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The Psychology of Spine Surgery Pain in Children

The Psychology of Spine Surgery Pain in Children

by | Nov 2, 2022 | Press Coverage, Scoliosis & Spine

Article previously posted on Orthopedics This Week

by Elizabeth Hofheinz, M.P.H., M. ED.
 
How catastrophic is surgical pain for children? A group of researchers from Scottish Rite for Children, the University of Texas (UT) Southwestern Medical Center, and The Chicago School of Professional Psychology (all in Texas) set out to examine pain catastrophizing in adolescent idiopathic scoliosis (AIS). Their work, “Pain Catastrophizing Influences Preoperative and Postoperative Patient-Reported Outcomes in Adolescent Idiopathic Scoliosis,” appears in the August 18, 2022, edition of The Journal of Bone and Joint Surgery.
 
“We began this work about seven years ago as we saw more adolescents having difficulty with pain postoperatively,” stated co-author Brandon Ramo, M.D. to OTW. Dr. Ramo, who is with Scottish Rite and UT Southwestern Medical Center, added, “We were able to undertake this work because we are fortunate enough to have a strong child psychology group in our hospital to partner with. The timing seems right in some ways because the pandemic has clearly accelerated the decline in mental health in our teenagers.”
 
The authors undertook a prospective cohort study of 189 consecutive patients undergoing posterior spinal fusion for AIS, comparing patients having clinically relevant pain catastrophizing with patients who had normal Pain Catastrophizing Scale scores.
 
They found that 20 patients (10.6%) engaged in pain catastrophizing. And, even though the demographic and radiographic variables were similar, the researchers determined that pain catastrophizing was associated with significantly lower preoperative scores than those in the normal pain catastrophizing group in all of the Scoliosis Research Society Questionnaire Domains: pain (2.98 versus 3.95), appearance (2.98 versus 3.48), activity (3.51 versus 4.06), mental health (3.12 versus 4.01), and total score (3.18 versus 3.84), except satisfaction (3.72 versus 3.69; p > 0.999).
 
“We showed a fairly high rate of pain catastrophizing in a ‘seemingly otherwise normal, healthy’ population of adolescent patients, 1 in 10, which means if you operate on AIS, you will encounter it at least several times per year,” commented Dr. Ramo to OTW. “These patients will finish with poorer outcomes than their peers, so if you don’t recognize this psychological trait, you can’t intervene beforehand (referral, expectation management) and their outcomes scores will be lower.”
 
“We showed good correlation with the Scoliosis Research Society Pain domain, which you could use as a proxy to detect this or use an electronic medical record (EMR)-based algorithm to deliver the Pain Catastrophizing Scale to those patients scoring below our threshold on the Scoliosis Research Society pain domain. The EMR computer can work for us to do this and identify at-risk kids with simple questions and a very simple algorithm.”
 
Time heals?
 
The good news about the paper, Dr. Ramo told OTW, “Patients with pain catastrophizing, because they start so low on their PRO scores, actually have larger increases in their scores after surgery, so while they never ‘catch up’ to their peers, they actually ‘do well’ with surgery and should still be offered these elective surgical procedures. Don’t be afraid to operate on them.”
 
“For us, this has changed our practice in that we have implemented an EMR-based process: we are now administering the Scoliosis Research Society questionnaire when we sign the patient up for surgery as a clinical tool, rather than as a research tool in the days before. We had our EMR developers build the Scoliosis Research Society questionnaire into our EMR, and using parameters from our study, if they score below a certain threshold on the Scoliosis Research Society questionnaire, the computer administers the Pain Catastrophizing Scale.”
 
“If they have a concerning pain catastrophizing score, the surgeon’s team is notified, and a consult can be placed to psychology well in advance of the surgery. This allows the patient to receive psychological support, perhaps improving expectations and maybe (that’s the next study) their outcomes.”

Read the full article.

Innovative Spinal Surgery Techniques for Scoliosis

Innovative Spinal Surgery Techniques for Scoliosis

by | Jun 30, 2022 | Scoliosis & Spine

In scoliosis patients with a significant curve of 50 degrees or more, spinal surgery is often the best treatment option. Surgery is also an option for scoliosis patients who did not achieve success with bracing. At Scottish Rite for Children, we offer multiple types of surgery to correct scoliosis including spinal fusions, as well as new and innovative methods like vertebral body tethering (VBT) and the magnetically controlled growing rods, also known as MAGEC rods, for children that are still growing.  Learn more about the different types of spinal surgery offered at Scottish Rite below.

Spinal Fusion
The most common surgery performed to treat scoliosis is called 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 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.

