Bracing for Scoliosis

Bracing for Scoliosis

by | Jun 16, 2023 | Scoliosis & Spine

At Scottish Rite for Children, we are committed to providing individualized patient care to every child. As one of the most common conditions our experts treat, scoliosis can present in many forms. Depending on the child and the severity of their curve, the plan for treatment can vary. 

Bracing is a treatment option for patients whose curve is smaller to moderate. It is during a patient’s adolescent years that he or she is growing the most, which means their curve can also grow. The ultimate goal of a brace is to prevent the curve from getting larger to ultimately avoid the need for surgery in the future. However, a brace does not cure scoliosis.

At Scottish Rite, there are different types of custom-made braces for patients. Below are the most common:

TLSO (Boston) Brace

  • TLSO stands for thoracolumbosacral orthosis.
  • For a child whose curve ranges from 25 to 40 degrees and is located in the middle to lower back.
  • This brace is worn during the day. Depending on the child’s curve, the doctor will prescribe the number of hours he or she should wear the brace.
  • Custom made for every child, the brace starts at the armpit and comes down to the pelvic bone.
  • The brace is worn under clothing.
  • Patients are able to remain active while wearing the brace. However, you must check with your doctor on any restrictions.

Providence (nighttime) Brace

  • Used for smaller curves located lower on the spine.
  • Most effective for patients who still have a good amount of growing left.
  • Because of its structure, this brace can only be worn at night.
  • The brace goes up one side of the body, essentially pushing the curve the opposite way.
  • The brace holds the spine in the correct straight position while growing during the night.
  • It is custom made for each child.
  • It doesn’t hurt, but if uncomfortable, it can be refitted.
  • Within a few days, patients say they are used to sleeping while wearing the brace.

Learn more about scoliosis bracing. 

Gracee Gets Back in the Game After The Tether™ Spinal Surgery — the First at Scottish Rite

Gracee Gets Back in the Game After The Tether™ Spinal Surgery — the First at Scottish Rite

by | Jun 1, 2023 | Scoliosis & Spine

Cover story previously published in Rite Up, 2023 – Issue 1.
by Kristi Shewmaker

Gracee never imagined that one day she would play basketball in the Dallas Mavericks® practice gym, much less play one-on-one against her 6’5” pediatric orthopedic surgeon. As a 15-year-old high school varsity basketball player of Tuscola, she also never imagined that three months before that, she would be the first patient at Scottish Rite for Children to receive The Tether™ Vertebral Body Tethering System, a surgically implanted spinal device that is used to treat scoliosis.

Gracee grew up with basketball. “As a little girl, she went to the gym a lot because we were in the gym a lot,” says Carla, her mother. Gracee’s father, Hunter, is the high school varsity girls basketball coach. Gracee watched him coach her older sister before playing herself.

Gracee started playing competitive basketball in second grade. “We sent letters home to the girls in her class saying that we were going to meet one day a week to skill and drill,” Hunter says, “and it grew from there.” Throughout the years, Hunter coached Gracee and her team in various leagues. In middle school, Gracee joined her school team. In high school, Gracee started on the varsity team with some of the same girls that she has played with since second grade. “What I love most about basketball is the friendships that come with it,” Gracee says.

The summer before her freshman year, Gracee was seeing a chiropractor for an issue with her hip flexor, and Hunter mentioned that she had scoliosis during the appointment. A school nurse had noticed it during a routine screening when Gracee was in elementary school. Her curve was less than 10°, so her pediatrician had been monitoring it. “When she laid down on the chiropractor’s table, and I saw her back,” Hunter says, “I was like, ‘Oh my gosh!’ We didn’t realize to what degree the curve had gotten.”

Hunter contacted Scottish Rite for Children for help, and there, Gracee was diagnosed with adolescent idiopathic scoliosis. This condition occurs in patients ages 10 to 18, and the cause is unknown. Her curve measured 42°. “I was shocked,” Gracee says. “I didn’t think it would be that bad.”

Initially, Gracee wore a brace to prevent further progression and to try to avoid surgery. However, within months, her curve progressed to more than 50°, which experts call the surgical threshold — the point when surgery is recommended to stop a curve from getting larger. “In a certain subset of kids wearing their braces, the curve still progresses,” says Jaysson T. Brooks, M.D., pediatric orthopedic surgeon. “They have so much growth potential left, their spine overpowers the brace.”

