Price Transparency
Standing Tall After Spinal Fusion Surgery

Standing Tall After Spinal Fusion Surgery

by | Jun 27, 2024 | Scoliosis & Spine

Previously published in Rite Up, 2024 – Issue 2.

In January of 2023, Delilah, a 12-year-old from San Antonio, was helping her mother, Angie, clean the house. As Delilah bent over to pick up something off the floor, Angie noticed that her backbone protruded from her back at an abnormal angle. “It caught me off guard,” Angie says. She called her husband into the room and asked Delilah to repeat the movement. He looked at Angie with wide eyes and said, “What was that?”

Delilah’s pediatrician suspected scoliosis and referred the family to an orthopedic physician.

“After taking an X-ray, he gave us the news that her spine was at an 84 degree angle,” Angie says. “Delilah and I had tears in our eyes.” Angie explained that because of the curves magnitude, the physician said that he would feel more comfortable recommending them to Scottish Rite for Children. “We had never heard of Scottish Rite, but it was the best advice and decision we ever made,” Angie says.

At Scottish Rite, pediatric orthopedic surgeon Megan E Johnson, M.D., diagnosed Delilah with adolescent idiopathic scoliosis, of which there is no known cause. Because her curve had surpassed the surgical magnitude of 50 degrees, Dr. Johnson recommended posterior spinal fusion, a surgery in which a rod is secured to the vertebrae to straighten the spine and hold the correction of the curve in place.

“Scoliosis progresses more rapidly when kids are undergoing their big growth spurt,” Dr. Johnson says.

“Delilah still had a lot of growth left, so she was at a greater risk of progression.”

Before surgery, Delilah asked thoughtful questions and expressed some worries. “I had a fear of like, what if I wake up during surgery?” she says. “And, what if it doesn’t turn out right, or what if they miss something?” Dr. Johnson marveled at Delilah’s maturity. “For being 11 at the time, Delilah asked great questions, advocated for herself and did her own research,” she says.

In October, the family traveled to Dallas for Delilah’s surgery and stayed at the Ronald McDonald House of Dallas, Scottish Rite’s community partner. “They took such good care of my family,” Angie says. “I’m very grateful for that.” After a successful surgery, Delilah’s curve was corrected from 95 to 20 degrees. She also got two inches taller. “Delilah exceeded our expectations,” Dr. Johnson says. “She has been a champ through it all.” Six months later, Angie cannot believe that Delilah had spinal surgery. “It boggles the mind because she’s back to being herself,” she says. “For us, Scottish Rite means hope, that everything is going to be OK.” Delilah agrees. “You can trust Scottish Rite,” she says, “and know that you are in great hands.”

Read the full issue.

Scoliosis Awareness Month: Wearing Your Scoliosis Brace

Scoliosis Awareness Month: Wearing Your Scoliosis Brace

by | Jun 21, 2024 | Scoliosis & Spine

At Scottish Rite for Children, our spine experts care for the common to the complex of scoliosis curves. The type of treatment required for the condition depends on the child, when they were diagnosed and the severity of the curve.

One treatment option for scoliosis is bracing. At Scottish Rite, our in-house Orthotics department creates custom braces – making sure it fits the child just right. Here are a few basics to know about the scoliosis brace:

  • The purpose of a brace is to help stop the curve from getting worse with a goal of preventing the patient from needing surgery.
  • Although it does not cure the condition, if used on a curve that ranges from 25 to 40 degrees and the child is still growing, it can be extremely effective.
  • Your doctor will determine the number of hours the brace should be worn throughout the day.
  • If the brace is uncomfortable, our team works with the patient to make adjustments as needed throughout treatment.

Different Types of Braces:

  • TLSO (thoracolumbosacral orthosis) – used for curves located in the mid to lower part of the back
  • Providence Brace– also known as the nighttime brace, used for curves that are less severe.

Being Active While Wearing Your Brace:

  • Our team encourages a child who must wear a brace to continue with their sport and/or activity.
  • Bracing for this condition is only temporary, and although adjustments might need to be made to make the brace more comfortable, etc., it is created to fit the child so they can continue being active.

