Michelle Welborn, M.D., Awarded Diane Ruth Abramson Shriners Children’s Professorship

Two years ago, Michelle Welborn, M.D., the chief of spine surgery at Shriners Children’s Portland, reported on a collagen marker that eventually could allow surgeons to better recognize when a patient with scoliosis should discontinue bracing treatment.

Now, because of this work, which she has been pursuing for about seven years, Dr. Welborn has been awarded a newly-endowed professorship to continue pursuing this potentially significant clinical work. Funded by a generous donor, the Diane Ruth Abramson Shriners Children’s Professorship lasts for five years and comes with an annual award that will allow her to continue her important research.

Growth Biomarker Discovered

Dr. Welborn’s research has shown that collagen X biomarker is a better indicator of skeletal maturity than the commonly used Risser score or Sanders stage. This likely will have implications for the treatment of scoliosis patients with growth modulation techniques and bracing.

The timing of scoliosis bracing can be tricky, particularly knowing when to stop the treatment. Bracing has been shown to arrest or slow the progression of some forms of scoliosis when the child is growing. But, once growth has stopped, the child no longer gets any spine-straightening benefit from the brace, and the braces can be uncomfortable and can cause emotional distress and sleep disturbance.

The way most patients are treated now, doctors direct the patient to stop wearing the brace when their assessment indicates the patient has no growth left. Unfortunately, because this determination is based on an uncertain clinical assessment, some patients are made to wear their brace six months longer than necessary to assure they have actually stopped growing and exhausted their potential.

Others may be stopped too early.

Potential for Personalized Care

Up to one in four patients whose Sanders stage would indicate they have stopped growing experience some progression of their scoliosis when they stop wearing their brace. It is not clear why. Is it because of the imprecision in the clinical assessment, and they actually do have some growth remaining? Or is it because their particular scoliosis was not being improved?

“We don’t know if in those kids whose curve worsened, it was because they were still growing or if their curve relaxed once it was out of a brace. This collagen biomarker has the potential to help clarify that,” Dr. Welborn said.

The financial support of the professorship will allow Dr. Welborn to continue to study the collagen X biomarker and delve into these questions.

“A collagen biomarker has the potential to change how we do things,” Dr. Welborn said. “Currently, when we treat scoliosis patients using existing measures of skeletal maturity, we are treating them based on the average individual. But, as our biomarker is patient specific, it could allow us to stop treating the average person, and start treating the individual.”

Diane Ruth Abramson Gift

The Diane Ruth Abramson Shriners Children’s Professorship is named for the late Diane Abramson, who generously left a gift to Shriners Children’s, designated for research in her estate.

"Dr. Welborn is really one of our most impressive and innovative physician scientists, and we're proud to support her in any way we can," said Mark Lalande, Ph.D., vice president of research at Shriners Children's, about the awarding of the professorship to Dr. Welborn.