Myths About Scoliosis: Causes & Treatment

Myths About Scoliosis: Causes & Treatment

What is Scoliosis?
Scoliosis is a progressive condition that causes the spine to curve into an “S” or “C” shape. It affects approximately two to three percent of school-aged children and is most common in girls ages 10-15. There are several different types of scoliosis, but the most common is adolescent idiopathic scoliosis (AIS).

Causes and Risk Factors
Idiopathic means that the cause is unknown. Research has proven that scoliosis has a genetic component and tends to run in families. Children with a family history of scoliosis are more at risk, especially those aged 10-15. Girls tend to be diagnosed with scoliosis more than boys, and the condition is not limited to a specific ethnicity or race. Groundbreaking research at Scottish Rite for Children is working to determine the cause of scoliosis, better understand factors that lead to curve progression, explore ways to prevent curve progression and improve treatments.

In congenital scoliosis, the cause is known. For example, a child may be born with a misshapen vertebra, one of the building blocks of the spine. Interestingly, recent research has also shown that congenital scoliosis may be partially genetic as well. Finally, a scoliosis curve may also develop from an underlying neurological disorder, known as neuromuscular scoliosis.

Dispelling the Myths
When it comes to scoliosis, it is important to know facts versus fiction. Below we correct some of the myths about scoliosis:

  •  Slouching, bad posture, sleeping position, or carrying heavy books, backpacks or purses will NOT cause scoliosis.
  • A lack of calcium will NOT cause scoliosis.
  • Scoliosis is NOT the result of doing anything “wrong,” and there’s NO way to prevent it.
  • Scoliosis does NOT cause severe or disabling pain in children.
  • Scoliosis CANNOT be prevented by exercise or by sitting up straight.
  • Scoliosis CAN continue into adulthood but is very treatable with bracing, physical therapy and/or surgery.
  • Surgery is NOT the only treatment available.
  • Chiropractic adjustments do NOT treat scoliosis.

Early Treatment is the Key
Early screening and intervention are key to successful scoliosis treatment. It is important that your child is screened by a health professional for scoliosis annually so that any abnormalities can be identified quickly. Screening involves looking at the spine via physical examination for asymmetry of the shoulders, shoulder blades and hips. A parent, school nurse or friend may notice a small difference in the shape of your child’s back or you might notice that clothes begin to fit differently.  Depending on where the curve is located in the spine, when you look in a mirror, you may see that one shoulder is raised or that “one hip is higher than the other.” In most schools, girls are screened in school at age 10 and again at age 12, while boys are screened once at age 13 or 14. If your child appears to have scoliosis during a screening, you will be notified and sometimes referred to an orthopedic specialist. If the specialist confirms true scoliosis, then the sooner treatment is begun, the need for surgery may be able to be avoided.

Bracing to Prevent Surgery
In less severe cases of scoliosis, surgery can altogether be avoided with the use of an orthotic brace. Braces are highly effective in treating scoliosis, but only if they are worn properly and according to the doctor’s guidelines. At Scottish Rite, all scoliosis braces are made on-site in our Orthotics & Prosthetics lab. This allows us to make same-day adjustments for fit or comfort. Wearing a brace diligently can prevent the progression of the curve, reducing the need or risk for surgery.

Each scoliosis brace that we make includes two dime-sized temperature sensors that track wear time. One is for our record keeping and can be tracked with each visit. The other is a Bluetooth sensor that can be connected to the parent and patient’s cell phone app. Created by Scottish Rite experts, the Brace Rite app uses real-time data, allowing parents, patients and your doctor to monitor wear time to ensure your child stays on track.

Physical Therapy to Prevent Progression
While scoliosis cannot be prevented, certain physical therapy techniques can be used to treat the condition and may prevent further progression. Scottish Rite has physical therapists that are trained and certified in the Schroth Method, a scoliosis-specific exercise approach. The Schroth Method focuses on correction of the curve pattern through a combination of stretching, strengthening and breathing in reverse directions, all based on each patient’s unique spinal curve. Using the Schroth Method can stop the progression of the curve, improve mobility and promote proper posture.