When Gracee and her family first met Dr. Brooks, they began discussing treatment options in anticipation of the need for surgery. Dr. Brooks presented two surgical options, including spinal fusion, which he calls “the gold standard treatment,” and The Tether™, a new non-fusion surgical device he had used previously to treat scoliosis but had not been used at Scottish Rite.

In a spinal fusion, screws are inserted into channels of bone surrounding the spinal canal. Two rods are secured into the back of the screws with set caps and tightened with a torque wrench. Bone graft is placed along the implant to help the vertebrae fuse together. This procedure stops the growth in the previously curved part of the spine and prevents the curve from coming back.

When using a tether, a flexible cord is attached with screws to the vertebrae on the side of the spine that curves outward, which is also known as the convexity of the curve. The tether slows the growth on the outward side of the curve while allowing the inward side of the spine to continue growing. During surgery, the flexible cord is tensioned, which corrects the curve to some degree. As a child grows, the spine grows straighter because the tether guides it into the correct alignment. The Tether™ is a non-fusion implant that allows children to maintain the majority of their natural spine flexibility
 
“Gracee was a good candidate for this procedure because her curve is flexible, and she was still really young from a bone standpoint, or skeletal maturity,” Dr. Brooks says. “The younger your skeleton is, the higher chance you have of getting taller, and using a tether requires you to be able to grow taller because it capitalizes on that growth.”
 
Over several appointments, Dr. Brooks discussed the pros and cons of each surgery, the difference in incisions, how X-rays look when rods versus a tether are attached to the spine, and the potential downsides and risks. “He did a really good job explaining the difference between the two,” Gracee says. “He also did a really good job of making me feel calmer.”
 
“There wasn’t a lot of anxiety on our part about which way to go,” Hunter says. “In my mind, vertebrae are meant to be flexible. If you can keep it the way God designed it, I think you’re better off. Obviously, there are times when the fusion is the only answer, but with this being another option, we wanted to try it.”
 
Gracee’s family chose this device because they wanted to maintain the overall flexibility of her spine as well as endure a shorter recovery period, so that Gracee could get back to playing basketball as quickly as possible.
 
“They are very intelligent and very pragmatic to approach a procedure that is this new and say, ‘I think this is going to be the right thing for my daughter,’” Dr. Brooks says. “They were mature enough as a family to say, ‘we’re okay with the potential consequences, but we think that the benefits outweigh the risks.’ You couldn’t have asked for a better family to be the first family for The Tether™ at Scottish Rite.”
In April of 2022, Gracee underwent surgery. “I wasn’t that nervous going into it,” Gracee says. “When I got out, I was excited to finally be good. I was excited about it.”
 
“The whole time, I felt like she was in very good hands,” Carla says. “Dr. Brooks’ knowledge is one thing, but he is very compassionate and caring as well. I truly felt like he loved my child.”

Two weeks later, Gracee went back to school. After six weeks, she played her first post-surgery game, and after three months, she found herself at the Dallas Mavericks® practice gym playing basketball with Dr. Brooks.

“It was a really cool experience,” Gracee says. “Dr. Brooks did pretty good.”

The feeling was mutual for Dr. Brooks. “It was a special opportunity for sure,” Dr. Brooks says. “I was pretty good at basketball in high school, but I’m super out of shape now. The only thing I had to my advantage was my height. Where she beat me in speed, I used my height.”
 
Gracee has played shooting guard for as long as she can remember. Hunter explains that she shoots in the 40% range from the three-point line. “Gracee’s a good shooter because she’s up at the gym at 5:00 or 5:30, three or four mornings a week working on her shots,” Hunter says. “Our basketball program is highly competitive. They’re ranked No. 2 in the state.”
 
In December, Gracee’s team won the Whataburger® Basketball Tournament, an invitation-only tournament in Fort Worth. When it was over, five players out of approximately 160 girls were chosen for the alltournament team. Gracee was one of the five.
 
“Going from being on a surgery table in April to being able to do that in December is just phenomenal,” Hunter says. “Gracee’s always been a spunky kid. There wasn’t much spunk a year ago, but we’re seeing it come back.”

Today, Hunter says that they have no regrets about choosing tethering, but he knows that it is still early. During surgery, Gracee’s spine was corrected to a little more than 30°. The goal is that the tether will continue to straighten her spine as she grows.

