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Share Your Story: Hole in One

Share Your Story: Hole in One

by | Jun 2, 2020 | Scoliosis & Spine, Uncategorized

Meet Phoebe, a patient seen by our spine experts. Learn more about her journey below.

Blog written by Phoebe’s mom, Victoria of Rockwall, TX.

When Phoebe was in sixth grade, she had her annual pediatrician visit and that was when our doctor first recommended further evaluation of her back. Phoebe’s shoulders were uneven, and she appeared to have an abnormal spinal curve. Our pediatrician recommended that we go to Scottish Rite for Children.

Phoebe became Dr. McIntosh’s patient and due to the degree of curvature in Phoebe’s spine, a scoliosis back brace was highly recommended and necessary to stop the progression of the curve. As a mother of a beautiful, young and active daughter, the news was a hard pill to swallow. We were very nervous and afraid of how the brace was going to impact our daughter’s lifestyle. Dr. McIntosh was very understanding and thorough, answered all our questions and made us, especially Phoebe, feel comfortable.

Dr. McIntosh is an expert and we felt confident that our daughter was in great hands.

That same day, we met with Kelsey in the Prosthetics department. She took measurements and designed Phoebe’s back brace. Phoebe loved all the staff and doctors but felt a special connection with Kelsey. She was funny, young at heart and spent a lot of time with Phoebe during the brace adjustments.

At that time, Phoebe was 11 years old and about to transition from elementary to middle school. It was hard to see her wear a thick plastic brace during the hot 100+ degree weather. Phoebe has always been tough, and she rarely complained. She didn’t like the brace, but she knew that it was the only option to stop the curvature progression. Many times, she would even wear it for more than the 20 hours a day that was recommended. She started with a 19-degree curvature and at the end of the process, she was at a 17-degree curvature, which was great.

As a family, we did different activities together and allowed Phoebe to try many different sports. Phoebe was able to play soccer and basketball, run track, and even participated in cheerleading – all throughout her bracing process. Dana Dempsey, the Scottish Rite Director of Therapeutic Recreation, invited us to participate in a Learn to Golf clinic. It was at this clinic when Phoebe decided to try golf and she fell in love with the sport! Through the years, she has participated in several different Learn to Golf clinics and is now on the varsity golf team at her high school. She even made the varsity team as a freshman!

We are beyond grateful for all of the staff and volunteers at Scottish Rite. Phoebe’s scoliosis experience was much brighter due to the care and love she felt, and we strongly recommend Scottish Rite to anyone else that may be going down this path.

Learn more about Phoebe’s Story and see how Learn to Golf changed her life. Click here.

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

Share Your Story: Caroline’s Curve

Share Your Story: Caroline’s Curve

by | Jun 11, 2019 | Scoliosis & Spine

Meet Caroline, a patient who is treated by our spine experts. Learn more about her journey below.

Blog written by Caroline’s mom, Christina, of Dallas. 

“What’s that little lump on her back?” This is how Caroline’s congenital scoliosis journey began, when she was almost nine months old.

We noticed a small lump on her back, around her spine, when she was leaning forward in the bathtub one evening. This discovery led to a lot of internet research and had me in tears, wondering what it could be. 
 
Her nine-month check-up was approaching, and we had her pediatrician take a look at her back. After his examination, he referred us to a pediatric orthopedic specialist

We were able to get in rather quickly and it was then that she was diagnosed with congenital scoliosis. Caroline had a 24-degree curve, plus a single hemivertebra at L2. When the doctor laid out the X-rays, we could immediately see that her spine was curved. We left that appointment in tears, shocked and terrified by all the things we had just been told. We were completely overcome with worry for our sweet girl and what her future would look like. He then referred us to the experts at Texas Scottish Rite Hospital for Children. Living in Dallas, we were familiar with the hospital.   

We immediately scheduled our appointment. Before our first visit, we did a good amount of research, just like any concerned parent would. We worried, we cried, we prayed, and we hoped for the best. When it was time for our appointment, we were prepared with all of our questions. When we arrived at the hospital, we were greeted with the smell of fresh popcorn and the sound of laughter from other children.

Every single person we saw had a smile on their face and was so friendly to Caroline and our family, putting us at ease.     

 
They took more X-rays of her back and chest, weighed and measured her, and then we waited to see Dr. McIntosh. As soon as she walked in, she told us that Caroline’s case was “not that bad.” She must have seen the extreme concern on our faces because her saying that immediately made our worries go away.  

She confirmed that it was congenital scoliosis with a single hemivertebra at L2. The hospital has a X-ray machine where the child stands upright rather than laying down. This method gives a more accurate reading. Here, her curve was only 19 degrees.
 
We also learned that since her hemivertebra was lower in her spine, it was not connected to nerves and there was no need to worry about possible nerve issues. She advised us to get Caroline’s heart and kidneys checked out since a large percentage of congenital scoliosis cases can also have heart or kidney issues. Her heart and kidneys ended up being just fine! We were so thankful.  

Dr. McIntosh said that she simply wanted to monitor Caroline and see her every six months. At our next appointment, there had been very little progression in Caroline’s curve – this was great news! Dr. McIntosh said that they will usually perform surgery once the curve gets to 40 degrees and the slower the progression, the more time Caroline will have to grow before possibly having to have surgery.    
 
We continue going for check-ups to monitor Caroline’s spine. We’ve been told there is a tiny chance she may never need surgery, but if she does, we feel confident in the doctors at Scottish Rite Hospital and no longer worry about our sweet girl. 

We have had such a wonderful experience and want to help others have the same opportunity. Caroline and I make children’s bracelets and we donate 100% of the proceeds back to the hospital.
 

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

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.
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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D CEO: Scottish Rite Wins Texas Hospital Association Award for Reducing Surgical Site Infections

D CEO: Scottish Rite Wins Texas Hospital Association Award for Reducing Surgical Site Infections

by | Mar 23, 2018 | Press Coverage, Research & Innovation

View original story on D CEO’s website here.

Dallas-based Texas Scottish Rite Hospital for Children won an award from the Texas Hospital Association for an initiative that reduced surgical site infection (SSI) rates among spinal fusion patients by 88 percent in 2016, the hospital said in a news release this week.

Scottish Rite Hospital received THA’s 2017 Bill Aston Award for Quality for its six-step bundled intervention approach. The award goes to a member hospital that has “measurable success in improving quality and patient outcomes through implementation of an evidence-based patient care initiative.”

Scottish Rite Hospital approached the issue in 2016 with a multidisciplinary committee that sought to improve the hospital’s quality and patient safety outcomes.

“Providing world-class orthopedic care is our highest priority,” Matt Chance, senior vice president of operations for Scottish Rite Hospital, said in a statement. “The continued efforts of our Quality Improvement team and the SSI committee to refine our procedures is just another example of how we constantly challenge ourselves to improve outcomes for our patients.”

For the full release, visit here.