My Child Needs Surgery – Now What?
Not all cases of scoliosis can be treated without surgery. In significant curves of 45 to 50 degrees or more, surgery may be the best treatment option. There are several surgical techniques used to treat scoliosis, but the most common is spinal fusion. In a spinal fusion, the curved vertebrae are fused together to create a single, solid bone. This stops the growth in the abnormal part of the spine and prevents the curve from worsening. Metal rods attached by screws, hooks and/or wires are used to hold the spine in place until the bone heals. In all spinal fusions, a bone graft is used to help promote the fusion and the bones grow together to create one solid bone. Once a spinal fusion has been performed, patients can usually return to their normal activities within three to four months. However, each case is unique and some timelines may differ. At Scottish Rite, our Sarah M. and Charles E. Seay/Martha and Pat Beard Center for Excellence in Spine employs six pediatric orthopedic surgeons who specialize in spinal surgery for scoliosis using the latest innovative techniques and treatment methods.

Learn more about the importance of scoliosis screening.

Share Your Story: Standing Tall

Share Your Story: Standing Tall

Meet Finn, a patient who is seen by our scoliosis and spine experts. Learn more about his journey below. Blog written by Finn.   I was diagnosed with scoliosis years ago. My curve was minor, and I would go to Scottish Rite for Children every six months for checkups. When I was about 10 years old, the curve started to worsen. Scottish Rite made me a back brace, which I would wear when sleeping, to try and prevent the curve from getting worse. My back didn’t cooperate with the brace. I think it’s because the scoliosis suddenly started curving my spine really fast. In less than a year, my curve grew about 20 degrees worse. I knew something wasn’t right. Breathing was getting harder, and I was easily tired. At my next checkup my fears were right, I found out I needed surgery to fix the curve. I also have a condition called osteogenesis imperfecta (OI), which causes me to have brittle bones. Because of this, everything felt extra scary. Would my bones be strong enough? Would I be able to do the things I love doing? So many questions. I think I was in shock.
On the day I found out that I was going to need surgery, Dr. Brooks spent lots of time talking with my family. And then a psychologist. And then child life. Several more team members came to meet us after that. Honestly, it was a fog by the time we left, but my high fear level was much better. The team members were all so positive and that made it easier to wrap my head around what was next. Because of the OI, we needed to make my bones as strong as possible before surgery, so I had an infusion to help with that.
A man wearing a shirt that says #belieber talks to a girl

My back continued to curve at a very fast rate, so my original surgery date was moved up. I was scared, but I really wanted the surgery to be over with. And sure enough, less than three months after finding out that I needed surgery, it was done. Looking back, the waiting was hard, but everything went really fast. I had lots of appointments to get ready for surgery, making sure everything was planned out. 

For me, making sure my true identity was understood, was another very important part. I am a transgender 13-year-old boy. I have a really hard time when I am misgendered. Getting my preferred gender and name to be used has been a battle at other places. Making sure my identity was honored was a priority for me and was a priority for the team at Scottish Rite. It’s hard enough being in the hospital without being misgendered.

The entire team was focused on making me as comfortable as possible, in every way possible.

Dr. Brooks told me I would be up and walking the day of my surgery or the very next morning. And I was! He also told me I would most likely stay for three nights, but I was able to go home after only two nights. Before my surgery, I went to sleep shorter than my mom and I woke up from surgery taller than her! Dr. Brooks told me I would be mostly recovered in three months and totally recovered in six months. I’m four months post surgery and almost completely recovered! Pretty soon I will be able to do everything I did before surgery. I’m already taller than I had been, and my lungs feel free to breathe. I also no longer have a scoliosis curve!  

DO YOU HAVE A STORY? WE WANT TO HEAR IT! SHARE YOUR STORY WITH US.

At the Forefront of Innovation: Spinal Surgery at Scottish Rite for Children

At the Forefront of Innovation: Spinal Surgery at Scottish Rite for Children

Hearing that your child needs spinal surgery for scoliosis brings a flood of questions and a lot of uncertainty. Using the newest technology and innovative methods, the experts at Scottish Rite for Children are some of the best pediatric orthopedic surgeons in the world. Our leaders support your child throughout treatment, making their spinal surgery a success from start to finish.