“If Gracee had walked into my clinic with a 30° curve, she would not have gotten surgery because 30° isn’t big enough,” Dr. Brooks says. “In the end, if nothing changes, it’s still a win because she has a curve that is stable. There are lots of kids walking around with 30° curves who are living full, successful lives.”

Hunter says that they would be happy if her curve stayed where it is and ecstatic if it improves even more. “We’re just fortunate that we’re talking about a scoliosis curve that is manageable,” Hunter says. “When you see what other families at Scottish Rite are dealing with and the care that you see being administered to them, it’s as close to heaven on earth as you think you’ll ever see.”
 
“Everyone works so hard to make the kids at Scottish Rite feel at home, to make me feel at home,” Gracee says. “I wasn’t scared to be the first kid at Scottish Rite to get The Tether™. I like being groundbreaking. I like being the first.”
 
“And, our experience at Scottish Rite,” Hunter says, “has been nothing but first-class.”

Read the full issue.

Share Your Story: Meet Marley

Share Your Story: Meet Marley

by | May 1, 2023 | Scoliosis & Spine

Meet Marley, a patient who is seen by our team of scoliosis and spine experts. She also appears in some of our new advertisements! Learn more about her journey below.

Blog written by Marley.

I first learned that I might have scoliosis when I was at my 7-year-old annual checkup with my pediatrician. I didn’t think that I had any symptoms, but when the doctor checked my back, they told my parents I had a curve. My pediatrician referred us to Scottish Rite because they are the experts in helping kids who have scoliosis! 

When we got to the Frisco location, I recognized the crayon logo from going to a park by the Dallas hospital. I’ve now been a patient at Scottish Rite for four years, and I see Dr. Ramo for my scoliosis treatment. On my first appointment, we learned that my curve was large for my age, since I hadn’t had my growth spurt yet. Dr. Ramo told us that as I grew, the curve might get worse, and I could end up having to have surgery. I started wearing a brace, and over the past four years, my curve has actually decreased, and I will most likely not need surgery if I continue on this path!

Dr. Ramo makes me feel like he knows me as a person and not just a patient. He always asks me about how I’m doing in the different sports I play, and he remembers things about my hobbies and interests. I also really enjoy talking to Kelsey, who makes my brace and works on it when I grow. Whenever she has to make me a new brace, she lets me pick out my design. The last time I had to get a new brace, she even helped track down the special pattern I wanted for my brace. 

My favorite thing about Scottish Rite are the volunteers. They are always at the front entrance, and I feel comfortable when they welcome me. I love when they give me stickers, books or popcorn. My entire experience has been great because everyone cares about me and wants to help me improve.

Favorite dessert?
Sugar cookies and vanilla ice cream with rainbow sprinkles. 

Favorite color?
My favorite color is metallic gold because it’s sparkly and shiny.

Favorite book?
My favorite book is The Vanderbeekers of 141st Street. 

What do you want to be when you grow up?
When I grow up, I want to be a marine biologist because I love the water, I love science and I love animals.

Do you have a favorite hobby/sport/interest? 
My favorite sports are swimming and kung fu. I also love to play the piano. 

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

Share Your Story: Jumping for Happiness

Share Your Story: Jumping for Happiness

by | Mar 6, 2023 | Scoliosis & Spine

Meet Mikayla, a patient who was seen by our team of scoliosis and spine experts. Learn more about her journey below.

Blog written by Mikayla.

When I was in the sixth grade, my mom noticed something weird on my back. She had my dad also look at what she was seeing, and he thought we needed to get a doctor to check this out. I went to my pediatrician, and he said it looked like I had a “mild” case of scoliosis. He then sent us to an orthopedic doctor, who took X-rays to look at my spine. As it turns out, I’m someone who hides their curve well.

My forward bend test did not show much of a visual deformity, but the X-rays really showed what was going on. I had an upper curve of 45 degrees and a lower curve of 50 degrees. This meant I would need to wear a brace for 20 hours a day, for several years. I was fitted for a scoliosis brace and started wearing it as soon as I could.

