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    A. Noelle Larson, M.D.

    BUILDING BETTER to reshape tomorrow.

    Perfecting pediatric scoliosis treatments that preserve motion

    A. Noelle Larson, M.D.

    Pediatric Orthopedic Surgeon, Professor, Department of Orthopedic Surgery

    Rochester, Minnesota

    It's a more rigorous training, more rigorous way of living, but once I had done my rotation in it, everyone could see that this is what I needed to do. My ultimate goal would be for children to be able to be children and not have to worry about their scoliosis, but I just don't want it to be their identity. I go in there with my full attention and I love it. I absolutely feel like it's my calling, and to work in a community of other surgeons and investigators that all share this mindset is really an honor.

    I am certain that there are better treatments out there. And it is my life’s work to find them.”

    When it comes to pioneering new pediatric scoliosis treatments, Dr. A. Noelle Larson and her team share the same philosophy: “We’re not looking for baby steps; we’re looking for leaps forward.” Advancing innovative procedures so that children can leap, jump, and grow into healthy adults is Dr. Larson’s work and her passion.

    Dr. Larson is a pediatric orthopedic surgeon at Mayo Clinic in Rochester, Minnesota. She is also a professor of orthopedic surgery specializing in scoliosis and pediatric spine conditions. But what truly sets her apart is her dogged determination not to let scoliosis define her patients. “That’s why I stay late after work to conduct my FDA studies and travel around the country to meet with other surgeons,” she says. “I am certain that there are better treatments out there. And it is my life’s work to find them,” she adds.

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    When she came to Mayo Clinic in 2011, Dr. Larson realized there was essentially one option for severe scoliosis: spinal fusion surgery. “We had temporary devices such as growing rods to get the child through their school-age years. Once old enough, they would receive a spinal fusion,” she says. Spinal fusion involves affixing screws and rods to the spine and holding it in a more correct, rigid position. One side effect of spinal fusion surgery is children can lose a significant range of motion. In addition, recovery can be long and uncomfortable.

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    “Coming into this field, I realized what we were doing in 2012 was similar to what we were doing in 1975,” she says. She knew a better way was possible. It was then she read about a promising procedure called vertebral body tethering. In 2015, Dr. Larson visited the few hospitals performing the procedure and brought the technique to Mayo Clinic. “We performed our first vertebral tethering procedure in 2015. At that point, it was so cutting-edge that the FDA had not yet approved it. We were taking screws and a cord used to fuse the back of the spine and actually putting them in the front part of the spine.”

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    Rather than one long incision in the back, vertebral body tethering involves making small incisions in the side, and instead of 20 screws and two rods, the surgeon uses one screw in each vertebra connected by a flexible cord, pulling the spine into a straighter position. Also, the spine isn’t locked down because it’s a plastic cord instead of rigid metal rods, allowing it to grow with the child. This approach offers much more freedom of movement and reduces recovery time. And as the child continues to grow, the spine may straighten even more. Dr. Larson adds, “It’s a much smaller procedure that preserves function.”

    And preserving function is what drives Dr. Larson. “At the end of the day,” she says, “the question is, ‘what are we trying to achieve?’ From a surgical standpoint, we care a lot about the X-rays; how straight the spine is. But if it was my back and my life, maybe I don’t care so much what my X-ray looks like. Maybe I care more about how I feel, whether my back moves, and if I can return to the activities I enjoy, like dancing, tennis, gymnastics, or rock climbing. If these are my passions, maybe I’m willing to accept a little less correction to maintain that function.”

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    Every day surgeons go to work and make a hundred life-changing decisions. This can develop a rather black-and-white personality. I still see the world in a lot of gray.”

    Dr. Larson takes the time to have an in-depth conversation with each patient and family to ensure she addresses their needs, concerns, and fears. “Every day surgeons go to work and make a hundred life-changing decisions. This can develop a rather black-and-white personality. I still see the world in a lot of gray,” she says. “My patients often ask me, ‘Dr. Larson, what would you do?’ And if they ask that, I’ll tell them. I’m all for honesty and transparency. I try to lay out every single treatment option and let them make the best decision for them.”

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    Mayo Clinic is synonymous with cutting-edge innovative treatments. But empathy is at the center of being a physician at Mayo Clinic. “In 2018, I attended a scoliosis support group convention. I spent the weekend with over a hundred parents and their daughters, listening to their experiences as scoliosis patients. It truly changed the way I interact with patients in clinic, every single day. Part of our role as physicians is to have empathy. To spend time thinking about what it’s like to walk in the patient’s shoes and wear a scoliosis brace. Or to have to take medications or get a special excuse to be pulled out of a gym class. I try to imagine what that feels like. And how do we make that experience better?” she says.

    Dr. Larson says becoming a pediatric orthopedist is truly a calling. “Once I had done my rotation in it, I knew that this is what I needed to do. When I face adversity or a challenge, it’s so much less than what other people are going through. Seeing a child in clinic who will soon be an adult and hopefully go out into the world and maybe someday teach my children or be my doctor? It’s truly an honor,” she says.

    If we’re doing the same thing in 10 years we’ve failed. Because we know there are better ways to care for children.”
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    As for the future, Dr. Larson has high expectations. In addition to vertebral tethering, she is studying the manipulation of the growth plate. “A lot of these conditions start with growth plate problems that cause the spine to deform. If we figure out how to fix the growth plate in the spine, we could correct a lot of these problems without needing screws and plates and metal,” she says. “If we’re doing the same thing in 10 years we’ve failed. Because we know there are better ways to care for children.”

    And when looking to the future, Dr. Larson is not hesitant to veer off the beaten path, “I’m not afraid to be wrong,” she says. “I’m able to ask why are we treating patients in this way? Why aren’t there other promising treatment options out there?” Because Dr. Larson knows the path forward isn’t always just a relentless search for answers. Sometimes the greatest leaps come by simply asking better questions.

    A. Noelle Larson, M.D.

    Dr. A. Noelle Larson is a pediatric orthopedic surgeon who helps children with spinal conditions such as scoliosis. Her team uses innovative techniques such as low-dose imaging and intraoperative computer-guided navigation to provide better options for pediatric patients. Dr. Larson is a leading expert who is renowned for using new approaches to scoliosis surgery that preserve spinal motion and growth. She is also leading efforts to develop tools to help families understand the risks and benefits of new surgical techniques, so they can make informed decisions when deciding which approach is best for their child.

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    What is vertebral body tethering?

    A cutting-edge surgical option for growing children with moderate to severe scoliosis, and certain spinal curve types.

    Learn more about vertebral body tethering
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    What is scoliosis?

    Scoliosis is a sideways curvature of the spine that most often is diagnosed in adolescents. Most cases of scoliosis are mild, but some curves worsen as children grow.

    Learn more about scoliosis
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    Scoliosis treatment

    Mayo Clinic Children’s Center has a comprehensive spine deformity treatment program with state-of-the-art spinal care for children from birth to adulthood.

    Learn more about scoliosis treatment

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