the neck or the low back. And in those cases, patients do extremely well because you only fuse a portion of their spine, and they still have all their range of motion and function and flexibility in their lumbar spine, and they go back to doing everything that they loved and did before. So the prognosis is really good. You, in certain situations, sometimes we have to extend the fusion all the way down to the pelvis. And in those cases, you know, you lose some flexibility and range of motion. But again, you know, children that get surgery from, for scoliosis, they do extremely well. They're very resilient. You know, their pain is definitely a lot more tolerable than, let's say, an adult patient who needed the same type of surgery. So patients, young patients generally do extremely well after this type of surgery. They don't. They don't really lose any component of their life. They go back to sports. They keep doing the same things that they were doing before. They may experience a little bit of soreness or stiffness after surgery, but it really does not limit their function overall.
>> Debra Schindler:How long does the surgeries usually take and how long are they in hospital after that?
>> Dr. Zan Naseer:The surgeries take a few hours. You know, again, if you're only doing the thoracic spine, it can range anywhere from, you know, three hours to six hours. It really depends on, how many levels we're fusing. So it is a big surgery U. it's typically only one surgery that we do if we're doing a scolia surgeries. Typically we just do one surgery in that day and we, we focus all our energy on that one case. But again, you know, children do well. They typically stay in the hospital for usually about three to four days, and then they go home. They don't need rehab. Most of the time they just go home. They're walking the same day after surgery.
>> Debra Schindler:Wow. No crutches?
>> Dr. Zan Naseer:no crutches or brace.
>> Debra Schindler:No more. And no brace.
>> Dr. Zan Naseer:No, that's a. That's a good question. You know, some. Some surgeons won't use a brace and some do. I typically don't. You know, the hardware that we put in, it's a very sturdy and rigid hardware. Typically you don't need a brace.
>> Debra Schindler:What kind of pain meds?
>> Dr. Zan Naseer:initially they'll get narcotics. You know, initially, we try to minimize the pain as best as we can because you're gonna have some pain. It's a big surger, it's a big incision. But, at MedStar here, we have a pain management department, or it's a department made up of anesthesiologists who really focus on providing a multimodal regimen. So we try to limit the narcotic use as much as possible because the narcotics can have some complications or side effects.
>> Debra Schindler:Sure.
>> Dr. Zan Naseer:But they really try to use three or four different types of medications together in a multi modal approach to try to limit the m. pain as much as possible.
>> Debra Schindler:What about for adults? Is the surgical approach different? Is there recovery different?
>> Dr. Zan Naseer:Both. Yeah. The approach. The approaches are different. You know, the techniques and the concepts of why you're fusing and what you're doing is different. And the recovery sometimes can be different. Know, in adults with the degenerative vis Scoliosis, sometimes they also have elements of what we call radiculopathy or pain down their leg. You know, we commonly know it as sciatica. Where you get pain that goes down the buttock or the thigh. And in those situations, we have to do much more than just diffusion. We also have to do something called a decompression, where we get rid of pressure on the nerves, we get rid of the arthritis that's kind of built up. So the concepts are similar, but the theory behind what we're doing is different. And often the recovery is a little bit different also.
>> Debra Schindler:Does it make sense to start adults with a brace or.
>> Dr. Zan Naseer:No, no. no brace for them. No, because, you know, the concept with the brace in adolescent neopathic scoliosis is you're.
>> Debra Schindler:You're still growing.
>> Dr. Zan Naseer:You're still growing, so therefore, you're bracing the child up until they stop growing. And in adults, you've already stopped growing. And really, the driver of the scoliosis is the kind of wear and tear and chronic degeneration that's occurring.
>> Debra Schindler:What do people ask you when they come in and they learn they have scoliosis? What's the most common question that they have or misconception that they might have that you're eager to clarify?
>> Dr. Zan Naseer:There's so many, You know, I would say the first few questions that, the parents and the patients have is, is it something that I did? You know, that caus. This is it my backpack? Is it too heavy? You know, is it my posture? Is it. Is it the way I sit in my chair? And these are all valid questions because, you know, anytime we're dealing with a medical problem or, you know, something comes up with our health, we try to, I think, subconsciously try to figure out, you know, what is there that I can do myself as the patient that can potentially help me.
>> Debra Schindler:And what's your answer to those questions? With a backpack and posture in the chair?