We provide a multidisciplinary, patient-centered approach to scoliosis treatment. Spinal maturity; the degree, extent and location of the curve; and the potential for progression are all considered when determining treatment.

Types of Scoliosis

  •  Adolescent idiopathic scoliosis (AIS) –  the most common form of scoliosis that occurs in children ages 10 to 18
  • Congenital scoliosis –  scoliosis that is present at birth and is due the intra-uterine formation of abnormally shaped/formed vertebrae
  • Early-onset scoliosis – scoliosis that occurs before the age of 9
  • Neuromuscular scoliosis –  secondary scoliosis that develops because of an underlying medical condition that adversely affects the brain, nerves, or muscles
  • Syndromic Scoliosis: An underlying genetic syndrome that causes the scoliosis

Additionally, scoliosis can be categorized by the following:

  • Thoracic scoliosis –  curve in the middle, or thoracic, part of the spine
  • Lumbar scoliosis – curve in the lower, or lumbar, part of the spine
  • Thoracolumbar scoliosis – curve in both the spine’s lower thoracic and upper lumbar parts

When Surgery is Needed for Scoliosis

Depending on the child and the severity of their curve, surgery may be the best treatment option. While not all cases of scoliosis require surgery, the following factors are an indication that surgery is needed:

  • Your curve is greater than 50 degrees, and/or
  • You have significant growth remaining
  • Your curve progressed to 50 degrees despite compliance with brace wear
  • You have a underlying neuromuscular or syndromic condition.

The most common type of surgery performed for scoliosis is a spinal fusion. In a spinal fusion, the curved vertebrae are fused together to create a single, solid bone. This stops the growth in the abnormal part of the spine and prevents the curve from worsening. Metal rods attached by screws, hooks or wires are used to hold the spine in place until the bone heals. In all spinal fusions, a bone graft is used to help promote the fusion and the bones grow together to create one solid bone.

Having Spinal Surgery at Scottish Rite

Led by Daniel J. Sucato, M.D., M.S., our Center for Excellence in Spine employs six pediatric orthopedic surgeons who specialize in spinal surgery for scoliosis. Our diverse team of surgeons works together to create individualized treatment plans for each patient and ensure that the child and the family know what to expect each step of the way. Multiple departments work together to provide a multidisciplinary approach to care and treatment. Orthopedics, Psychology, Physical Therapy and more will address all your child and their needs to ensure they are prepared for surgery. Our psychologists help our patients cope with having surgery and address their feelings about their procedure, giving children the opportunity to express their emotions. Following surgery, our team works with your child to make recovery as easy as possible.

Tackling the Most Complex Cases

New and innovative techniques allow our experts to tackle the most difficult cases.  This includes Magnetic Expanded Growth Rods (MCGR), Halo Gravity Traction (HGT), Vertebral Body Tethering (VBT), and Posterior Spinal Fusion (PSF). Our experts have experience treating complex cases, such as treating patients with a curve of over 100 degrees.

Road to Recovery

Following surgery, our team begins the recovery process with the patient. Using different pain management techniques. Our physicians are dedicated to seeing each patient through their recovery.

After a spinal fusion, it is common to need to minimize bending or heavy lifting. Our surgeons will go over limitations and discuss the importance of proper aftercare. Our team works with each patient to determine readiness to return to activities and coaches them through the recovery process.

How to Learn More and Become a Patient

Learn more about our Center for Excellence in Spine and scoliosis treatment.

Learn how to and how to make an appointment with one of our world-renowned experts.

Share Your Story: A Family Affair

Share Your Story: A Family Affair

Meet Anna and Ellen, patients seen by our multidisciplinary team of experts. Learn more about their journey below.

Blog written by Anna and Ellen’s mom, Keeley.  

When our daughter Anna was 5 years old, she started telling us that her left arm felt funny and not right, so we took her to be seen at our local hospital in Oxfordshire, England. She had X-rays taken, and we were told all was well, so we continued on with our life. Our family was in the middle of packing and preparing for a move, a less-stressful life on the Isle of Man just off the U.K. mainland.

After being in our new home about four weeks, one day Anna came home from school really upset, saying that her arm was in a lot of pain. I immediately took her to another doctor to have it re-examined. I could tell this doctor was concerned, and he instantly referred us to see another specialist the very next day. At that appointment, our lives were changed forever.

