behrooz akbarnia
Behrooz Akbarnia M.D.
Board Certified
ramin-bagheri
Ramin Bagheri M.D.
Board Certified
greg mundis
Gregory Mundis M.D.
Board Certified

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Scripps Clinic Torrey Pines
10666 North Torrey Pines Rd
La Jolla, CA 92037
858-554-7988

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The Growing Spine Program

Treatment for Young Children with Progressive Early Onset Scoliosis San Diego Center for Spinal Disorders

The San Diego Growing Spine Program was established by Behrooz A. Akbarnia, MD, in 1996. This program was developed because of the lack of effective treatment for progressive scoliosis in very young children. Another goal of the program is to help very young children and their families better understand the special challenges of Early Onset Scoliosis. This comprehensive program includes initial evaluation and offers treatment options both in the non-operative and operative arenas, as well as continued follow-up care during the treatment process.

Early Onset Scoliosis is an uncommon problem. As a result, we receive referrals from many states and countries and our center encourages families to communicate through initial telephone consultation and study recommended educational materials before traveling to San Diego. We facilitate patient reference contacts with families of children treated within the San Diego Program. Parents are always encouraged to obtain additional medical opinions regarding treatment options as dictated by their child’s condition. The San Diego Center for Spinal Disorders team will keep a close communication and help families through their treatment process, assisting with further education, housing, insurance authorizations, etc.

Non-operative care includes observation with periodic return for a physical examination and scoliosis x-rays. The purpose is to determine whether the scoliosis curve(s) are worsening or remain unchanged. If it is determined that a curve is worsening, special brace or cast treatment may be offered to attempt to control the curve(s) during growth. Not all young patients are candidates for non-operative treatment; this treatment is based on the unique condition of the child. Others may require surgical treatment to prevent further progression.

In addition to standard surgical procedures, operative care at the San Diego Center for Spinal Disorders includes use of the "Growing Rod" Technique evolved at our center over the past few years. This treatment option is offered for those young children who have progressive curve(s) and have either failed non-operative treatment or are not good candidates for that type of care. This technique utilizes a very limited spinal fusion only in the areas of the spine where spinal implants (hooks or screws) are attached. Spinal rods link to these anchors and span the area of curvature to act as an “internal brace,” both controlling the curve and allowing for spinal and chest growth over time (see illustration and x-rays below). A brace is required only for the short-term, until the limited fusion areas have healed. Periodic return to the Growing Spine team is necessary to examine the patient, check the x-ray, and lengthen the spinal implants, which are typically done via outpatient surgery. This periodic care continues until the patient has achieved growth or is otherwise no longer benefiting from treatment.

Because Early Onset Scoliosis is uncommon, it has been largely overlooked by the Medical Community until recently. As a result, there is very little medical literature addressing this problem and any current treatment modalities. One of the recent significant steps toward overcoming this deficiency is the creation of the Growing Spine Committee by the Scoliosis Research Society. This committee plans to play an active role in research and education addressing these issues.

The San Diego Center for Spinal Disorders is a internationally recognized center for the treatment of spine deformity in very young children with a variety of causes. It is also the central site for the Growing Spine Study Group. Headed by Dr. Akbarnia and coordinated by Pat Kostial, RN, BSN, this group meets on a regular basis to consider past and current clinical issues, as well as to discuss ongoing research projects regarding the growing spine with progressive scoliosis. There are also tutorials offered through the Pediatric Orthopaedic Society of North America (POSNA) and the Scoliosis Research Society (SRS). These tutorials are held in San Diego and other cities to train surgeons on Growing Rod non-fusion techniques. Surgeons interested in learning these techniques should register through those societies.

When interested, parents of patients having surgical treatment at our center are encouraged to participate in one of the ongoing clinical studies, approved by the Institutional Review Board at Children’s Hospital and Health Center, allowing our doctors to review medical records and x-rays to determine the effectiveness of this treatment. Children age 7 and older may also express written interest in participating in this important project as well.

For more information, please refer to the bibliography and current research topics provided in this section. If you have questions regarding our Center’s Growing Spine Program, please contact the Center’s Nurse Coordinator, Pat Kostial, RN, BSN at 858-554-7988 or by e-mail at pkostial@sandiego-spine.com.


47 month old female with diagnosis of juvenile idiopathic scoliosis treated surgically with dual growing rod instrumentation. Preoperative and postoperative AP images shown


Growing rod instrumentation technique illustrating both foundation and connector sites


Graph showing scoliosis curve correction and maintenance as well as spinal growth over 7.5 years in a 5 + 10 year old female treated with the growing rod technique until final fusion in 2004