The Spine Center in the Division of Pediatric Orthopaedic Surgery at UPMC Children’s Hospital of Pittsburgh, provides a comprehensive array care and services full the full spectrum of spinal conditions and disorders – common and rare – in pediatric patients.
This includes evaluations and multimodal treatment approaches, including surgical (operative) and nonsurgical (nonoperative) management options for complex congenital and early onset scoliosis, and adolescent idiopathic scoliosis and Scheuermann’s kyphosis.
Additionally, the Spine Center treats patients with other complex spinal deformities, including spinal stenosis, disc herniations and slipped intravertebral discs, and spondylolisthesis. The Spine Center also collaborates with several multidisciplinary clinics at UPMC Children’s related to neuromuscular and other syndromic conditions, notably the Cerebral Palsy clinic, Spasticity clinic, Muscular Dystrophy Clinic, rare metabolic diseases clinic and the Pediatric Spina Bifida Program.
Leading the clinical and research efforts of the Spine Center at UPMC Children’s are co-director Stephen Mendelson, MD, director of the Pediatric Orthopaedic Surgery Fellowship Program at UPMC Children’s and the University of Pittsburgh School of Medicine and co-director Ozgur Dede, MD, associate professor of Orthopaedic Surgery, who took over the role of Division Chief in September 2024. Both have a particular interest in caring for children with neuromuscular conditions.
“We see a wide variety of spinal deformities in children at our Spine Center. Some only require monitoring or nonoperative care, such as casts, bracing, or physical therapy, whereas others dictate the use of operative techniques and combination approaches. Our goal is to provide the full range of nonsurgical and surgical care options that are tailored to each patient’s unique clinical situation,” says Dr. Mendelson.
A Multidisciplinary Clinic Model
Clinical care for patients begins with a comprehensive assessment, including imaging, physical evaluation, and a comprehensive review. The Spine Center employs EOS imaging technology, which delivers high-resolution, low-radiation, full-body imaging and supports both two- and three-dimensional spinal assessments to aid in in the diagnosis and development of care plans
The clinic also collaborates with partners at UPMC Children’s, including orthotic specialists, physical therapists, and regularly works with colleagues in neurology, physiatry, and pulmonology based on the patients underlying condition and needs.
“Having all of these capabilities at UPMC Children’s allows us to streamline care, particularly in complex cases, where we can collaborate with other specialties based on what our patient needs to achieve comprehensive care and optimal outcomes,” says Dr. Mendelson.
When Surgical Intervention Becomes a Necessity in Idiopathic Scoliosis
In cases of idiopathic scoliosis, surgical options are typically considered when the patients spinal curvature reaches a threshold where future complications are expected. For idiopathic scoliosis, this is often around 50 degrees of curvature. Beyond this level of curvature, there is a likelihood of progression leading to pain, postural imbalance, cosmetic concerns, and in some cases, pulmonary or gastrointestinal issues.
“We start thinking about surgery when the deformity is predicted to lead to cascading problems in the future, even if the patient is asymptomatic at the time of diagnosis,” says Dr. Mendelson. “Complications often include chronic pain, impaired pulmonary function, or, in neuromuscular cases, difficulties with feeding, hygiene, and positioning. Our goal is to reserve our surgical options for the cases that make the most sense clinically.”
Operative Techniques and Intraoperative Technology
Most surgical corrections for scoliosis involve posterior spinal fusion, but other approaches are used when appropriate. The Spine Center employs several advanced technologies to enhance safety and precision during surgery.
This includes intraoperative three-dimensional navigation for implant placement, real-time neuromonitoring to track motor and sensory nerve function, and enhanced anesthetic protocols developed in collaboration with Pediatric Anesthesia.
“We use multimodal intraoperative strategies that improve safety and outcomes,” says Dr. Mendelson. “Navigation and neuromonitoring are particularly valuable in complex cases where the anatomy is distorted or atypical.”
Surgical planning for complex deformities may include 3D-printed spine models, created in partnership with UPMC’s biomedical engineering resources.
Collaboration
Our orthopaedic spine surgeons collaborate with UPMC Children’s neurological surgeons in complex cases, as well as with physical medicine and rehabilitation and neurology specialistsfor children with neurological disorders to provide comprehensive care to children with spinal cord injury, spasticity, and severe spinal deformities. Current collaborative efforts include the multidisciplinary clinics at UPMC Children’s for spina bifida, cerebral palsy, spasticity, and muscular dystrophy.
Postoperative Management and Multimodal Pain Control Strategies
The Spine Center follows contemporary pain management protocols centered on multimodal analgesia, limiting opioid use. UPMC Children’s is also a site for a large-scale study of spinal anesthesia techniques led by the Department of Anesthesiology.
“Our approach now is to use multiple agents in smaller doses to manage pain more effectively while minimizing side effects,” says Dr. Mendelson.
Postoperative follow-up is adjusted based on the child’s skeletal maturity and deformity severity. Patients entering peak growth phases are monitored more closely to assess the risk of further progression.
Motion-Preserving Technologies
One of the field’s most active areas of investigation involves exploring alternatives to spinal fusion. The Spine Center team, including Dr. Mendelson and Dr. Dede, are certified to perform vertebral body tethering (VBT), a growth-modulating technique that allows continued motion at the affected spine segments.
“Tethering is an interesting technique with some promise, but the data on long-term outcomes are still emerging,” says Dr. Mendelson. “We are conservative in adopting new procedures broadly until we are confident they are safe, effective, and durable.”
Research Projects
The Spine Center also functions as a platform for embedded clinical research. Patients routinely contribute to longitudinal studies by completing validated outcome measures and participating in follow-up protocols that enable data-driven evaluation of long-term treatment impact.
One of the long-term studies led by the spine center was initiated by the former Division chief and spine surgeon Timothy Ward, MD. Our team at the spine center is following patients who chose nonoperative treatment for idiopathic scoliosis into adulthood in an effort to better understand the natural history of these spinal deformities and enable better treatment recommendations for patients and their families.
The Spine Center is also part of several multicenter registries and studies, including the HARMS Study Group, a subgroup within HARMS called Setting Scoliosis Straight. Another of national and international research projects the Spine Center is currently involved in is the Pediatric Spine Study Group.
Other research projects and questions the Spine Center is working to answer are optimizing and decreasing the risk of perioperative complications in children with scoliosis. The overall goal is to improve the safety of spinal surgery and optimize the outcomes in children with spinal deformity.
“We’re also looking into the safety of pedicle screw placement, the role of intraoperative navigation, and radiation-free technologies for intraoperative navigation to spare the patient and care team from excessive amounts of ionizing radiation, which is particularly important in very young children who may be more susceptible to its off-target effects,” says Dr. Dede.
As a whole, the Spine Center serves as both an exemplary clinical care program and research engine tackling the full spectrum of child and adolescent spinal conditions. The Spine Center’s ability to follow patients over many years is helping to refine treatment strategies and better define long-term outcomes.
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