My parents decided to reach out to Scottish Rite for Children for a second opinion, and January 2017 was the first time I visited my new family at Scottish Rite. Everyone was nice and amazing. At our first visit with Dr. Richards, we explained my medical history leading up to that point, and the Orthotics department looked over my brace. As soon as the orthotist looked at my brace, he suggested that I have a new one made at Scottish Rite. The first step in that process was for me to have a new X-ray in the fancy EOS machine. We were told to go have these images taken, grab a bite to eat, and then we would hear from Orthotics. No sooner had we sat down with our food in the cafeteria, we were called back to the clinic. 

scotish-rite-sign_.jpg

Dr. Richards and a few other people were already in the clinic room, and I could tell something was wrong. He told me that my curve had progressed, and my measurements were at the point of needing surgery. At this point in time, I thought my life was over! All that was important to me was gymnastics. My first doctor told me that if I had surgery, I would not be able to participate in gymnastics. But this was not the case at Scottish Rite. Dr. Richards explained to me everything he would do to save the motion in my spine. He said that following surgery and recovery, I could still do gymnastics, but it might feel a little different. I had my spinal fusion surgery in February 2017 and that is when my new life started. 

Following my surgery, my stay in the hospital was nothing but amazing. All the nurses and doctors were excellent. Of course, the healing process was a long time, but I got right back to everything as soon as I could. Being out of school for six weeks was also pretty fun. 

I was so excited when I was able to go back to gymnastics. Dr. Richards was right, things did feel a little different, but I was able to do everything I could before. It was around that time that I decided to try some other sports and started to play volleyball and basketball and run track. As soon as I found track, I felt like I had found my happiness again! I competed in the 100m hurdles, 300m hurdles, long jump and the triple jump. I felt wonderful and was able to do it all. 

It was around that same time I had my one-year post-op appointment with Dr. Richards. I told him all about the track events I was participating in, and he was amazed at everything I was doing! It felt great to hear that I was medically cleared to continue jumping, throwing my body around, and I was able to keep doing what I loved. 

Prior to my surgery, I thought that athletics was something I would never get to experience. Now, I’m the record holder at my high school for the 100m hurdles, and I’ve found something that makes me happy!

I have committed to Tarleton State University and plan to compete on the Track & Field Team while studying accounting.

Scottish Rite allowed my dreams to come true. When I first learned about my scoliosis diagnosis, I thought gymnastics was gone, and I never even thought track was something I would do. With the treatment I received at Scottish Rite, I am now healthy and able to do everything other kids can do. My favorite activities are going to the gym or running at the track. I love to do crafts, crochet, read my Bible and I aspire to become a high school accounting teacher and coach track and field. See ya’ around on the track!

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

Share Your Story: Strong and Independent

Share Your Story: Strong and Independent

by | Jan 4, 2023 | Scoliosis & Spine

Rhudi, a strong and independent 18-year-old from Natalia, Texas, had her life turned around when she was diagnosed with congenital kyphoscoliosis, a severe form of scoliosis that causes the spine to curve both to the side and forward or backward. Rhudi was an infant when her mom first noticed a curvature to her spine. Initially, Rhudi was monitored by a local South Texas orthopedist, but when she became a teenager, her spinal curve progressed, and they sought care and treatment from the experts at Scottish Rite for Children in Dallas.

Her condition took her away from her school, her friends and her family, but Rhudi’s parents were determined to get her the best treatment possible and to get her back home and active. In 2019, Rhudi underwent surgery with Daniel J. Sucato, M.D., M.S., which included the application of halo gravity traction, a device that attaches to the head and gently stretches the spine using a pulley device.

Rhudi was an inpatient at Scottish Rite while she continued treatment for her scoliosis and was in a wheelchair for about six months. While she was an inpatient, Rhudi made many friends and built relationships with the other inpatients and the staff who cared for her. During her physical therapy treatment, she was encouraged to go to college after graduating high school to become a physical therapist. She is now a senior in high school. She does all the things she loves, which includes Color Guard, mariachi, playing the violin and singing! She has learned a lot through her journey and hopes to keep helping others to work hard for their success.

“This hospital has taught me a lot and has made me who I am today. I have learned how to be a strong and independent person by working really hard for my successes.” – Rhudi

Learn more about our Center for Excellence in Spine.