Taking Care of Your Skin
The brace pushes firmly on your body and will cause redness of your skin. Over time the skin in the pressure areas may become darkened and tougher. These changes are temporary and may improve brace comfort. If you develop a sore, your brace needs adjustment.

Clothing Suggestions

  • We recommend you wear a form fitting tank top under the brace. It is more comfortable when there is something between you and the brace.
  • Loose-fitting clothing will hide the brace better than form-fitting clothing.
  • Bras without underwire may be more comfortable.
  • To make using the bathroom easier while wearing the brace, wear your underwear over the brace.

Taking Care of the Brace
To help prevent skin irritation, the inside of the brace must be cleaned at least once a week, or more often as needed. Use a cloth to wipe the brace clean using soap and water or rubbing alcohol.

Learn more about scoliosis bracing.

Scoliosis Awareness Month: What is Scoliosis?

Scoliosis Awareness Month: What is Scoliosis?

by | Jun 11, 2024 | Scoliosis & Spine

What is it?
Scoliosis is not a disease. It is an abnormal curvature of the spine. In addition to the spine curving sideways, it also twists, making the ribs (which are attached to the spine) look uneven. This may cause a prominence or a “bump” on the back. Other signs include a shoulder or hip that looks higher than the other or the chest may appear uneven. Scoliosis is usually a painless condition. Children with scoliosis are no more likely than kids without scoliosis to have back pain.

The diagnosis of scoliosis is confirmed by taking an X‐ray of the spine. If a curve measures more than 10 degrees, it is called scoliosis.

Who has it?
Scoliosis usually occurs in early adolescence and becomes more noticeable during a growth spurt. Approximately 0.5 percent of young people develop scoliosis that requires treatment. Girls have scoliosis eight times more often than boys. Sometimes scoliosis can be found in several family members, for several generations.

Why does it happen?
There are several different types of scoliosis that affect children.

Idiopathic Scoliosis
The most common type of scoliosis is idiopathic, which means the exact cause is not known. Idiopathic scoliosis can occur in infants, toddlers and young children, but the majority of cases occur from age 10 to the time a child is fully grown. Scoliosis tends to run in families. It is not a disease that is caught from someone else like a cold. There is nothing you could have done to prevent it. It is not caused by carrying heavy books, backpacks or purses, slouching, sleeping wrong or from a lack of calcium.

Congenital scoliosis
Congenital means that you are born with the condition. Congenital scoliosis starts at the spine forms very early in pregnancy. Part of one or more of the vertebra does not form completely, or the vertebra does not separate properly. Other abnormalities may also be present such as ribs may be missing or there can be ribs that are fused together. This type of scoliosis can be associated with other health issues including heart and kidney problems.

Neuromuscular scoliosis
Any medical condition that affects the muscles and the nerves can lead to scoliosis and this is known as neuromuscular scoliosis. This is most commonly due to muscle imbalance and/or weakness. Examples of neuromuscular conditions that can lead to scoliosis include cerebral palsy, spina bifida and muscular dystrophy.

How is it found?
Finding scoliosis is easy when the back is examined closely but it can be missed if someone isn’t looking for it. Parents or friends might notice the curve, but most curves are found through a school screening program or by a pediatrician. A trained examiner can detect even a slight curve when a person bends over to touch her or his toes. If a curve is suspected, a referral is often made to an orthopedic doctor. Print this PDF.

What may be noticed on someone who has scoliosis:

  1. One shoulder may be higher than the other.
  2. One scapula (shoulder blade) may be higher or more prominent than the other.
  3. When the arms hang loosely at the side of the body, there may be more space between the arm and the body on one side.
  4. One hip may appear to be higher than the other.
  5. The head may not be centered exactly over the pelvis.
  6. The waist may be flattened on one side; skin creases may be present on one side of the waist.

What are the types of curves?
Curves occur in the spine between the neck and the pelvis. They are named depending on their location. The most common type is in the upper back (thoracic) and tends to curve to the right. Other curves are in the lower (lumbar) spine. Many children have both types of curves.

How are curves treated?
Treatment depends on how big the curve is when it’s detected and how much growth is left. Curves can worsen during the major growth spurts. Curves less than 20 degrees may not need any treatment except to be checked by the doctor from time to time until the child has stopped growing.