>> Dr. Zan Naseer:Yeah, you know, it's, I tell patients, like, this is not your fault. You know, specifically with scoliosis, this was likely going to happen, you know, no matter what sports you played or no matter how you held your backpack. You know, again, it's an idiopathic condition. But. But we know that most of the time it's not due to posture or the backpack or the sports you played, and that there was a propensity for this to develop regardless of, you know, how you lived your life, and they.
>> Debra Schindler:Can have a normal life moving forward with treatment.
>> Dr. Zan Naseer:Yeah, that. That's the main point that I try to hit home because, you know, especially I have three kids. You know, especially when you have kids, you know, you can get nervous, you can get scared about multiple different things. And as a parent, you start thinking, you know, how is their life going to be 30 years down the line? And I think that's the point that I try to hammer home is even with the scoliosis, if it's treated adequately, you can live a normal, healthy life without issue.
>> Debra Schindler:What advice would you have for parents, in terms of, managing the condition long term? How can someone with scoliosis live an active life?
>> Dr. Zan Naseer:I think, initially, you know, when you're diagnosed with the condition, definitely see someone, get the diagnosis, get an Opinion, get all the facts, get all the imaging and have, have a plan. This is not something that should be avoided. When I was in my training, I worked at this great hospital where we would treat patients from all over the world that didn't have access to care. And for example, people from Indonesia and the Philippines that didn't have scoliosis surgeons and those conditions went untreated for years. And these kids would fly over to the states and they had 120 degree curves that could have been prevented, you know, if they had a plan. So I think with parents with kids with small curves, any degree of curvature, see a physician that deals with these conditions so that you can have a plan moving forward and just know that even if it goes to the surgical route, you know, after surgery, children usually have a, you know, a fulfilled, healthy life where they can participate in all types of activities.
>> Debra Schindler:Were you able to help those children?
>> Dr. Zan Naseer:Yeah, we were definitely, you know, that was part of our goal at that hospital is to provide care regardless of whether or not they had insurance or, you know, how severe their curvature was. And we definitely helped them.
>> Debra Schindler:Can scoliosis be prevented? If it's not about backpacks and chairs and posture, how could we prevent it?
>> Dr. Zan Naseer:yeah, I think that's the billion dollar question. You know, if we can prevent it, that would be the best scenario. But at this time, there's no barely know why it happens. I think if we continue to research and figure out the leading causes of why it develops and it goes from not just being idiopathic, but to being a disease entity that we have a cause for, then yes, I think there might be therapies in the future that can help. but as of now, it's not something that we really, can prevent. There are surgical strategies which we can talk about that are new and modern that actually can prevent a fusion. We call those motion preserving procedures and it a, it's a hot new topic in the, in the world of scoliosis.
>> Debra Schindler:Should parents ask for that?
>> Dr. Zan Naseer:I think they should, yeah. It's, you know, this type of procedure is called the vertebral body tethering. It's a motion preserving surgery, meaning that we don't do a fusion. It's essentially consists of putting in screws and then this rope like tether that actually anchors the spine. And as the child gets older, the tether actually gets taught and it actually straightens out the spine with the child's growth. And you know, this was initially developed several years ago and it's been fine Tuned over the years and it's definitely a great option for children who are still growing, that have a curvature that's suitable for this type of procedure. But it is a very, very specific criterion that is needed for to be eligible for this type of procedure.
>> Debra Schindler:Are we doing them here?
>> Dr. Zan Naseer:We don't do them at MedStar, but there are a handful of institutions in the country that do them. The place where I trained, we actually did those at that hospital.
>> Debra Schindler:So I loved before we started recording, talking with you and finding out that you're a Baltimore boy, you're a local guy from, not far from where I grew up. What caused you to veer towards spine surgery in orthopedics?
>> Dr. Zan Naseer:Yeah.
>> Debra Schindler:Did something happen?
>> Dr. Zan Naseer:No. You know, I grew up in Maryland, went to high school and college here. And you know, I always knew I wanted to be a doctor. And you know, I guess when you're in medical school, the biggest decision is, you know, what type of specialty do you want to go into. And for me, it was throughout my rotations and working with patients, I felt like I wanted to provide something that gave a immediate impact to someone's life. And surgery itself, just the broad category of surgery, was the specialty where I felt like I could provide a service through technical expertise that could help a patient right there and then. It wasn't until I rotated with the orthopedic department where I did my medical school that I really was fascinad by the technology in orthopedics and really fascinated by the types of procedures in the variety of cases. And spine surgeons specifically, it seems like this very complex area of the body, which it is. But you know, when it comes to the new technology and the innovation in the field, it's really an up and coming field where there's so much room for advancement and improvement. And you know, I wanted to get into a field that still had room to improve and you know, change the lives of others. And I think spine surgery was thefect perfect mix of technological advancement and room and also being able to provide surgeries that could help people get back to a, normal living.
