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Scoliosis Awareness Month: Casting for Scoliosis

Scoliosis Awareness Month: Casting for Scoliosis

by | Jun 27, 2018 | Scoliosis & Spine

Casting is a form of treatment for scoliosis and is used to prevent the curve from getting larger when children are young and growing rapidly. The cast works like a brace to control curve progression, but cannot be removed. Casts can be used when doctors are unable to control curve progression with a brace. As with a brace, when the cast is removed, the curve will still be present. Our goal is to keep the curve from getting larger.

Your child will be admitted to the hospital the day before or on the morning of each cast application. Your child will be given general anesthesia and will be asleep in the casting room before the doctor applies the cast. Gentle traction is used to correct the scoliosis curve as much as possible. The doctor applies a T-shirt liner and soft padding to protect the skin before the cast is applied. The cast will have holes (or “windows”) to allow the stomach to expand for eating and to allow plenty of room for breathing.

Your child will be able to go home either the same day the cast is applied or the day after. This cast may have an impact on your child’s balance and walking. Close supervision is important to prevent injuries from falls. Your child will adjust to the cast in a few days.

It is important for the cast to remain dry. If your child wears diapers, you will have to tuck the diaper under the cast at the hips. Your child will not be able to take a regular bath or shower while wearing a scoliosis cast. You will have to sponge-bathe your child during this time, as water will ruin the cast and can damage your child’s skin under the cast. Because of your child’s rapid growth, the cast will have to be changed every two to three months for up to one year. 

How to care for your child’s scoliosis cast:

  • Keep the cast as clean and dry as possible at all times to prevent skin breakdown and damage to the cast.
  • Give your child a sponge bath daily and wash all areas of skin not under the cast. Never give a bath or shower in the cast.
  • If itching is a problem you may use a hair dryer on cool setting to blow into the cast. You can also use distractions, such as games, music, reading, video games or counting to distract your child.
  • Never put anything in the cast to scratch the skin, as this can cause a sore or infection. You can pull the T-shirt liner up and down to relieve itching.
  • Never use powder inside the cast, as it may clump and irritate the skin. Do not use oil or lotion under or around the edges of the cast.
  • Never permit a child around a pool with a cast on or allow him/her to ride in a boat.
  • Do not allow your child to play in sand or dirt.
  • It is OK to draw on your child’s cast or put stickers on it. Be creative. Have fun with the cast.
  • You will be given a cast care book before you go home. The nurse will give you further instructions and waterproof tape and moleskin for cast edges to use at home as needed.

Call Scottish Rite Hospital:

  • If the cast is too tight.
  • If your child has decreased movement or sensation (tingling) in arms or legs.
  • If you notice skin breakdown.
  • If the cast cracks or breaks.
  • If you notice the cast position has changed.
  • If you notice a foul odor (beyond body odor). This can indicate a wound under the cast.
  • If an object (such as a toy, rocks, fork, etc.) gets into the cast and cannot be removed. This can cause a pressure wound under the cast.
  • If the cast is causing pain.
#SRHaccess Facebook LIVE Recap: Scoliosis FAQs

#SRHaccess Facebook LIVE Recap: Scoliosis FAQs

by | Jun 22, 2018 | Scoliosis & Spine

In honor of Scoliosis Awareness Month, clinical manager Jennifer Bowden, R.N., joined us on Facebook LIVE to discuss the most frequently asked questions about scoliosis. Below is a recap of the conversation.

Watch the live segment. 

What is the difference between an ambulatory care and inpatient nurse?

  • An ambulatory care nurse, also known as clinic nurse, is the nurse a patient will see when he or she has a clinic visit.
  • An inpatient nurse takes care of the patient once out of surgery.

At an initial appointment for scoliosis, what can a patient expect? 

  • The patient is seen by their doctor and clinic nurse. They could also be evaluated by a physician’s assistant or fellow/resident.
  • If the patient does not have X-rays on file, it is possible that they may be sent to radiology to have those taken.
  • The doctor will complete a clinical exam to check for scoliosis.
  • Depending on the outcome of the clinical exam, X-rays are checked if there are concerns regarding a potential curve in the back.
  • The doctor will give the patient a time frame of when he or she needs to come back for another visit.

Scoliosis Surgery 
Who do the parents contact if they have questions about surgery?

  • Clinic nurse
  • Families are encouraged to call with any questions they may have at any time.
  • Our staff encourage parents/patients to write down any and all questions.

While a patient is in surgery, where does the parent/guardian wait?