We learned the devastating news that Anna’s X-rays actually showed a very large tumor, from her left shoulder down to her elbow. He advised us to move straight back to Oxfordshire, so she could be under the care of an oncology team. After a whirlwind couple of weeks, we were back in Oxfordshire, and Anna started her very long journey of chemotherapy and other treatments for her Osteosarcoma bone cancer.

patient sitting on a chair

In May 2017, on her 6th birthday, she had a surgery to remove the tumor. The cancerous humerus bone was taken out and replaced with the fibula from her right leg. Many months of rehabilitation followed, but by May 2018, Anna was in remission. Unfortunately, this was short lived, and by December, she once again had that “funny” feeling in her left shoulder. Investigative scans confirmed a recurrence.

Further surgery and many more months of chemo followed. It was devastating telling her she had to go through it all again, and lose her beautiful new hair. But Anna is a real fighter and a true inspiration to all. She persevered through treatment to make it back into remission for the second time.

Her father and I researched every possible option to try and keep this beast at bay. In August 2019, she was accepted onto a clinical trial at Memorial Sloan Kettering Cancer Center in New York. Our wonderful friends and small community of Chipping Norton in England rallied together. A Team Anna fundraising campaign took off, and many celebrities, pop stars and kind-hearted generous people joined in to help raise the huge amount of funding needed to get Anna to New York. By January 2020, we had made it, and Anna was able to start the treatment.

Just as we were about to leave for New York, life threw us another challenge. Our 13-year-old daughter Ellen was diagnosed with scoliosis and needed spinal fusion surgery. It was very difficult to come to terms with another one of our children having medical problems. The NHS doctors in the U.K. were unable to treat it within the necessary timescales. Even if we could somehow have managed to have the surgery done privately in the U.K., our family would have been separated for many months while my husband and I both took care of the girls, in different countries.

mirror selfie
Having Ellen’s spinal surgery done in New York wasn’t an option due to the huge costs involved. We were at a complete loss about what to do.

Once we arrived in New York, we serendipitously crossed paths with a wonderful woman, who just so happened to be a nurse at Scottish Rite for Children. We began talking, and before we knew it, Ellen had an appointment with Dr. Sucato. Our family was taking a road trip to Texas.

Ellen had a consultation with Dr. Sucato, and we scheduled her spinal fusion surgery. His entire team was wonderful, and we couldn’t actually believe all of this was happening! She underwent successful surgery in July 2020, and with the support of Dr. Sucato and his fabulous team, she is doing great.

Just as we were due to return home to England, we had another unbelievable turn of events. Anna had a fall at a swimming pool and broke right through the new bone in her arm. Another terrifying ordeal, but yet again, Scottish Rite came to our rescue. Anna was able to be seen by Dr. Oishi. She underwent surgery, where metal plates and brackets were inserted into her arm, and the blood supply was stimulated. Anna was also able to talk through things with Dr. Herge in psychology. Both Dr. Oishi and Dr. Herge are incredible members of Scottish Rite’s formidable team, and we are incredibly thankful for them!

 

At every turn, our entire family felt like we were being taken care of. Each and every person we interacted with at Scottish Rite genuinely cares and only wants what is best for the patient.

Following a period of rehab and checkups, our family was able to return home to England with two very healthy, strong and happy daughters. It was amazing to be back under one roof with our oldest daughter, who had stayed in England this entire time. Words cannot express how eternally grateful, thankful and overwhelmed we are with the care, kindness and support we have received. Thank you Scottish Rite. You’re the best!

DO YOU HAVE A STORY? WE WANT TO HEAR IT! SHARE YOUR STORY WITH US.

Detecting and Treating Scoliosis

Detecting and Treating Scoliosis

Content included below was previously presented at the 2021 Pediatric Orthopedic Education Symposium by pediatric orthopedic surgeon Megan E. Johnson, M.D.

People hear the term scoliosis often, but they may not know what it means. Pediatric orthopedic surgeon Megan E. Johnson, M.D., walked through each phase of detecting and treating scoliosis in a recent lecture. This summary provides health care professionals with a succinct summary and language to navigate the steps and conversations with patients presenting with suspected scoliosis.