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

Get to Know our Staff: Emily Lachmann, Clinical Research

Get to Know our Staff: Emily Lachmann, Clinical Research

by | Dec 14, 2022 | Scoliosis & Spine

Each year, our team seeks out college students interested in pursuing a career in medicine. Clinical Orthopedic Research Assistants (CORA) are hired at Scottish Rite for Children to assist our experts in performing clinical research tasks and collaborating on research projects. CORA staff are also mentored by our experts and given valuable advice and guidance for their future. Each CORA staff member specializes in a specific area of study and works with the experts in that department, receiving a well-rounded experience in their field of interest.

What inspired you to apply for the CORA/MSRF position?
After deciding to take a gap year before medical school, I was unsure about what I wanted to do. I applied for the CORA program because this position encompassed everything that I was searching for to prepare me for medical school from taking on research projects, working with a physician mentor, having lots of shadowing opportunities and getting experience with patients.

Have you always been interested in medicine and/or research?
I have always been interested in medicine, but my interest in research did not develop until my undergraduate years at Baylor University. During that time, I worked for a principal investigator that was developing a phone application to detect early stages of retinoblastoma (eye cancer) in children. This really opened my eyes to the impact of research, particularly in pediatrics, where we have the power to change children’s lives. I am so grateful to continue this type of work at Scottish Rite for Children.

What is it like working at Scottish Rite for Children?
Working at Scottish Rite has beyond exceeded my expectations. The staff here are so kind, and everyone truly values the mission of the organization to give children back their childhood. From my first day, the research team and the clinic staff were so welcoming and wanting to help me succeed in this new role. Specifically, the members of the Spine Research team have gone above and beyond to teach me the skills I need to be a successful researcher and future physician. Although Scottish Rite is made up of many different departments, it is clear that we are one big team.

Can you share a few sentences about someone at Scottish Rite who has been a mentor to you and how they have impacted your experience? What project are you working on with that mentor?
Dr. Amy L. McIntosh was the first mentor I worked with, and she was quick to make an impact on me. I was unaware of her impact at the time, but after learning more about her, I feel privileged to have her as a mentor. Her work as the Director of Clinical Safety, her passion to support women in STEM and her lead as the principal investigator to one of our largest scoliosis studies is inspiring to someone who is starting their career in medicine. When I am down in the clinic, Dr. McIntosh is always very welcoming and constantly inviting me to shadow with her. She takes the time to show me X-rays so that I can learn and better my understanding of complex conditions. In addition to working closely with her on the Early Onset Scoliosis study, Dr. McIntosh gave me the opportunity to work with her on a manuscript about reducing patient narcotic usage after scoliosis surgery, which recently got accepted to a pediatric anesthesia journal!

How do you think this experience will impact your career path?
The CORA program gave me invaluable experiences that were both helpful toward my immediate goal of medical school and will be helpful toward my long-term career goals. The experience working with patients, learning how to collaborate with principal investigators, and understanding the ins and outs of clinical research will have endless benefits. All these experiences have grown my confidence in communicating with patients and the various medical teams, applying to medical school and in my abilities as a researcher.

What progress have you made toward your career goal since beginning the program?
Since beginning this program, I have been accepted to medical school and will be attending UT Southwestern, Class of 2027. Also, I have had the opportunity to be an author on multiple abstracts and publications, one of which recently just got accepted by a pediatric anesthesia journal!

What is your favorite project that you are currently working on or have worked on at Scottish Rite?
My work on the Early Onset Scoliosis Study is my favorite and most rewarding project. The children are the most resilient and sweet. Getting to see and work with these patients and their families is the highlight of my day. It is so rewarding and fun to share the research process with them and to educate them on the impact research can have for future children.

What advice do you have for future CORA/MSRF participants?
Be thankful for this opportunity! Scottish Rite for Children is such a special place filled with the most supportive staff. Be a good team player, work hard and always put the patients first!

What is one thing most people don’t know about you?
I love playing sports and am extremely competitive! Last year, I broke my finger playing flag football. (I am also an orthopedic patient myself!)

Anything else you would like to add?
This program is not just a job. The CORA program does lots of fun activities outside of work, too! For example, we put together a relay team to take down the doctors at the Dallas Marathon this December!

If you are interested in a career in medicine and plan to take a year or two after college before applying to medical school, learn more about becoming a clinical orthopedic research assistant (CORA) on our careers page. Applications for June 2023 positions are being accepted through spring of 2023.

If you are in medical school and are interested in a research opportunity, learn more about becoming a medical student research fellow (MSRF) on our careers page.