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3 Advanced Scoliosis Treatment Methods

Pediatric scoliosis, which is diagnosed when a curvature of the spine is detected, affects approximately 2 to 3 perfect of school-aged kids. Depending on the severity of the curvature, some patients may need advanced treatment from a trusted facility like the Texas Scottish Rite Hospital for Children (TSRHC). Learn more about this condition and what types of treatment are available to find out if you or your child should see a specialist for treatment.

What’s at Stake

In order to determine the best treatment, specialists consider the following factors regarding a patient’s scoliosis:

  • Degree: How severe is the curve? Does it cause problems in the child’s daily life?
  • Location: Is the curve located in the upper, middle, or lower spine?
  • Maturity: How much growth is left in the child’s spine?
  • Progression: What is the potential for progression? Has the child reached his or her adolescent growth spurt yet?

Keeping an Eye on Things

scoliometer reading

The first type of treatment for scoliosis is observation. This method is limited to milder cases of scoliosis. Typically, a curve of less than 20 degrees are regularly monitored by a doctor to determine if and how much progression is taking place. In these situations, advanced care from a specialized facility like TSRHC is not necessary. The observation can take place through routine clinical examinations and/or radiographic monitoring.

Bracing for the Future

scoliosis brace

For more severe curves of 25 to 45 degrees, braces (also known as orthoses) are often used to treat scoliosis. Scoliosis bracing can help to keep the curve from progressing, particularly during an adolescent growth spurt. Most braces are custom-made from special plastics to conform to the patient’s body. Depending on the patient’s condition, a brace may need to be worn for most of the day and night or only at night.

Scoliosis Surgical Treatment

For the most serious cases of scoliosis, specialists may recommend surgery to treat the condition. About 30 years ago, TSRHC researchers developed a surgical implant that eliminated the need for casts or braces after surgery. TSRHC released a revised version in 2005 that is smaller, easier to use, and more versatile, allowing for improved treatment of scoliosis. This method continues to be one of the most widely used surgical implants for spinal deformity. TSRHC has also recently started utilizing magnetic spinal rod systems that can be easily adjusted in minutes with no anesthesia, surgery, or recovery required.

What’s Next in Scoliosis Research

Scoliosis research

TSRHC continues to be at the top of the field when it comes to scoliosis research. In 2007, researchers at TSRHC identified the first gene linked to idiopathic scoliosis. Two other genes lending insight to this condition were also identified. With these discoveries, TSRHC may be able to ultimately find a genetic cause for scoliosis.

Being diagnosed with scoliosis doesn’t have to be scary for kids (or their parents). At TSRHC, patients can receive highly innovative scoliosis treatments from advanced specialists in the field.

5 Facts About the Movement Science Laboratory at TSRHC

Screen Shot 2015-09-03 at_ 11.08.50 AMThe Movement Science Laboratory at Texas Scottish Rite Hospital for Children uses revolutionary technology to evaluate and identify pediatric movement, so doctors can decide on the best course of treatment.

What is the Movement Science Laboratory, and how does it benefit children, researchers and the community?

Technology Based on Video Games

The same technology that helps designers create video games contributes to the work in the Movement Science Laboratory. The laboratory’s staff employs multiple cameras that track markers on a child’s body. As the child moves through the exercises in the laboratory, the cameras record and process the information. A computer translates that data into a moving stick figure that doctors and scientists can then analyze.


Laboratory Used for Both Treatment and Research

Staff members at the Movement Science Laboratory use the technology to research disorders and conditions that impact pediatric movement. However, the laboratory also serves as a diagnostic aid, so it serves double duty, both conducting research and providing treatment. Doctors refer children to TSRHC for observation and evaluation.

Staff Can Measure Multiple Types of Movement

The camera- and computer-aided technology only constitutes part of the research conducted at the Movement Science Laboratory. Researchers at TSRHC use the facility to measure all types of movement. For example, a plate embedded in the laboratory’s floor allows researchers to measure the pressure a child exerts with each step.

Other devices help to measure a child’s limb strength, flexibility, range of motion, and dynamic joint motion. Researchers can also do electromyography (EMG) to analyze the electrical signals muscles send to the brain during movement.

Staff Is Comfortable Working With Children

Kids often develop anxiety when faced with a clinical setting. Fortunately, the TSRHC staff knows how to help children feel comfortable and safe. When kids visit for research or testing, staff members encourage parents to bring along favorite toys or stuffed animals, so their children feel more at home.

Additionally, after staff members record a child’s movements via the cameras and computers, they invite the child to show off a fun movement of his or her choice. Seeing a crazy dance on the screen, for instance, shows children the fun side of the experience.

You Can Participate

The Movement Science Laboratory at TSRHC invites participants who wish to give their time to research. You can call 214-559-7580 to talk about participation in a research study. If you meet the project’s qualifications, you have a chance to help TSRHC make an even greater impact on children’s lives.

You might also find yourself at the laboratory because of your pediatrician’s concerns about your child’s movements. In addition to movement disorders and conditions, the laboratory also works with children who wear prosthetic devices.