If a child is still growing and the curve is greater than 20 degrees, the doctor might recommend wearing a brace. Bracing will not correct a curve. The goal of bracing is to help prevent the curve from getting worse during growth. Braces must be worn as prescribed by the doctor during the growing years in order to be effective. After growth is completed or if the curve does not respond to bracing, the brace is no longer worn.

If a curve is advanced, the doctor may suggest an operation to correct the scoliosis. Allowing a large curve to progress could interfere with heart and lung function in later years. The most common type of operation is called posterior spinal instrumentation and fusion. Instrumentation refers to metal rods and screws that are attached to the spine to hold it in the corrected position. Fusion refers to the bone graft that is placed along the spine making the vertebrae one solid piece.

Learn more about the importance of scoliosis screening.

A Parent’s and Patient’s Perspective on Scoliosis – Allison’s Amazing Journey

A Parent’s and Patient’s Perspective on Scoliosis – Allison’s Amazing Journey

by | Jun 7, 2024 | Scoliosis & Spine

Lisa, mom of Allison, shares what it was like for her daughter Allison to be treated at Scottish for Children for scoliosis:
 
What brought you guys to Scottish Rite?
Allison was 8 years old when we went to her pediatrician for back pain she had recently been experiencing. At her appointment, the doctor noticed a curve in her spine and diagnosed her with scoliosis. After confirming her condition with an X-ray, Allison was referred to Scottish Rite for Children by her doctor. We were also told by others to go to Scottish Rite for the best care possible. From the moment we walked in the front doors, the sense of peace we felt was so overwhelming. We knew our decision to come to Scottish Rite was the right one!
 
What was your experience like with Dr. Ramo and the Scottish Rite staff?
The compassion Dr. Ramo, his nurse Marivel and his entire team showed us is something we will never forget. As parents who were very concerned about this diagnosis, Dr. Ramo explained everything thoroughly. He answered all our questions and addressed our concerns, which made us feel very confident in the treatment and surgery plan for Allison. With her very young age and significant curve, her treatment plan was to insert MAGEC® growing rods which would be lengthened every six months to allow for more growth before her spinal fusion. With Dr. Ramo’s expertise and knowledge, we knew we would get through this.

Do you have any advice for parents whose children have recently been diagnosed with scoliosis? 
Remember that as worried as you might be for your child, your child is scared and worried, too. Encourage them to write down or ask questions they may have about their treatment plan and surgery. Dr. Ramo would always ask Allison if she had any questions for him. He would answer every question looking directly at her, so she understood. Him taking the extra time to do all of this made her feel better and settled her fears. 
 
What’s it like to see Allison where she is today? 
Seeing Allison where she is today fills us with such gratitude. The doctors at Scottish Rite are unmatched in their skills. God has given them their knowledge and expertise in their chosen field and helps them perform miracles every day. We feel blessed to have been a part of these miracles. 

What do you want people to know about Allison’s accomplishments?
We are so proud of Allison’s accomplishments. She has been on the honor roll since she first started school. She recently graduated high school as a member of the National Honor Society, AP Ambassadors, and she was enrolled in Dual Credit and On Ramps classes. Because of her high academic achievement, she has qualified for automatic acceptance to the University of Texas at Austin and Texas A & M. She has also been accepted to SMU, UNT, Baylor and TCU. She recently made her decision to commit to TCU to further her academic career by majoring in marketing. She is excited to experience college life living in the dorm and meeting new friends. 
We are also proud of her involvement with the Peer Support program at Scottish Rite. She has talked on the phone and on FaceTime with other patients – walking them through the process of scoliosis surgery. She has said, “If I can help someone else by answering their questions in hopes of making them feel better and easing their fears, than every minute I’m on the phone with them is worth it. Hopefully, they can see and hear that I did it, and they can too!”
 
Is there anything you want to say to Dr. Ramo and his team?
We are eternally grateful to Dr. Ramo and his team. They are like family to us. We recently returned to Scottish Rite to see Dr. Ramo for her final follow up. Walking through those doors again felt like coming home! Marivel changed her schedule to be there when we came just so she could see Allison and catch up on her progress! What a great visit we all had! Scottish Rite will always hold a special place in our hearts! 
 