  • Patient will be assigned a room on the inpatient unit – parents can wait in that room.
  • Surgery waiting area is on the 4th floor – quiet and away from hustle and bustle
  • Cafeteria – on the C level by the A elevators
  • While the patient is in surgery, the parent/guardian must stay inside the hospital at all times.
  • Each parent/guardian is given a pager to be notified/updated regarding the progress of the surgery.

Most common updates during surgery

  • It takes about an hour to get the patient prepped before surgery actually begins.
  • The parent/guardian is updated when the surgery actually begins.
  • Updates come every one to two hours
  • Parents are notified when the patient is being closed up.
  • When the surgery is complete, the surgeon will call and speak to the parent.

What does the admission process for spine surgery look like?

  • Most spine patients check into the hospital the day before surgery.
  • Labs and X-rays are taken, if needed
  • Clinical photos are taken so that the patient can remember what he or she looked like before the surgery.
  • The patient and their family are able to meet their care team:
    • Inpatient nurse
    • If needed, a child life specialist and physical/occupational therapist
    • OR nurse
    • Anesthesiologist

What happens after surgery?

  • The patient will be in recovery (PACU) for half an hour to an hour or longer.
  • Once the patient is awake and the breathing tube is removed, the parents are called to see their child in recovery.
  • Parents are escorted to the patient’s room and the recovery nurse will take the patient to their room.
  • Recovery nurse will give the inpatient nurse a report on the child.

Who is the patient seeing after surgery?

  • Inpatient nurse
  • Patient care techs
  • Doctors
  • Residents and fellows

Pain management after surgery

  • Education on pain takes place before surgery
  • Really sore and still after surgery – the nurse teaches the patient how to assess their pain

Will the patient wake up during surgery?

  • No, the patient is fully asleep during surgery.
  • Anesthesia is given to the patient to keep them asleep
  • The patient’s spinal cord wil be monitored throughout the duration of the surgery.

Movement after surgery

  • Physical or occupational therapy can be part of the process after surgery, if needed.
  • Nurses help patients get out of bed.
  • The nurse will teach the patient how to roll over, prop themselves up and turn over.
  • The care taker at home will also be taught how to help the patient get out of bed and move around safely.

Going home after surgery

  • Pain is under control
  • Incision looks good
  • Patient is up and moving
  • Eating and drinking – no vomiting
  • Bowel movement in the hospital – biggest problem after this surgery is constipation and gut issues

The drive home from the hospital: Is there a certain set up needed in the car? 

  • Every patient is different
  • Take pain medication close to when departing the hospital
  • Most patients like to recline in the car seat versus sitting up straight.
  • The nurse will help the patient down to the car and will make sure they are safely situated inside the car.
  • Every hour to two hours, we recommend the patient to get up and move/change positions.

Specific bed set up at home

  • No restrictions on the bed setup at home
  • If the bed is upstairs, recommend sleeping somewhere downstairs
  • No hospital bed is necessary
  • Some patients like being in a recliner, instead of lying flat

Incision care

  • Nurses educate parent/guardian on how to change the dressing covering the incision.
  • No creams or lotions on the incision until told by your doctor.
  • A nurse will provide the parent with supplies to change the dressing.
  • No soaking the incision, showers only – do not want the incision under water because it could cause an infection
  • After shower, remove the dressing, pat area dry and then apply a new dressing

Will the patient have a scar from surgery?

  • Yes, a long and thin scar down the middle of their back.
  • If well taken care of, it will flatten out and look like a faint pencil mark down the middle of the patient’s back.
  • For at least two years after surgery, it is recommended that the scar be covered with sunscreen or a shirt when out in the sun.
Adolescent Idiopathic Scoliosis

Adolescent Idiopathic Scoliosis

by | Jun 18, 2018 | Scoliosis & Spine

Article originally published by staff orthopedist Amy L. McIntosh, M.D., in first quarter, 2018 issue of Pediatric Society of Greater Dallas newsletter. 
What is scoliosis?
Scoliosis is a rotation in the spinal column that creates a “C”-shaped single curve or an “S”-shaped double curve, when viewed from behind (Figure 1). Some cases worsen with time and can result in serious problems such as abnormal appearance in posture, increasing back pain as one ages, and in the worst cases, interference with heart and lung function. Idiopathic (no underlying cause) scoliosis occurs in 2 to 3% of the adolescent population, usually affecting young people between the ages of 10 to 16. Scoliosis onset is usually earlier in girls than in boys—generally, ages 10 to 14 for girls and 12 to 16 for boys.