The Movement Science Lab creates a safe, high-tech space for studying and diagnosing movement issues in children. Whether you are visiting for research or diagnostics, you can benefit from the experience.

5 Common Questions About Limb Lengthening

If your limbs aren’t the same length, you can experience problems as you grow. In some cases, doctors can use a limb-lengthening device to even your limbs out, making it easier for you to life an active, healthy life. If you’re curious about what limb lengthening involves and how it will affect your day-to-day life, you’ll find the answers you’re looking for here.

Do I Have to Have Surgery?

If the difference between the lengths of your limbs is significant (more than 1 inch), you may need surgery to correct the condition. At Texas Scottish Rite Hospital for Children (TSRHC), physicians have developed an advanced device called the TRUE/LOK™ External Fixation System, a modification of the Ilizarov Frame, that helps your limb grow over a number of months. This device is attached to your body during surgery.

How Does the Limb-Lengthening Device Work?

During surgery, doctors separate the bone in your shorter limb. The TRUE/LOK™ External Fixation System has rods that are attached to this part of the bone. These rods are connected to an external frame attached to the outside of your limb. The frame will support your limb while the rods help the bone to grow. Over the course of many months, your limb could be lengthened by up to 6 inches!

Limb Lengthening

Will Limb Lengthening Hurt?

During surgery, you’ll be under anesthesia, so you won’t feel a thing. As you wear the frame, however, you may experience some discomfort. Some patients feel soreness when they have to turn the rods to help their bones lengthen. Your doctor may be able to give you medication to minimize the pain. In addition, TSRHC has psychologists who can teach you other ways to manage your pain.

How Long Will I Wear the Frame?

The amount of time you will need to wear the frame will be determined by how much your limb needs to grow. For most patients, the TRUE/LOK™ only needs to be worn for six to nine months. During that time, you’ll turn the rods several times per day to help the bone in your limb grow. Most of the bone lengthening actually takes place in the first few months. After that, the frame is worn for stability as your bones heal into place.

Can I Still Act Like a Normal Kid?

After you spend a little time healing from your surgery, you can go back to school. You can also participate in your favorite activities while you wear the frame, including most sports. You can even go swimming as long as you swim in a salinated or chlorinated pool. Your wardrobe may need to be adjusted to include pants, shorts, or skirts that fit over your TRUE/LOK™ frame. Because you’ll only have to visit the doctor every couple of weeks, you’ll essentially be able to keep up your regular routine.

Think of limb lengthening like wearing braces on your teeth. It causes a little discomfort at the time, but it’s worth it in the long run.. You’ll be in great hands when you have your limb lengthening done by the experts at TSRHC.

Understanding Pediatric Rheumatology

Pediatric rheumatology is a medical discipline that strives to address arthritis and other rheumatic conditions in children. What does pediatric rheumatology involve? What causes rheumatic conditions in children? What can doctors do to help?

Rheumatology—An Overview

Rheumatologists deal a lot with arthritis, but “arthritis” is a broad term that takes in more than a hundred unique conditions.

Doctors will diagnose rheumatic conditions by taking note of symptoms such as swelling and stiffness in the joints, a limited range of motion, and pain in the joints, muscles or other bodily structures. Some conditions may also come with fever, weakness or rash. A skilled rheumatologist will make note of all symptoms and perform tests to determine which condition is affecting the child.

Examples of Rheumatic Conditions

There are many more rheumatic conditions than listed here, but some of the most common conditions that we treat at TSRHC include:

  • Juvenile arthritis
  • Scleroderma
  • Vasculitis
  • Dermatomyositis:

Other reasons for referral may include:

  • · Prolonged joint swelling or pain
  • · Non-traumatic musculoskeletal pain
  • · Weakness
  • · Rash
  • · Fever of unknown origin

Causes of Rheumatic Conditions in Children

Pediatric Rheumatology

Scientists have yet to pinpoint the exact causes for most rheumatic conditions. However, there are several factors that may play a role in the occurrence of these diseases. Genetics, trauma, infection, certain hormones, strenuous wear and tear on joints, and metabolic disturbances could all have something to do with the onset or worsening of rheumatic conditions.

Pediatric Rheumatology and TSRHC

In 1956, the hospital established one of the country’s first pediatric rheumatology clinics. Today the clinic is led by internationally recognized pediatric rheumatologist Marilynn Punaro, M.D. TSRHC’s rheumatology clinic is widely recognized as one of the nation’s premier clinical treatment and research centers for rheumatic conditions, including juvenile arthritis, dermatomyositis and scleroderma.

For more information about becoming a patient at TSRHC, please visit www.tsrhc.org/becoming-a-patient or contact our patient access department at (214) 559-7477.

Meet the Prevou family, whose struggle with an advanced form of arthritis led researchers at TSRHC to conduct a genetic study of the disease. The study resulted in better treatment methods for the three Prevou brothers, all now in college, and others suffering from PAPA syndrome.