Allison, a former patient treated by Brandon A. Ramo, M.D., for scoliosis, shares her experience at Scottish Rite and what other kids should know:
 
Tell us about your journey with scoliosis and Scottish Rite for Children.
My journey with scoliosis and Scottish Rite for Children started when I was in second grade after I began to experience severe back pain. Even though I was very young, I knew that something was wrong. My parents took me to Scottish Rite, and I had growing rods put in to straighten my spine. About every six months, I would have my growing rods lengthened as my torso grew. When I was in fourth grade, I had my final spinal fusion. In the beginning, I was very scared about my situation since there were so many uncertainties. Scottish Rite for Children helped me tremendously through everything by having phenomenal staff who supported me through my journey. I felt comfortable throughout the entire process, which made my journey a lot easier and helped me through my fears. 
 
What would you tell other kids about Scottish Rite?
I would tell other kids that Scottish Rite is the best hospital and has some of the best people you will ever meet. No matter what you are going through, they will be there to support you in any way possible and help you have an easier experience. There are fun things to do that give you things to look forward to when you go. You will meet staff who are the most compassionate and caring people you have ever met. Overall, Scottish Rite is an amazing place with outstanding people and resources. 
 
What is your advice to other kids who have been diagnosed with scoliosis?
I would advise other kids who have been diagnosed with scoliosis to not be afraid. I was very afraid when I was first diagnosed, but my fears were eased when I realized what amazing people would be taking care of me and helping me through my situation. It may seem scary at first, but trust me, it will become a lot less scary. Remember that you have people supporting you and wishing the best for you! 
 
What is your favorite thing about or favorite memory of Scottish Rite?
One of my favorite things about Scottish Rite was the dogs that visit you every week in the Inpatient Unit. I can remember how excited I was to pet the dogs, especially since I never had a dog. I was amazed that the dogs were so intelligent. Many of them knew all kinds of tricks, and one of them could even tell you it’s age. This was a memorable experience for me since I was really scared of having surgery, and having the dogs visit me helped me calm down and feel better about the situation. 
 
What are your plans after high school graduation?
After high school graduation, I am going to be attending college at TCU and majoring in marketing. I am really excited for my new home as a frog, and I am ready to get the education I need to make a difference with my future career. I am also looking forward to living on campus and making new friends. I am thrilled to be able to further my academic career at college. 
 
Some patients with scoliosis are worried surgery will cause them back pain when they get older. Can you share a little about your experience?
In my experience, my back pain became significantly better after I had surgery. Before I had surgery, I would get random episodes of extreme back pain. As I have gotten older and since I have had surgery, I have little to no back pain. The surgery for me was life changing in terms of pain. I can sit and stand for long periods of time, which I wasn’t able to do before. Now, I don’t even think about my back anymore in my daily life since it doesn’t really hurt anymore. 
 
Is there anything you would want to say to Dr. Ramo and his team?
I would want to tell Dr. Ramo, Marivel and his entire team thank you for everything you have done for me. They did an exceptional job treating me and helping me through my scoliosis journey. There are not enough words to describe how thankful I am for the team and how they supported me. They were always there for me and answered all my questions regarding my scoliosis. I always felt at ease at Scottish Rite because of my confidence in Dr. Ramo and his team and their outstanding skills and capabilities.
 
Learn more about our expert scoliosis care and our Center for Excellence in Spine.
 

