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A Shared Passion to Protect and Serve

A Shared Passion to Protect and Serve

by | Oct 25, 2023 | Scoliosis & Spine

Published in Rite Up, 2023 – Issue 3. 
 
Last summer, the Inpatient Unit at Scottish Rite for Children had extra security and cuteness overload in the form of a 4-year-old patient lovingly referred to as Policeman Joseph. Donning a police vest, badge, walkie-talkie and binoculars, Joseph, of Gonzales, Louisiana, made daily rounds to keep his fellow patients safe. “He’s got a huge personality stuffed inside a little body,” says Randi, his mother.
 
Joseph has congenital kyphoscoliosis. In utero, his vertebrae formed differently, which caused both kyphosis, or an outward spinal curve, and scoliosis, a sideways curve. At age 2, Joseph was referred to Scottish Rite for Children where he received expert care from pediatric orthopedic surgeon Amy L. McIntosh, M.D.

When Dr. McIntosh evaluated Joseph, his curve measured more than 80°, which was beyond the point when surgery is recommended. “For young children who have severe congenital curves, bracing or casting doesn’t help because of the abnormal vertebrae,” Dr. McIntosh says. “You have to wait until they’re big enough to surgically fit an implant in them.” Dr. McIntosh monitored Joseph until he was 4. When his curve reached 100°, she recommended six weeks of halo-gravity traction followed by surgery.

Halo-gravity traction gently stretches and straightens a significantly curved spine in a slow, safe manner. “It’s like taking a spring that’s coiled up and slowly uncoiling it over time,” Dr. McIntosh says. While Joseph was under anesthesia, Dr. McIntosh applied the halo by attaching it to his skull. “I didn’t even feel it,” Joseph says. “It was super magic!” With the help of his care team, Joseph could fasten his halo to a traction device on a pulley system that connected to his walker, wheelchair or bed.
 
While in traction, Joseph participated in therapeutic recreation, physical therapy (PT) and fun activities in Child Life. “He made friends with everyone, especially the security officers,” Randi says, “and he loved growing his muscles in PT, so he could keep his new friends safe. Scottish Rite became our second family, a home away from home.”
 
When traction was complete, Joseph underwent surgery. Dr. McIntosh inserted a magnetic growing rod, also known as the MAGEC® System, on one side of his spine and a sliding traditional growing rod on the other side. After a successful procedure, his curve measured 42° — a correction of almost 60%. “He got almost two inches taller,” Dr. McIntosh says.

 Going forward, the rods in Joseph’s back will be lengthened as he grows. Rather than undergoing multiple surgeries, an external magnetic device will be used to locate the magnet inside the rod to lengthen it. “The magnetic rod acts as a motor to drive the traditional rod that will slide,” Dr. McIntosh says. This hybrid construct will control the correction of Joseph’s spine until he stops growing and ultimately receives a definitive spinal surgery. “Joseph’s care has been top-notch,” Randi says. “Dr. McIntosh is absolutely the best, a true godsend.”
 
On his last day at Scottish Rite, Policeman Joseph made his final rounds, protecting the kids and doing a celebratory safety dance on his way out.
 
Read the full issue.

Nighttime Bracing Coupled with Physiotherapeutic Scoliosis-specific Exercises Can Reduce Adolescent Spinal Curves

Nighttime Bracing Coupled with Physiotherapeutic Scoliosis-specific Exercises Can Reduce Adolescent Spinal Curves

by | May 17, 2023 | Research & Innovation

Scoliosis is one of the most common pediatric orthopedic conditions and presents very differently depending on the patient. Research into nonoperative treatment methods has shown promising results for using a Providence or nighttime brace in addition to physiotherapeutic scoliosis-specific exercises (PSSE).

Scottish Rite for Children pediatric orthopedic surgeon Amy L. McIntosh, M.D., and a  team of physical therapists, orthotists, and others conducted this prospective comparative study to evaluate the effectiveness of PSSE in skeletally immature patients with adolescent idiopathic scoliosis treated with nighttime bracing (PSSE group) compared with the standard of care of nighttime bracing alone (control group). Their findings were published in the Journal of Pediatric Orthopaedics in the article “The Addition of Daytime Physiotherapeutic Scoliosis-Specific Exercises to Adolescent Idiopathic Scoliosis Nighttime Bracing Reduces Curve Progression.”

Skeletally immature patients with adolescent idiopathic scoliosis (AIS) who have moderate curves are treated with thoracolumbosacral orthoses, which are designed for nighttime wear. The effectiveness of PSSE in addition to nighttime bracing compared with nighttime bracing alone was unknown. Patients in this study met the following inclusion criteria: diagnosis of AIS, Providence brace treatment, ages 10 to 16 years, thoracolumbar or lumbar primary curve <35 degrees, Risser stage 0, and females <1-year postmenarchal.