Figure 1

When should I screen patients for adolescent idiopathic scoliosis (AIS)?
Scoliosis screening is designed to identify adolescents with abnormal spinal curvature. Screening can detect scoliosis at an early stage, when the curve is mild. Most curves can be treated without surgery if detected before becoming too severe. Therefore, early detection is the key to controlling spinal deformities. Ideally, spinal screening should be conducted as a part of the annual examination for females at age 10 and 12 years, and males once at age 13 or 14 years. Signs to watch for include (see Figure 2):

  • One shoulder higher than the other. One shoulder blade higher or more prominent than the other
  • One hip higher than the other.
  • Space between arms and body greater on one side.
  • Leaning to one side.
  • Head not centered directly above the pelvis.
  • When bending forward, thoracic rib prominence or lumbar fullness that is asymmetric to the opposite side. (+ Adams forward bend test) (Figure 3)​

If any of these signs are present, then the child should be referred to a pediatric orthopedic surgeon. Texas Scottish Rite Hospital for Children has a low dose X-ray machine (EOS) that obtains high quality images with significantly less radiation exposure to the patient. For that reason, please do not obtain X-rays. Just refer the patient if clinical signs of scoliosis are apparent on physical exam. The orthopedic surgeon will obtain standing, full length (posterior-anterior and lateral) spine X-rays to measure the cobb angle in both the frontal and sagittal planes. The Cobb angle measurement and the skeletal maturity of the child will determine the treatment.
What are the treatment options for AIS?
Observation:
Routine rescreening or observation by the physician is a form of treatment for mild curves (11-20 degrees). This observation period consists of regular clinical exams and spine X-rays throughout the rapid growth years of adolescence until the spine is mature. It is important to note that more than 90 percent of patients with scoliosis require no treatment other than observation. 

Brace: 
For curves greater than 20 degrees in patients that are still growing rapidly, a brace is prescribed. The brace can prevent the curve from progressing and may eliminate the need for spinal surgery. However, the brace cannot correct the curve that already exists. Bracing is generally recommended for curves between 20 to 40 degrees in adolescent patients with significant growth remaining. The main factor in achieving a high rate of bracing success is the number of hours a day that the brace is worn. Various spinal orthoses are available, with the most common being a Thoracolumbo Sacral Orthosis (TLSO). The TLSO is named by the areas it is designed to stabilize: the thoracic, lumbar and sacral parts of the spine. It is cosmetically acceptable as it can be covered well by clothing. Wearing a brace is not an easy treatment for an adolescent. Even covered by clothing, it is hot, hard and can make the student feel self-conscious. Getting into a daily routine of wearing the brace while participating in activities helps with compliance, which is key to successful treatment.

Surgery: 
Some patients present with severe spinal deformity, and other patients scoliosis worsens despite compliant brace wear.  In these specific patients, surgery can reduce a portion of the curve and prevent it from increasing in the future. Usually, surgery is reserved for adolescents and pre-adolescents who already have a curve of 45 to 50 degrees or more. The most common surgical procedure is a posterior spinal fusion with instrumentation and bone graft.

This type of surgery involves attaching rods to the spinal column to help straighten it. The bone graft between the affected vertebrae encourages fusion to prevent further progression of the curve. Instrumentation refers to the various rods, screws, hooks or wires that are used to hold the spine in the corrected position while the bone fusion occurs. The instrumentation is rarely removed. Following surgery, the fused section is no longer flexible. The average hospital stay is about two to three days, and the student can usually return to school in approximately four weeks. During the first six months after surgery, some limits will be placed on strenuous physical activity. After this healing phase, the surgeon will usually release the patient for all activities, including competitive, low-contact sports.
Does physical therapy help treat scoliosis?
The Schroth method is a nonsurgical option for scoliosis treatment. It uses exercises customized for each patient to return the curved spine to a more natural position. The goal of Schroth exercises is to de-rotate, elongate and stabilize the spine in a three-dimensional plane. This is achieved through physical therapy that focuses on:

  • Restoring muscular symmetry and alignment of posture
  • Breathing into the concave side of the body
  • Teaching you to be aware of your posture

This approach to scoliosis treatment was developed by Katharina Schroth and further popularized by her daughter Christa. Born in Germany in the late 1800s, Katharina Schroth had scoliosis that was unsuccessfully treated with bracing. She developed her own breathing technique and exercises to manage her scoliosis. She and her daughter opened a clinic, where they treated more than 150 patients at a time.
A Schroth-trained physical therapist or specialist should guide you in learning this program. The duration of this treatment varies and the patient is expected to continue exercises at home to keep scoliosis in check.