DO YOU HAVE A STORY? WE WANT TO HEAR IT! SHARE YOUR STORY WITH US.
Let’s Be More Specific About “Non-Specific” Back Pain

Let’s Be More Specific About “Non-Specific” Back Pain

by | May 28, 2024 | Scoliosis & Spine

This article was originally published in a 2021 newsletter for the Pediatric Society of Greater Dallas. Written by physical medicine & rehabilitation physician Jason R. Petrasic, M.D., FAAPMR

Watch Petrasic give a lecture on this topic a Navigating Back Pain in Adolescents.  It should be no surprise that prevalence numbers for back pain in adolescence steadily increase with age and are nearly identical to that of the adult population by the age of 18. However, young patients and their parents are often surprised when formal evaluations of their insidious onset back pain symptoms yield unremarkable results. Then comes the common “diagnosis” that seemingly no one wants to hear: non-specific back pain. However, arguably this is not a diagnosis at all. The term suggests to the patient that there is no identifiable cause of their symptom. As a patient, or a parent, I want to be able to attribute the symptoms I’m feeling to a diagnosis and know there is an available treatment for my diagnosis. Furthermore, I want to know the underlying cause of my symptom or diagnosis so that I can potentially try to prevent its recurrence in the future. Clearly there are countless cases where a vague symptom or complex of symptoms is not associated with any obvious underlying diagnosis, but my suggestion is that adolescent non-specific back pain is more often a diagnosis of myofascial pain syndrome.
 
Pain is a subjective symptom, and, therefore, is influenced by a multitude of factors including actual tissue injury, previous experiences, mental health disorders, sleep quality, and central processing of pain signals. All of these can influence the intensity and duration of pain experienced from any underlying cause. In the absence of identifiable tissue injury, consider the possibility of unidentifiable tissue injury (i.e., at the cellular level) like the concept of delayed onset muscle soreness (DOMS) which is the typical muscle soreness, or pain, suffered after an intense bout of exercise in individuals not acclimated to such workouts. There may be a source of pain that is not a result of obvious structural injury and is not observable on currently available imaging modalities, nor is there a routinely used lab study to identify or screen for it. However, there may be a source of stress and tension on the supportive spine muscle(s) in a growing skeleton with disproportionally lower muscle strength, muscle endurance, and flexibility (or any combination of the three) involving key muscles that when the stress exceeds the back’s ability to support it the affected area becomes painfully symptomatic. This is most typical of myofascial pain syndrome where the problem lies at the muscle cellular level. Insidious onset neck, upper, or lower back pain are the most common presenting complaints with symptoms usually being described as intermittent and exacerbated by prolonged sitting and/or standing/walking. Rest or lying down often alleviates symptoms. Common exam findings include full range of motion of the affected area with or without tenderness to palpation, and bilaterally or asymmetrically tight hamstrings (best tested by checking popliteal angles with patient examined in the supine position with ipsilateral hip flexed to 90deg) and/or hip flexor muscles (best tested by performing the Thomas test).

Watch Petrasic demonstrate a thoracolumbar exam in an adolescent.

It is still key to consider more serious structural problems with the spine elements or muscles (or with other adjacent organ systems) when a thorough history, physical examination, and available lab or imaging studies suggests them, but when it is believed or confirmed that those problems are absent or much less likely, then myofascial pain syndrome should be more strongly entertained. This type of diagnosis offers both a long-term treatment, but often more importantly it also offers reassurance that something more serious is not developing or lingering. It should also be noted that myofascial pain syndrome can affect an adolescent competitive athlete seemingly just as easily as their more sedentary counterparts. Physical activities or competitive sports do not necessarily equate to adequate resistance training and stretching as is often assumed, especially in active, growing adolescents. Often kids involved in athletics put even more demand on their “core” and supporting musculature further exacerbating the deficit. A well-rounded, consistently, and persistently performed home exercise program is key to treating this problem along with emphasizing continued exercise and physical activity, and in some cases arranging for supplemental guidance by a physical therapist knowledgeable in spine/back care can help to optimize and accelerate recovery of more constant or severe symptoms.

Comfort level in diagnosing musculoskeletal conditions can often be understandably uneasy when musculoskeletal complaints are being fielded by primary care providers or specialists in other unassociated fields of practice. Myofascial pain syndrome is merely being suggested as a potentially likely benign diagnosis for an otherwise very common complaint that offers improved clarity to families and may help limit anxiety about what may be going missed or undiagnosed.

Learn more about Spondylolysis: A Common Cause of Back Pain in Young Athletes.

