Back on Track

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By Rich Radford

A surgical solution for Alexandra

When Alexandra Cavazos was 13 years old, she was diagnosed with scoliosis. Her mother and grandmother had the condition, so it wasn’t a complete surprise. But Alexandra’s case was aggravated by osteogenesis imperfecta, a genetic condition that causes weak bones. 

Alexandra Cavazos_Back on Track

Nearly 20,000 people are diagnosed with osteogenesis imperfecta (OI) each year, also known as brittle bone disease. Severe forms of the condition can be life-threatening and cause major bone deformities. Alexandra has the mildest type of OI, which makes her susceptible to bone fractures and increased the severity of her scoliosis.

As a young teenager, Alexandra wore a back brace for 18 months in an attempt to slow her scoliosis. Unfortunately, her spine continued to curve after the bracing period was over. In the years that followed, she noticed her clothes weren’t fitting her shoulders properly, and she was experiencing pain in her back.

Alexandra’s mother, Cindy, was concerned about the progression of her daughter’s condition and wondered whether she should explore surgical solutions when a chance conversation caught her attention. “A teacher at my school was talking about her daughter’s scoliosis surgery at CHKD,” Cindy says. “She had nothing but good things to say about their experience, so I suggested Alexandra look into CHKD’s program.”

As a 19-year-old freshman at Princeton University, Alexandra began her own research and learned that CHKD’s spine program specializes in all aspects of scoliosis treatment, from corrective bracing and physical therapy, to spinal fusion surgery. For surgical cases, a multidisciplinary team of orthopedic surgeons and neurosurgeons, anesthesiologists, pediatric intensive care specialists, nurses and pediatric physical therapists work together to provide comprehensive personalized care to each patient.

As she reviewed the list of orthopedic surgeons at CHKD, she discovered that Dr. Marc Cardelia also attended Princeton. She felt an immediate connection.

Alexandra knew that if surgery were recommended, she would require a recovery period. She worried that it might interrupt the big plans she had for her sophomore year: a spring semester abroad in Australia at the University of Melbourne. “I could tell my scoliosis was getting worse,” Alexandra says. “I decided that if I was going to need the surgery, then I wanted to do it early in my summer break to give me the best chance of going to Australia the following spring.”

Alexandra and her parents drove from their home in Williamsburg to meet Dr. Cardelia at CHKD’s Health and Surgery Center at Oyster Point in Newport News to discuss her treatment options. “The MRI revealed a 53-degree curve in her spine, well over the 40-degree measurement that can indicate a need for surgery,“ said Dr. Cardelia. “Spinal fusion involves straightening the spine by attaching a rod to the vertebrae with screws and fusing the vertebrae together, but her osteogenesis imperfecta was a complicating factor” says Dr. Cardelia. “We had to make sure Alexandra’s vertebrae were strong enough to handle the screws that hold the bars in place.”

CHKD’s spine team performs an average of 85 scoliosis surgeries a year. In more complex cases like Alexandra’s, an orthopedic surgeon and a neurosurgeon who understand the interdependency between the bones and nerves of the spine work together in the operating room to achieve the best possible outcome for the patient. Dr. Cardelia and Dr. John Birknes, a pediatric neurosurgeon at CHKD, would team up for Alexandra’s operation.

Using an MRI, Dr. Cardelia and Dr. Birknes were able to identify which vertebrae were dense enough to withstand the pressure of the procedure. “The images of her spine were very encouraging. We were able to see that she had good bone strength at key points,” says Dr. Birknes. “This would allow us to get the best possible results for Alexandra.”

Alexandra’s surgery was scheduled for June, which would allow her to return to school in the fall and study in Australia in the spring.

During the six-hour operation, Drs. Cardelia and Birknes placed the corrective rods along her spine to straighten it, fusing select vertebrae in place. The rods extend approximately two-thirds of the way down Alexandra’s back, stopping at her midsection to preserve the natural flexibility of her waist. A five-day hospital stay at CHKD and two-month recovery period at home followed. “The first month was challenging,” says Alexandra, whose rehabilitation included stretching, bending and a gradual increase in her walking distances. With the goal of returning to college in the fall, Alexandra made steady progress. “At the end of the second month, I had no pain at all,” she says.

By August, Dr. Cardelia had cleared Alexandra for physical activity, encouraging her to work out on the treadmill, elliptical and bike. When it was time to return to Princeton for her fall semester, Alexandra was ready to stand up to her next challenge – the curriculum of her chemical engineering major.

“Everything went smoothly, and I’m so glad I had the surgery when I did,” says Alexandra, who left in February as planned to study in Australia. “This was an important investment in my health for the future.”

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