Scottish Rite Hospital is currently investigating the use of Schroth physical therapy alone and combined with brace treatment for patients with mild scoliotic curves.

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Share Your Story: The Journey of a Scoliosis Patient

Share Your Story: The Journey of a Scoliosis Patient

by | Jun 15, 2018 | Scoliosis & Spine

Meet Peyton, a spine patient who had surgery to correct her scoliosis. Peyton was diagnosed with adolescent idiopathic scoliosis (AIS) at age 14. Learn more about her journey below. 

Blog written by Peyton, age 21 of Frisco. 

Hi y’all! I’m Peyton and in honor of Scoliosis Awareness Month I am sharing my story with adolescent idiopathic scoliosis (AIS) at Scottish Rite Hospital. I’ll take you through my journey, beginning with diagnosis, my decision to have spinal fusion surgery and ending with recovery and where I am today.

My diagnosis process was actually a bit peculiar, as other hospitals and treatment centers that assessed my spinal curvature diagnosed the asymmetry they were seeing as “overdevelopment of muscle” on one side of my back. I was an all-star cheerleader/competitive athlete for 13 years growing up, and I was a flyer. For those who aren’t familiar with the sport of cheerleading, a flyer is the athlete in the air that executes body positions on the hands of the bases who are holding them up. Initially, the statement of “overdevelopment of muscle” seemed feasible, as I was consistently working and stretching one side of my back with little time and attention spent on the other side. The diagnosis wasn’t settling right with my mom. Additionally, my best friend’s mom, who also has scoliosis, was the first person to catch and actually call this so-called ‘overdevelopment’ scoliosis.

 

This confirmed my mom’s suspicions, so we met with my childhood pediatrician who referred us to Texas Scottish Rite Hospital for Children in Dallas, where I was diagnosed with adolescent idiopathic scoliosis at age 14 by Dr. Brandon Ramo.

Peyton and dad x ray_2

Once diagnosed, my treatment plan began immediately with bracing. I will be honest, as an athlete and highly active teen who was involved in numerous school organizations, school cheerleading, school athletics and all-star competitive cheerleading, the idea of being limited by bracing was not easy for me to wrap my head around. The goal was to be in the brace for at least 18 and up to 22 hours a day. If memory serves me correctly, upon hearing this, I immediately started crying. I thought this meant that I was going to have to stop cheering and, seemingly, everything else that I was involved in. At that point, Dr. Ramo discussed with me that time spent in the brace was an important goal, but I didn’t have to stop doing my activities. 

In his expert opinion, he credited the reason that my body didn’t physically reflect what was going on internally was because I was an athlete training at an elite level, thus, developing an extremely strong core. Physically, my body did show evident signs of scoliosis, such as what is commonly referred to as “the hump” on the right side of my back, uneven shoulders and a short torso, but nothing like what is commonly seen in patients who are not training at the level that I was. 

Fast forward four years. I had just turned 18 and was beginning my first year at Texas Christian University (TCU). While my all-star cheerleading career had come to an end, I was embarking on my college cheerleading journey that fall. Dr. Ramo and I agreed that because my growth plates were now closed, there was no need to brace while in college. The plan was to watch my curve and see if it progressed even after my growth plates had closed. Unfortunately, my curve did continue, officially making me a candidate for spinal fusion surgery. As you can imagine, this was not the greatest of news. From the second I was diagnosed, I had been adamantly against surgery, and told my mom time and time again that I would never even consider it. 

Peyton
Dr. Ramo knew this. He also knew I wasn’t in pain and my condition wasn’t preventing me from living my dream and achieving my goal to cheer for a Big 12/Division 1 university. Our plan, at that point, was to monitor my curve throughout the next year. Dr. Ramo was careful to make certain that I understood the big picture while still giving me personal space to make my own informed decision. He communicated his opinion, which was that I would benefit greatly in the long run by electing to have the surgery. He told me to come to him when I was ready to entertain surgery as an option for myself and/or when my cheerleading career was finished – then we would talk.

Almost one year to the date later, I had what I call a “come to Jesus” moment. A light went off in my head and I just knew. I knew my body was changing. I knew, for the first time ever, that my body was physically reflecting what was taking place internally. I knew I needed the surgery. So, one month before the end of my sophomore year at TCU, I called my parents and asked them to schedule a consultation for surgery. When I arrived for my appointment in May 2016, there was a note on my chart that said “consultation.” When Dr. Ramo walked in and saw this, he thought it was a mistake. I told him it wasn’t, and I was ready. Being the miracle worker that I believe him to be, he scheduled my surgery for June 15, 2016.