Scoliosis Physical Therapy for Stronger, Straighter Spines

Scoliosis Physical Therapy for Stronger, Straighter Spines

by | Jan 2, 2024 | Scoliosis & Spine

If your child has scoliosis, chances are you’ve already discussed many treatment options with a pediatric spine specialist. The specialist may have recommended a “wait and see” approach to determine whether your child’s curve gets worse or stays the same. You may have learned about braces and casts to keep the spine straight, and you’ve likely researched surgeries that can correct the condition. One option you may not have considered is scoliosis physical therapy. 

This specialized form of physical therapy allows kids and their families to be actively involved in their treatment by addressing muscle and posture issues that can develop due to scoliosis. 

How Physical Therapy Helps Kids With Scoliosis 

Scoliosis is an abnormal curvature of the spine. In children with the condition, the spine may twist or be shaped like a C or an S rather than straight. You might notice your that your child has uneven hips or shoulders, but the condition does not always cause symptoms. When it does, children may complain of back pain, difficulty breathing and shoulder pain. 

With scoliosis physical therapy, children work with specially trained therapists to learn scoliosis-specific exercises that correct posture and retrain muscles. These programs help slow or prevent the progression of a spinal curve and may counteract the effects a curved spine can have on the body. Physical therapy can also reduce pain and improve breathing.

Exercises your child learns may focus on improving:

·       Functional movement, so your child can go about their daily activities

·       Range of motion, as kids with scoliosis may have limited mobility 

·       Strength in the muscles surrounding the spine, hips, shoulders, head and lower body

The Schroth Method 

There are a few different scoliosis physical therapy programs that have been developed. At Scottish Rite for Children, several of our physical therapists have completed specialized training in one type, known as the Schroth method. 

Physical therapists use this method to teach children exercises and breathing techniques that strengthen muscles throughout their bodies. The intent is to improve their posture and ability to perform typical daily activities, such as sitting, standing, lying down and walking. 

During these sessions, physical therapists often have children stand in front of mirrors so they can see how scoliosis affects their posture and movement. The therapist asks the child to breathe in specific patterns or tighten his or her muscles to elongate and stabilize the spine. Sessions can last 45 to 60 minutes, and children can continue the exercises at home between sessions.

Schroth exercises help treat another spine condition many adolescents develop — kyphosis. This spinal disorder happens when a curve causes rounding in the upper back. 

Planning a Physical Therapy Program for Your Child 

Many websites offer exercise tips for people with scoliosis, but working with a dedicated physical therapist helps ensure your child performs exercises specific to their needs.

Before the sessions begin, your child will have an evaluation with a pediatric spine specialist, who can determine the type of scoliosis your child has and the magnitude of the spinal curve. 

The physical therapist uses this information to determine which exercises your child needs and teaches him or her the correct way to do each exercise. As your child improves, the therapist will adapt the program to ensure your child gets the most benefit.

The amount of time your child needs scoliosis physical therapy depends on his or her diagnosis. Even after your child completes the recommended number of sessions, the therapist may provide instructions for a home exercise program to relieve symptoms and prevent the spinal curve from worsening.

Combining the Schroth Method With Traditional Physical Therapy

Traditional physical therapy focuses on the side-to-side curve of the spine. Schroth exercises address this issue from a three-dimensional perspective, straightening the spine from back to front and side to side and correcting spinal twisting. 

For this reason, a scoliosis specialist may combine traditional physical therapy with the Schroth method as they work with your child. 

Scoliosis Care Beyond Physical Therapy 

Some children do well with physical therapy alone. Typically, however, a child will have physical therapy along with wearing a scoliosis brace. 

For some kids, more care is needed. Children with spinal curves greater than 50 degrees often require surgery. Children whose curves have worsened despite wearing a brace may need surgery as well. 

Still, children who need surgery may benefit from a scoliosis physical therapy program. Physical therapy can help regain movement and muscle strength as they recover.

Like any form of exercise, physical therapy has many benefits. While it can’t cure or “fix” your child’s curve, physical therapy strengthens your child’s muscles and helps him or her better manage scoliosis, which can make a big difference in everyday life. 

The scoliosis team at Scottish Rite for Children has years of experience treating children with varying degrees of scoliosis. For more information about physical therapy for scoliosis, schedule an appointment to discuss scoliosis care.