>> Debra Schindler:Is there anything on the horizon now that we might look forward to in terms of, spine surgery and scoliosis treatment?
>> Dr. Zan Naseer:Yeah. So at MedStar specifically, we where're in one of the few institutions in the country that have a spine robot. And this is a robot that allows us to precisely and accurately place screws into the spine and allows us to do surgery more efficiently with less blood loss. And one of my interest is being able to provide scoliosis surgery using the spine robot. It's a new and up and coming field, but I think it really gives the surgeon the advantage of having peace of mind and knowing that every screw is optimized and individualized for the patient and using technology and artificial intelligence to, provide a more safer and adequate experience for the patient.
>> Debra Schindler:Is that the Excelsius?
>> Dr. Zan Naseer:That is the Excelsus. Ye.
>> Debra Schindler:Should people ask for that if they're looking for scoliosis surgery?
>> Dr. Zan Naseer:Definitely. I think, you know, I'm an advocate for technology. I think technology has made our lives a lot simpler and has really given us options that have proven to be complex in the past. And technology is not something that we should be scared of. We should embrace it. We should optimize it for different procedures. We currently use the spine robot for many of our adult spine cases for different pathologies. And I think it's being able to use it for scoliosis is, something that's on the frontier.
>> Debra Schindler:You know, a lot of people, they go to a surgeon and they think the surgeon is going to push them into operations or surgery that maybe they don't need. And I liked hearing you say that you'll start out with a brace, which might take years. And I asked, why wouldn't someone just want to get the quick fix and get the surgery? And it sounded to me like you wouldn't recommend that. That is not your recommendation. Right off the bat, who shouldn'get surgery, who should not get surgery right away, who would not be a candidate for scoliosis surgery?
>> Dr. Zan Naseer:Very nuanced conversation. But if we're specifically talking about adolescent scoliosis, if your curve is less than 50 degrees, I would say even less than 45, 40 degrees, you should definitely not consider surgery. Right off the bat. Bracing definitely can prevent progression of the curve. Strra therapy has great literature and research behind it. And I tell all my patients, these are conversations I have in the room with all of my patients. As you know, I went into surgery to be able to offer surgeries to patients to make them feel better and get them back to normal life. But 90% of my day when I'm seeing patients in the office is trying to figure out how I can get patients better without surgery. Surgery is something that can't be undone once it's done, it's there. But if there are conservative avenues that we can try, and I think all patients should try them, and if they can get you better or at least stop the progression of disease and you're not burning any bridges, I think that's always a reasonable option.
>> Debra Schindler:Spine surgery is always a last resort.
>> Dr. Zan Naseer:Always. It should always be the last resort. I think there's a lot of fear when it comes to spine surgery, both from patients perspective and families. And, I think the take home is you should not be scared of the potential fixes that there are because the prognosis for children with adolescent scoliosis prognosis is actually really good. This is a condition that should not be ignored. If it's diagnosed, then you should definitely seek out consultation from a appropriate spine surgeon, someone that deals with pediatric scoliosis, and really talk to that surgeon and customize a plan for your child, for the patient, whether that includes observation, serial radiographs, bracing, and then ultimately if the curve progresses, then the conversation is there are many good surgical options and ways to fix this. And even if it includes a fusion, patients historically do extremely well after ausion. So I guess the biggest takeaways don't be scared. Have a plan. Have someone that you can talk to, someone that is comfortable in doing scoliosis surgeries. And we definitely can at MedStar.
>> Debra Schindler:Excellent advice. Thank you. And thank you for being with us on MedStar Health DocTalk talk anytime. we've been talking with MedStar Health orthopedic spine surgeon Dr. Zan Nassir. To learn more about Dr. Nasir, visit medstarhealth.org Nassir N A S E R or to make an appointment. Call 410-248-8054 to share feedback on this episode or to request a topic for another episode of Doc Talk. I welcome your email. You can send it to Debra Schindler, medstar.net D E B R a s c H I n m D L e r@medstar.net.
