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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.

Stress Fractures in the Spine: Spondylolysis

Stress Fractures in the Spine: Spondylolysis

by | Dec 7, 2021 | Research & Innovation

Pediatric orthopedic surgeon Jaysson T. Brooks, M.D., presented this as part of Coffee, Kids and Orthopedics education series. Brooks provided a detailed discussion of evaluating stress fractures in the spines of adolescents.

You can  and print the pdf.

watch the full lecture -What is Spondylolysis?

The facet joints in the back of the spine are connected by small segments of bone called pars interarticularis. Since this portion of the spine doesn’t get a great blood supply, it is at risk for stress fractures. This condition is called spondylolysis. Spondylolysis occurs more commonly at the L5 level and less commonly at the L4 level.

Most kids aren’t born with spondylolysis; it is caused by overuse and repetitive mechanical stress or forces. Activities or sports with repetitive hyperextension can cause a stress fracture of the spine. We see a higher incidence of spondylolysis in adolescents – as many as 47% of those with back pain. This is typically higher during growth spurts. The condition is much less frequent in adults. Some estimate 5% of adults with low back pain have spondylolysis.

In some cases, the stress fracture occurs bilaterally and the vertebra can slip forward, which is called spondylolisthesis. If a slipped vertebra presses on a nerve, it might cause severe shooting pain down the leg, and surgery may be required. However, if it breaks and doesn’t slip forward, surgery might not be necessary.

Spondylolysis: Genetic Predisposition?

  • Spondylolysis occurs in 15-70% of first-degree relatives
  • Prevalence
    • White: 6%
    • Black: 2-3%
    • Indigenous American (Inuit): as high as 40%

History Matters

There is a higher prevalence of spondylolysis in elite athletes who report playing sports with repetitive hyperextension/rotation of the lumbar spine. Back pain should raise suspicion in these athletes:

  • Football lineman
  • Cheerleaders
  • Gymnasts
  • Weightlifters
  • Divers / Swimmers

Back pain without a history of injury or repetitive activities is less likely to be caused by a stress fracture. In cases with shooting or decentralized pain, disc herniation should be considered.

Exam

The physical exam to assess for a stress fracture begins with palpation, and pain should be centralized around L5-S1 area. Active extension and hyperextension will be more painful than flexion. Coordination and strength should not be affected unless there is some nerve involvement, but pain may impact their ability to perform activities like heel walking and single leg hopping.

Imaging

In most cases, especially if the patient heard a “pop” and has acute low back pain, a standing anterior-posterior (AP) and lateral X-ray of the lower lumbar spine is recommended.

A study published in the Journal of Pediatric Orthopaedics looked at 2,846 patients with a median age of 14.6 years that were seen for back pain. 76% had no clear cause for their back pain, and less than 61% had two or fewer follow-up visits. This is a good reminder that not every patient with back pain has a stress fracture.
X-rays may not show early signs of spondylolysis. Rather than automatically ordering advanced imaging, a pediatric sports or spine referral may be the best next step because MRIs may also be inconclusive.

Treatment

Treat conservatively first.

  • Activity Modification: 3 – 6 months
  • Physical Therapy: 3 – 6 months
    • Focus on core strengthening to improve lumbar stability
  • Non-steroidal anti-inflammatory drugs (NSAIDS)
    • Meloxicam and/or diclofenac cream
    • Naproxen
  • Bracing may provide comfort but does not affect return to activities.

Often patients only want to do one of these, but that may make extend their recovery by several months.
It is acceptable if a fracture never heals on an X-ray as long as the symptoms go away. If six months of conservative treatments only show slight improvements, a pars injection may help their symptoms. Some patients are injected every six months.

Surgery should always be a last resort.
If the gap is not too wide, a screw is used for a direct pars interarticularis repair. A fusion of the surrounding vertebra may be considered if a loss of motion is acceptable.

Check out our latest on-demand lectures available for medical professionals.

Dallas Morning News: Scottish Rite for Children offers premier scoliosis treatment for pediatric patients

Dallas Morning News: Scottish Rite for Children offers premier scoliosis treatment for pediatric patients

by | May 26, 2021 | Centennial, Press Coverage

Scottish Rite for Children has dedicated the past 100 years to improving the care of children worldwide, offering premier scoliosis treatment for pediatric patients. 

An estimated 9 million school-age youth in the U.S. are affected by scoliosis. At Scottish Rite, researchers in the Sarah M. and Charles E. Seay Center for Musculoskeletal Research are hard at work studying the causes of scoliosis. 

Read more about how Scottish Rite is changing the trajectory for a boundless childhood, with specialized expert care made specifically for growing kids.  

The O&P Edge: Bracing the Curve

The O&P Edge: Bracing the Curve

by | Apr 15, 2021 | Press Coverage, Prosthetics & Orthotics

Scoliosis is one of the most common conditions our experts treat, and it presents in many forms – from the common to the complex. 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. At Scottish Rite, our in-house Orthotics department creates custom braces – making sure it fits the child just right.
 
Orthotics clinical coordinator, Kara Davis, CPO/L, FAAOP, spoke with The O&P Edge, discussing the effectiveness of bracing as a treatment for adolescent idiopathic scoliosis.
 
Read the full article.

Megan E. Johnson, M.D., Joins Scottish Rite for Children’s Surgical Team

Megan E. Johnson, M.D., Joins Scottish Rite for Children’s Surgical Team

by | Sep 24, 2020 | General News

(DALLAS – September 24, 2020) – Megan E. Johnson, M.D.,has joined the pediatric orthopedic surgical staff at Scottish Rite for Children. Johnson completed her fellowship at Scottish Rite for Children in 2015 and will see general pediatric orthopedic surgery patients, with a focus on spine, primarily at the Dallas facility. 

“We feel very fortunate to be able to recruit Dr. Johnson from Vanderbilt as we know she is a superstar who will be a great addition to our team and to the organization,” says Scottish Rite Chief of Staff Daniel J. Sucato, M.D., M.S. “She is someone I would call “talent-plus” as she has all of the hard skills of being a great clinician and surgeon along with the soft skills of being a great individual who will enrich the lives of the children and families we are privileged to treat and will continue to help us deliver the greatest care to our patients.”  

Before completing Scottish Rite for Children’s Dorothy & Bryant Edwards Fellowship in Orthopedics and Scoliosis in 2015, Johnson attended medical school at Vanderbilt University, where she earned her Doctor of Medicine. She completed her orthopedic surgical residency at Vanderbilt University Medical Center in Nashville, Tennessee.  Johnson previously served as an assistant professor of orthopedics at Monroe Carrell Jr. Children’s Hospital of Vanderbilt. 

“I am so excited and grateful to have the opportunity to come back to Scottish Rite and practice orthopedic surgery,” says Johnson. “Scottish Rite is an internationally recognized leader in pediatric orthopedics, and I love that the organization is full of people who share my passion for helping children.”

“Dr. Johnson’s expertise ensures that Scottish Rite continues to be committed to providing exceptional and innovative care to all who enter our doors,” says President/CEO Robert L. Walker. “We are excited to have her back on our team.”

Johnson is board certified by the American Board of Pediatrics in Orthopedic Surgery. She is an Assistant Professor at The University of Texas Southwestern Medical Center Department of Orthopedic Surgery, a member of the American Academy of Orthopaedic Surgeons (AAOS) and the Ruth Jackson Orthopedic Society, as well as a candidate member of the Pediatric Orthopedic Society of North America (POSNA) and the Scoliosis Research Society.