I arrived for surgery early on the morning of June 15, 2016. My surgery was approximately six and half hours long with zero complications. The early morning hours on the day after surgery were a bit rough as they transitioned me from IV pain meds to oral. My team of nurses took absolute perfect care of me.

They were extraordinarily compassionate, while still making sure to keep me on track in terms of movement. I stayed in the hospital for three days and went home on day four after my procedure. Once I was home, I stopped taking all narcotic pain medications and, instead, alternated between hospital doses of Advil and Tylenol.

 

I also relied heavily on pillows, lots and lots of pillows, that helped prop me up and keep me comfortable while sitting or lying down. I highly recommend a wedge pillow for ease of getting in and out of bed.

Peyton and nurse pre op_1

My biggest tip is to move as much as possible during the day, especially if you feel yourself getting uncomfortable, and even during the night when you wake up to take medicine. It helps the muscles in your back not stiffen up so much as your body gets use to the new you. My recovery was just as my surgery, completely complication free. For this I will be forever grateful.

I believe that choosing to get spinal fusion surgery is the best decision I will ever make for myself. I know that’s a huge statement, but I whole-heartedly stand by it. My body is far better aligned now. Clothing fits me better. I am no longer self-conscious about the physical aspects of scoliosis, and as a matter of fact, I’m quite proud of my scar! It has been amazing to see how my body has changed and adjusted to how it’s supposed to be post-surgery. Physically, I can do absolutely anything I could before, other than pulling elite cheerleading body positions or yoga positions that require a lot of back arch flexibility.

To the entire staff at Scottish Rite Hospital, the gratitude I have for you is difficult to communicate. Thank you for giving me a body that will be physically capable of doing absolutely anything that I want to do for the rest of my life.
I celebrate two years since my surgery today, June 15, 2018!

 

Do you have a story? We want to hear it! Share your story with us. 

#SRHaccess Facebook LIVE Recap: MAGEC Rods

#SRHaccess Facebook LIVE Recap: MAGEC Rods

by | Sep 29, 2017 | Scoliosis & Spine

On this week’s Facebook live, Amy L. McIntosh, M.D. joined us to discuss MAGEC rods – an innovative treatment used for early onset scoliosis (EOS). Below is a recap of the conversation.

What is a MAGEC rod?
A MAGEC rod is a growing device technique used for patients diagnosed with early onset scoliosis (EOS) – children under the age of 10. This is a less invasive, innovative treatment which reduces the amount of surgeries a child must undergo.

Qualifications for MAGEC rod treatment:

  • Children diagnosed with early onset scoliosis.
  • A curve approaching 50 degrees and other forms of treatment (i.e. bracing, casting) have not been successful.

What medical tests are done to determine the severity of a curve?

  • Scottish Rite Hospital has an advanced imaging technology call the EOS machine. The system produces long length images of the spine with significantly less radiation than other imaging tools.
  • Based off the x-ray, the curve is measured by your doctor to determine the degree.

What happens after the rod is placed?

  • After surgery, a patient will stay in the hospital for three to five days on average.
  • The back must heal from the surgery and after four to six months, the patient will return to clinic for his or her first lengthening session.

How is the MAGEC rod lengthened?

  • Your doctor will use a magnetic wand to locate the magnets in the rod and will make a mark on your back.
  • An External Remote Control (ERC) is the device used to expand the rod in your back. The device can make a loud noise, but our Child Life team is there to make your child feel as comfortable as possible.

Can the child be active while having the MAGEC rod?
•    Our doctors support patients being active and staying healthy.
•    Recommended activities include: biking, swimming, walking and hiking while having the MAGEC rod.

Watch this segment on Facebook.

Ayalin’s Moment – Scoliosis

Ayalin’s Moment – Scoliosis

by | Jun 1, 2017 | Scoliosis & Spine

In or out of halo traction, Ayalin dazzles. Even a diagnosis of scoliosis couldn’t dampen her enthusiasm. After corrective surgery at Scottish Rite Hospital, Ayalin embraces every moment, especially those that include dance. This month, we will be giving you a deeper look at Sarah M. and Charles E. Seay/Martha and Pat Beard Center for Excellence in Spine Research on our Facebook page in honor of #ScoliosisAwarenessMonth. Join us for patient stories, flashbacks and interesting facts. For more information, visit our Scoliosis & Spine page.