Mason Bunker is a little boy with a long medical history. He had surgeries for two unrelated conditions by the time he was nine months old. And then before he even celebrated his first birthday, his mother noticed an unusual hump on his back while giving him a bath.
Mason was referred to Stuart Braun, MD, Chief of Pediatric Orthopaedics and Director of Floating Hospital’s Scoliosis and Spinal Deformity Program. Muscles in the infant’s left side were underdeveloped, leaving his spine to be slowly pulled to the right. Mason was diagnosed with scoliosis, a rare ailment that affects 2 to 3 percent of Americans. “If there’s a 1 percent chance of something happening, my son will be the 1 percent,” Nicole Bunker says with a weary laugh.
The treatments for scoliosis typically start with the least-invasive options and then progress, if needed, to more-invasive methods. So Dr. Braun recommended that Mason begin by wearing a back brace in hopes of preventing his curve from worsening. If that proved ineffective, he said, Mason would have to wear a series of torso casts. Unfortunately, after a year of wearing the brace, the curvature of Mason’s spine only got worse. So when Mason was two, Dr. Braun and the family decided to transition to Risser casts. These casts, which were shaped a bit like a tank top were applied in the operating room when Mason was under anesthesia. This allowed Dr. Braun to more precisely apply the casts in hopes of gaining better control over the scoliosis. Mason wore a cast 24/7, switching to a new one every three to four months as he grew. As Dr. Braun and the family formed a bond, the doctor took to drawing superheroes on the casts to help Mason be brave.
After many months it was clear the casts were not succeeding at preventing Mason’s spine curvature from getting worse. “We were always hoping it would work,” Nicole recalls. “It was always, ‘Just one more cast! Let’s just try one more cast!”
So by the time Mason was four, it was time for his parents and Dr. Braun to consider other options. “He had a room full of superhero casts,” Dr. Braun says, “but we were going to need another solution.” At that point Dr. Braun proposed a more powerful, but also more invasive, treatment: a metal rod that would be surgically implanted in Mason’s back to straighten his spine. “The rods function sort of like a three-dimensional car tire jack,” Dr. Braun explains. “As the rods are adjusted, they slowly straighten the spine, sort of like the jack lifts the car.” Every six months or so, Mason would have to return for another operation so the rod could be lengthened as he grew. Nicole was concerned about what the rods would mean for Mason. “All those surgeries, and Mason would have to be put under every time, and he’d have to miss a lot of school,” she recalls thinking.
There was one more option available: a version of the rods that, once implanted, could be lengthened as needed using external magnets. Rather than returning to the operating room to extend the rods, Dr. Braun could just activate the magnet during a routine office visit. This would avoid the many return visits to the operating room and the brief hospitalizations that would follow. The new device had been gaining popularity in Europe, but only a few had been placed in the United States.
Dr. Braun was intrigued by the technology, but wanted to investigate further. “I am a cautious surgeon,” Braun says, “and I don’t adopt new techniques without doing extensive research.” So Dr. Braun and the family initially decided the traditional rods were the right course. But as Dr. Braun continued to look into the procedure, he became more comfortable with it.
“The more I researched the device and procedure, the more I learned, and the more I thought about it, I decided that it could be done safely,” Dr. Braun says. “The benefits were so great that they outweighed the risks. And I felt like Mason was the perfect candidate for this procedure.” Dr. Braun explains that good candidates for the operation are of a certain size and are in overall good health. It’s also important, he said, that the child’s parents have the schedule flexibility to make the required follow-up visits.
In June 2015, Dr. Braun performed the operation on Mason, who was then five. The boy spent less than a week in the hospital and then went home. A physical therapist came to the house for about a week and a half, and Mason recovered well, gaining strength and independence. After that, “he was up and ready to go,” Nicole says. “He kept asking, ‘Can I walk more? I want to walk more!”
At his first appointment to lengthen the rods, everyone was nervous. “But Mason just laid down, they put the small magnetic machine over the rods, hit the button and that was it,” commented Nicole. The lengthening took about two minutes, and X-rays confirmed that the rods had been properly extended by about 3 millimeters. “It’s absolutely amazing,” Nicole says. “And so was Dr. Braun. He has just been unbelievable to my family through this entire process.” Mason has since returned for several successful and comfortable lengthenings, gaining height and correction with each outpatient visit.
Mason’s curvature is already “significantly improved,” Dr. Braun says, but Mason will need the rods until his spine stops growing. The rod currently in his back will allow for several years of gradual lengthening, after which it’s possible that another rod will have to be implanted to replace the first. “That’s something that we’ll just have to see when we get there,” Nicole says.
Dr. Braun says that Mason’s procedure is “another example of Floating Hospital being on the leading edge of patient care.” And that message seems to be resonating. Dr. Braun says he already has a number of good candidates for his next magic rods procedure.
To refer a patient to Dr. Braun or Floating Hospital’s Department of Pediatric Orthopaedics, please call 866-784-5038.