Patients in this group completed at least eight hours of one-on-one outpatient physical therapy sessions from a Schroth-based (Barcelona Scoliosis Physical Therapy School) certified physical therapist. All patients participated in Schroth therapy at Scottish Rite for Children and were given a standardized exercise prescription algorithm. They also committed to performing a home exercise program for a minimum of 15 minutes a day, five days a week, for at least one year. They were encouraged to maintain a corrective posture throughout the day during activities of daily living.

The primary outcome measures were curve magnitude of the primary curve and the rate of curve progression. Curve magnitude was digitally measured using the Cobb method, and baseline curves averaged 25 degrees, which is at the lowest bracing threshold recommended by the Scoliosis Research Society. These patients either presented with a Cobb  angle ≥ 25 degrees or had demonstrated curve progression to a Cobb angle ≥ 25 degrees.

Both groups demonstrated positive results, 22% of curves improved at skeletal maturity, and only 9% required surgery. However, the PSSE group had no change in curve magnitude at the final visit compared with curve progression in the control group (1 vs. 7 degrees, P<0.01). Furthermore, the PSSE group had a lower rate of curve progression >5 degrees at the final visit (14% vs. 43%, P<0.01). The PSSE group also had less conversion to full-time bracing after 1 year (5% vs. 24%, P=0.046), but the differences were no longer significant at the final visit (14% vs. 27%).

Their research confirms that Schroth-based physical therapy, in conjunction with wearing a brace at night, reduces curve progression after one year and at skeletal maturity. This information is helpful to patients and their families experiencing scoliosis and could be used as an encouragement for compliance with the treatment.

Learn more about scoliosis and orthopedic research.

Bike Safety Awareness

Bike Safety Awareness

by | May 5, 2023 | Spotlight

No matter where you live, biking is a great way to get outdoors and be active. Whether it’s for pleasure, to exercise or for commuting purposes, biking has numerous physical and mental benefits — the key is to do it safely.

“Biking is a low-impact resistance exercise that is great for building muscles, improving coordination and increasing mobility, but just like any physical activity, biking comes with risks. Bruises and minor cuts are usually the leading types of injuries involving bicycles, followed by fractures, concussions, muscle strains and sprains. You can significantly lower that risk by taking safety precautions and following the rules of the road,” said Amy L. McIntosh, M.D., FAAOS, orthopedic surgeon, and spokesperson for the American Academy of Orthopaedic Surgeons (AAOS).

May is National Bicycle Safety Awareness Month, which serves as a reminder of the importance of bicycle safety all year long. The AAOS shares the following information about bicycle injury prevention and strategies for how you and your family can stay safe.

Common bicycle injuries
There were more than 325,000 preventable bike-related injuries in the U.S. in 2020, according to the National Safety Council (NSC). Bruises and minor cuts are usually the leading types of injuries involving bicycles, followed by fractures, muscle strains and sprains. However, serious injuries, including death, do occur. According to the NSC, there were nearly 1,260 preventable bicycle-related deaths in 2020.

Helmet safety
No matter what your age or level of experience, you should wear a helmet every time you bike. Cuts, bruises and even broken bones will heal, but damage to your brain can be permanent. Even a low-speed fall can result in serious head injury.

When choosing a helmet, make sure it is:

  • Snug — It should not slide from side-to-side or front-to-back.
  • Level — It should be square on top of your head, covering the top of the forehead. It should not tilt in any direction.
  • Stable — The chin strap keeps the helmet from rocking in any direction. Chin straps should be replaced if any part of the buckle breaks. Otherwise, a helmet may fly off in an accident.

Road safety rules
When biking, it’s important to be aware of your surroundings and follow the rules of the road. Start by familiarizing yourself with the bicycle rules of the road in your city or state, and do not ride if you are looking at your phone or mobile device. Pull over to the side to change your music, check your map or answer a call. Ride in the direction of traffic and always follow traffic signs and lights. Signal your turns or your intentions so that drivers can anticipate your actions, and if you are riding with others, ride in single file.

“Staying alert and aware of your surroundings — even when traffic appears light — can help bicyclists to prevent musculoskeletal injuries,” added Dr. McIntosh.


Choose bike routes wisely
Avoid riding on high-traffic roads and instead select streets with fewer and slower cars. Whenever possible, choose streets with designated bicycle lanes. If there is not a bicycle lane, ride on the right shoulder of the road. When a street lane is too narrow for a vehicle and bicycle to safely ride side by side, or if there are several parked cars on the street, you will need to join traffic and ride toward the center of the road.

Pace yourself and prevent injuries
Cycling can be vigorous exercise, so make sure you are fit enough to participate before you start pedaling. Make sure you understand how to use the gears on your bike to help control your physical exertion level. Additionally, change riding positions periodically to reduce stress on pressure points and avoid overstressing muscles. Finally, stay hydrated by bringing water, especially on longer rides.

Supervise young riders
Whether it’s their first ride or they’ve been cycling for a few years, younger riders benefit from someone watching and advising them. Younger children or people just learning to ride should only do so away from moving vehicles and traffic. New riders may need reminders to avoid distracted cycling.

Visit the AAOS Newsroom to learn more about bike safety, injury prevention and find musculoskeletal facts and figures.

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.