Watch the full lecture or download this summary

Defining scoliosis
Scoliosis is a structural lateral rotated curvature of the spine. For a condition to qualify as scoliosis, the Cobb angle, or the measurement of the degree of side-to-side spinal curvature, must be a minimum of 10 degrees. If the Cobb angle is less than 10 degrees, it is considered a spinal asymmetry, not scoliosis.

What are the types of scoliosis? 

  • Idiopathic scoliosis: The most common type of scoliosis. Idiopathic means that all other causes of scoliosis have been ruled out.
  • Congenital scoliosis: When vertebral malformations cause a curvature of the spine. The vertebrae weren’t formed correctly or haven’t separated from the other surrounding vertebrae correctly.
  • Neuromuscular and syndromic scoliosis: Occurs in patients with underlying neurologic disorders like cerebral palsy, spina bifida and other genetic conditions.

What age is scoliosis diagnosed?
Scoliosis may be diagnosed at any age, but earlier recognition often improves treatment options and outcomes. A patient’s age also helps to define the type of scoliosis that they may have.

  • Infantile idiopathic scoliosis: patient is between 0 and 3 years old at the time of diagnosis.
  • Juvenile idiopathic scoliosis: patient is between 4 and 9 years old at the time of diagnosis.
  • Adolescent idiopathic scoliosis: patient is 10 years or older at the time of diagnosis.

The most common type is adolescent idiopathic scoliosis (AIS). The patient’s curve typically goes to the right and can include either the thoracic or lumbar spine or both.

What history and physical exam findings are important with scoliosis?
In order to evaluate patients, it is important to learn if patients have had back pain, headaches, other neurologic symptoms or a family history of scoliosis. For girls, it is also necessary to know their menstrual history to gauge where they are in their growth cycle.

The physical exam is focused on identifying asymmetries in static posture. This includes:

  • Differences in shoulder height.
  • Scapular asymmetry – scapulae are at different heights or one is more retracted.
  • Pelvic obliquity – iliac crests are at different heights.
  • Trunk shift – drawing an imaginary line from the patient’s head to their waist and seeing if the head is centered over their waist.
  • Waist asymmetry – a visible bulge (typically on left) on the convex side of a lumbar curve, and crease on the concave side of the curve.

Special test
A very common test for scoliosis that most people are familiar with is the Adams forward bend test. Patients bend forward at the waist, and the examiner looks for signs of rotational deformities. Curves in the coronal plane cause rotation in the axial plane, which are visible in the Adams test. For example, a left midline lumbar prominence and the prominence of the right ribs are evident with a right thoracic curve.

Neurologic exam
A thorough neurologic exam assesses for asymmetries and changes in sensation, reflexes and motor function in the trunk and lower extremities. The patellar tendon, the Achilles tendon and the abdomen are tested to look for symmetry in reflexes. Being hyper-reflexive is fine when it is present on both sides. If there are reflexes on one side and not the other, it is an abnormal finding. Foot abnormalities, like a cavovarus foot or a significant flat foot on just one side, may indicate an underlying neurologic concern.

What radiologic imaging is used to diagnose scoliosis?
Plain film radiology (X-rays)
X-rays are essential to assess the patient’s scoliosis. Full-length X-rays of the spine, including the pelvis and the top parts of the hips and femurs, will give physicians all the information that they need to determine what the curve looks like, how big the curves are and how much growth the patient has left. Full-length X-rays are necessary for final diagnosis and treatment planning. Scottish Rite for Children uses advanced imaging technology called EOS, which utilizes a very-low-dose radiation for efficient and effective full-length images. To avoid unnecessarily repeating X-rays, images are not required for referrals for suspected scoliosis.

Advanced imaging
An MRI is indicated with these findings:

  • Curve abnormalities like a left-sided curve, a back that is rounder than expected or an abnormal appearing curve.
  • Short and sharp curves and kyphosis are red flags requiring further evaluation with an MRI.
  • Abnormal neurologic exam or other neurologic symptoms, like daily headaches.
  • Significant progression in the patient’s curve between follow-up appointments.