  • Patients who have a spinal fusion will see an immediate improvement in the curve of their spine. This surgery also prevents the spine’s curve from progressing over time.
  • Most patients have a recovery period of about six weeks, during which some activities like bending or heavy lifting must be limited.
  • Following a spinal fusion, most patients can return to their normal activities after recovery, which usually is about four to six months.
  • In most cases, patients who undergo a spinal fusion do not require any additional surgeries.

Vertebral Body Tethering (VBT)
VBT is a surgical treatment for idiopathic scoliosis in growing children. This surgery technique uses a strong, flexible cord that is attached to the spine with screws and anchors and as a child grows, their spine will straighten over time. The cord encourages the spine to straighten as the patient grows. Vertebral body tethering is a growth modulation treatment that takes advantage of the spine’s natural growth. Growth modulation means modifying the normal growth patterns through tethering. The tether is placed along the curved side of the spine. This tether is used to slow down the growth of the curved side of the spine while the untethered side continues to grow. By using a tether, the spine can continue to bend and flex. It is not a fusion procedure which is an advantage of pursuing this treatment.

  • VBT is an ideal treatment for children with idiopathic scoliosis who have curves of 30 to 65 degrees and who have significant bone growth remaining.
  • Unlike a spinal fusion, VBT allows for greater mobility and flexibility of the spine.
  • VBT surgery is less invasive than a spinal fusion and involves a shorter recovery time. In most cases, patients can return to most activities within three to four weeks after the surgery.
  • Unless a concern with the tether develops, the implants will not need to be removed once placed by the surgeon.

MAGEC (MAGnetic Expansion Control) System ®
A MAGEC rod is a growing device technique used for patients diagnosed with early-onset scoliosis (EOS) – children under the age of 10. In comparison to a spinal fusion, this is a less invasive, innovative treatment that reduces the number of surgeries a child must undergo. Once the surgery has been performed and the MAGEC rod is in place, the back must heal for about four to six months. Once the spine has healed, then the patient will return to the clinic for his or her first lengthening session. During lengthening, the physician will use a magnetic wand to locate the magnets inside the MAGEC rod and make a mark on the back. Using an External Remote Control (ERC) device, the doctor will then lengthen the rod with a noninvasive adjustment. An X-ray or ultrasound of the spine is then used to confirm the procedure’s success.

  • The MAGEC rod is ideal for patients under the age of 10 who have a curve approaching 50 degrees and other forms of treatment (i.e. bracing, casting) have not been successful.
  • Children may need several lengthening sessions over time to achieve proper results.
  • During the ongoing lengthening sessions, children may remain active and continue all their favorite activities.
  • Lengthening sessions do not typically cause pain and additional surgeries are not usually required.

Each surgical technique has different uses and not all types of surgery will be the right fit for every patient. It is important to discuss all treatment options with your doctor to learn what will work best for your child.

Learn more about scoliosis treatment and surgery at Scottish Rite for Children.

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

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

by | Jun 22, 2022 | Scoliosis & Spine

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.

Genetics Team Attends International Meeting in China

Genetics Team Attends International Meeting in China

by | Apr 10, 2018 | Research & Innovation

Staff from Scottish Rite Hospital travel near and far to participate in medical conferences to share their most recent research and learn from other experts in the field. Last week, members from our genetics research team were in Shenzhen and Guangzhou, China to attend the International Consortium for Spinal Genetics, Development and Disease (ICSGDD) conference. The ICSGDD includes two groups who combined after last year’s inaugural international conference, “Genomic Approaches to Understanding and Treating Scoliosis.” The hospital led and largely organized this three-day, two-part meeting with the first half in Shenzhen hosted by the University of Hong Kong and the second half in Guangzhou hosted by Sun Yat Sen University Hospital.

The conference included faculty and presenters from across the world who have been selected to provide the latest innovations within scoliosis genetic research. Scottish Rite Hospital’s Director of Molecular Genetics Carol Wise, Ph.D. is one of three conference chairpersons. As a leader and co-founder of ICSGDD, she understands its significance and the impact it could have for patients diagnosed with scoliosis. “This group has made great strides over the past year to bring better treatment for complex forms of scoliosis,” says Wise. “The ICSGDD conference is unique because it brings together experts in scoliosis genetic research from different areas of the world. The diversity of the group cultivates collaboration and in-depth discussions to better understand these conditions.”

This international conference is one of many that the hospital is actively involved with each year. As a research and teaching institution, it is important for staff to learn from fellow medical professionals and share their expertise, both locally and internationally, to ultimately provide the best care possible to our patients.

Learn more about the hospital’s Sarah M. & Charles E. Seay Center for Musculoskeletal Research.