What factors are considered in planning treatment for scoliosis?
The goal of scoliosis treatment is to keep the spinal curve(s) as small as possible and prevent progression to surgery. The following are considered:

  • Age of the patient.
  • How skeletally mature they are.
  • Size of the scoliosis curve(s).

Bracing
Bracing is recommended for patients with curves between 20-25 and 40 degrees if they have at least two years of growth remaining. Thoracic lumbar sacral orthosis (TLSO) braces are worn 18 to 20 hours a day and are typically used for curves in the thoracic spine or both the thoracic and lumbar spine. If the patient only has a lumbar curve that is flexible, nighttime bracing may be recommended.

Surgery
Surgery is recommended when the patient’s curve has a Cobb angle of 50 degrees or more to prevent the curve from progressing into adulthood. Surgery is generally not recommended until the patient is at least 10 years old because if the fusion is done too early, the growth of the patient’s spine can cause some secondary issues.

When should a patient with suspected scoliosis see a pediatric orthopedic specialist?
Patients should be referred to Scottish Rite for Children:

  • If they have a scoliosis curve and are still skeletally immature.
  • If they are fully grown with a significant deformity that is visible in the clinical exam.
  • If they have a scoliosis curve with an abnormal neurological exam, chronic back pain, daily headaches, an asymmetric foot deformity or any other unusual symptoms.

Many patients evaluated at Scottish Rite for Children do not have scoliosis, but our team provides reassurance and recommendations for monitoring over time. Annual or six-month observation visits are indicated for some patients since curves change as the patient grows.

Are you interested in learning more? Visit our on-demand page for more educational opportunities including scoliosis and orthopedic topics.

Luke’s Journey: Not Missing a Beat Through Scoliosis Treatment

Luke’s Journey: Not Missing a Beat Through Scoliosis Treatment

Cover story previously published in Rite Up, 2021 – Issue 1.

by Hayley Hair

The rhythm, the tempo, and the heartbeat — all fitting descriptors for the function of a band’s percussion section, but using an even more compelling name like the backbone depicts their role more succinctly. Just like a spine, all those sharp pops of the quad drums, the satisfying crashes of the cymbals, and the low, palpable rumbles of the bass drums provide stability, support, flexibility, and movement to the ensemble. No one knows this juxtaposition more personally than Luke, the McKinney North High School bass drum percussionist and Scottish Rite for Children patient cared for by our scoliosis experts.

Plenty can be learned about adolescent idiopathic scoliosis (AIS) by following Luke’s journey. AIS, or scoliosis with an unknown cause starting after age 10, makes the spine curve or twist into a “C” or “S” shape. Luke’s personal experience covers the broad spectrum of how the progressive condition is diagnosed, observed, and expertly managed with an individualized treatment plan.

“Luke’s pediatrician identified the minor curvature of his spine and uneven shoulders at his 9-year-old well visit,” Luke’s mom, Christy, says about the outset. “The pediatrician immediately referred us to Scottish Rite, and the initial plan was to monitor Luke every six months to identify any changes that may occur.”

Scoliosis Observation and Expertise 
Luke and Christy’s first visit at Scottish Rite for Children was with Amy L. McIntosh, M.D., medical director of clinical safety and a pediatric orthopedic surgeon. “I think that’s one of the greatest things about Scottish Rite — we have so many treatment options for scoliosis,” McIntosh says about the expertise and exceptional care the institution offers.

Clinical observation might not seem like much of an active plan at first, but consistent monitoring of the child’s growth is key. Catching any progression in spine curvature is crucial for effectively managing scoliosis. Christy, a registered nurse, is the coordinator of health services for McKinney Independent School District, which serves more than 23,000 students in North Texas. She has experience with AIS through her work with state-mandated scoliosis screenings in school as well as training other health professionals about the condition, so McIntosh and Christy are on the same page about early detection. “Scoliosis screening is very important.” McIntosh says. “Catching a curve early, when it is small, is the most important factor when it relates to brace treatment success.”

A Brace Just for Luke 
As Luke continued to grow, unfortunately, so did his curve. McIntosh first prescribed a Providence brace, or a nighttime brace made for smaller curves, for Luke to wear while he slept that would help to slow his curve progression. “I thought it would just go away like a sickness, like braces for your teeth,” Luke says.

His new brace, along with all of Scottish Rite patients’ braces, is custom-made for his curve. “The coolest thing about our bracing program is that the orthotists work at Scottish Rite, and they make all the braces in-house,” McIntosh says. “If you are going to wear a brace, it might as well work really well for you.”

And during each patient’s clinic visit, the multidisciplinary care team specific to the child’s condition is nearby. “We have the orthotists with us, the nursing team, physicians, the physical and occupational therapists — everybody’s ready on hand in the clinic to provide the best comprehensive care for each patient,” Chief of Staff Daniel J. Sucato, M.D., M.S., says. As director of the Sarah M. and Charles E. Seay/Martha and Pat Beard Center for Excellence in Spine Research, Sucato leads an institution-wide team that focuses on researching the cause and behavior of scoliosis in children and adolescents and controlling and correcting curve progression with innovative treatments.

More Hours in the Brace
As Luke kept growing, again, so did his curve. McIntosh had more in her arsenal and upped his support to a custom thoracolumbosacral orthosis (TLSO) brace. Made for wear under clothing day and night, the TLSO brace wraps around the upper body from under the arms to the pelvic bone. Luke’s curve affected both the upper, or thoracic, and the lower, or lumbar, regions, creating a twisted “S” shape.

Patients, like Luke, wear their braces for 18 to 24 months for many hours a day. That timing is determined by the age at presentation, the curve magnitude, and how much growth remains. “Currently, the brace is the only treatment that has been scientifically proven to prevent the progression of scoliosis to a surgical magnitude,” McIntosh says.

Correcting Scoliosis with Surgery
“He wore his brace until the ninth grade, and he was so compliant,” Christy says. “He even tried to wear the brace while he was in marching band while carrying  the bass drum, but he couldn’t. It was too much, so  he started taking it off for band.”

Luke literally and metaphorically carries the beat on his back while he zigs and zags across the football field holding his enormous bass drum. Fastened to a frame that hooks over both shoulders, the drum weighs more than 20 pounds and juts out far enough to move when the wind blows. Luke loves to be a part of the drumline, and when asked if he plans to continue studying music in college, he replies, “100 percent.” Some of his best friends are in the band. “It’s a great way to meet people, and I’ve made close friends that will probably last quite  a while,” Luke says.

Luke wore his brace up to 22 hours a day, but his curve kept progressing. When his curve grew to more than 50 degrees, surgical correction was recommended. Luke experienced some discomfort and breathing difficulty as well. “When it was really bad, like after band practice, after marching out there with my drum for a while, it just hurt,” Luke says. “I tried to get Luke’s spine through it as best as I could, X-ray before surgery but sometimes I’d have to sit out and do stretches. It wasn’t bad to the point where I couldn’t do anything, but it was just constant.”

Getting ready for surgery, Luke looked to McIntosh to explain the next steps. “She gave me a 3-D model of what the surgery would look like on my back,” Luke says. “I got to play with it and bend it to see the difference between a normal back and a back with spinal fusion. It made me feel better.”

Luke had a posterior spinal fusion with instrumentation and bone grafting, the most common scoliosis surgical procedure. By attaching rods to the spinal column and then grafting bone to the affected area, the spinal curve is corrected and encouraged to fuse to prevent further curve progression. Following surgery, the fused section is no longer flexible.

Recovery takes several months for patients to get back to their desired activities, and it takes up to a year for the spinal fusion to fully heal. During Luke’s recovery, the drumline and their teacher, Michael Reed, brought a huge card signed by everyone with well wishes during a visit to his house.

After years of wearing a brace and surgery, Luke has advice for others going through bracing and surgery for scoliosis. “If they are going through bracing, I’d tell them to wear their brace as much as possible to try to avoid the surgery,” Luke says. “If they are about to get into the surgery, don’t worry about it too much. They are professionals, and they know what they are doing.”

Luke gained a few inches in height and has no more pain following surgical correction. “It is a lot easier to do stuff with my back like this,” Luke says. Even though there are reminders each day about his spinal fusion, he says he wouldn’t change a thing about his treatment at Scottish Rite for Children. “You are in the best hands,” he says. “They know exactly what to do.”

Read the full issue.