What turns a young athlete into a lifelong athlete? – TSRHC Sports Medicine

Various specialties have studied the characteristics that make a young athlete stick with his or her sport. From a psychological perspective, those who think sports are fun are more likely to continue to participate in sports and later, lead a healthier lifestyle that includes physical activity.

softballAround 12 or 13 years old, athletes progress to a more competitive sport environment and the pressures really start to grow. Winning, or being the best, becomes more important as elite team tryouts and college scholarship dreams come into play.

According to TSRHC Psychology Fellow and Sport Psychologist, Dr. Erica Force, this is the window of time where athletes begin to drop out of sports completely. “To keep our kids participating in physical activity for the long term, it’s important for parents to foster a positive and fun environment. Parents can do that by asking questions that focus on effort and hard work rather than only asking questions about results of the competition.”

Here are some ideas to help shift the conversation from negative to positive:

  • Be a good listener and offer encouragement regardless of the outcome of a game
  • Keep your own emotions under control
  • Ask about their experience while playing:
    • Did you put forth your best effort?
    • Did you have fun?
    • Did you help your team?
    • Were you a good sport?

For information about TSRHC’s Sports Medicine Center, please visit our website at tsrhc.org/sports. For information on TSRHC’s Psychology Department, please visit tsrhc.org/psychology.

Have you ever thought about how bones grow? – TSRHC Sports Medicine

We all know that our ears and nose have soft tissue called cartilage. But many don’t realize that this is also found in young bones. These areas are called growth centers and are filled with cartilage until those cells are replaced with bone. Like our ears, these areas in pediatric bones are soft and pliable. This increases the risk of damage from traumatic injuries, and even common orthopedic procedures.


Some growth centers are called epiphyses, which typically lead to changes in the length of a bone. Tendons and muscles are connected to other growth centers called apophyses, which typically control the changes in the shape of a bone. The muscle pulling on these centers adds to the risk of injury. The growth centers “show up” and “go away” in x-rays in certain sequences. Pediatric orthopedic sports surgeons, like Dr. Philip Wilson and Dr. Henry Ellis, have studied how bones grow and how to assess how much growth is left by looking at x-rays. Many times, the most helpful x-ray is of the hand, where there are many growth centers to assess. With this expertise, they are able to offer the right treatment at the right time for young athletes with joint injuries.

According to Dr. Ellis, taking care of young athletes is very different than taking care of adults. He says, “We must take into consideration how much more growing an athlete will do, especially when managing fractures and complex knee ligament injuries.”

Decisions made in the early years of growth have the potential to impact knee alignment and leg symmetry years later. The risk of these complications is low with proper management by pediatric specialists.

For information about TSRHC’s Center for Excellence in Sports Medicine, please visit our website at tsrhc.org/sports.

TSRHC Welcomes New Hand Surgeon Dr. Christopher Stutz

Stutz - Whitecoat copyPediatric orthopedic hand surgeon Dr. Christopher M. Stutz has joined the staff of TSRHC, working with the team at the Charles E. Seay, Jr. Hand Center led by Dr. Marybeth Ezaki.

Stutz earned his medical degree from the University of Texas Health Science Center at Houston and completed an internship and residency at Vanderbilt University Medical Center in Nashville, Tenn. He was a hand and micro-vascular surgery fellow at Washington University and a congenital hand surgery fellow at TSRHC.

Stutz is an assistant professor of orthopedic surgery at UT Southwestern Medical Center and certified by the American Board of Orthopaedic Surgery. He is a member of the Pediatric Orthopaedic Society of North America and a candidate member of the American Society for Surgery of the Hand and the American Academy of Orthopaedic Surgery.

Read more about Stutz in his bio. Welcome to Scottish Rite Hospital!!

Researchers from TSRHC Find Clues Relating Scoliosis to Gender

Adolescent scoliosis, the spine-twisting condition that affects two to three percent of the population, has long mystified scientists. Scoliosis often runs in families, but until now, researchers haven’t been able to pinpoint a specific cause for the progressive deformity. However, thanks to a recent study conducted by Dr. Carol Wise of Texas Scottish Rite Hospital for Children (TSRHC), scientists are now one step closer to identifying a cause and hopefully a cure.

Different Types of Scoliosis

Scoliosis is classified in several ways. Children with congenital scoliosis are born with a vertebral defect that can eventually lead to a spine curvature of 50 percent or more. By contrast, children with neuromuscular scoliosis suffer a degenerative spinal condition that results from a neuromuscular condition such as cerebral palsy or spinal cord injury. In about 80-85 percent of all cases, doctors are unable to find the cause of scoliosis.

Scoliosis Genetics Research

PAX1 Gene: Girls vs. Boys

Because scoliosis often affects members of the same family, researchers suspect that genetic factors play a role in its development. When Wise and her team investigated a gene that influences early spinal development called PAX1, they made an astonishing discovery: Boys with scoliosis don’t manifest PAX1 genetic markers for the disease, but girls with the diagnosis do. In fact, most boys – those with scoliosis and those without – harbor no markers for the condition in their PAX1 genes.

This significant finding suggests that gender differences buried within the PAX1 gene could contribute to the development of scoliosis in girls. It also suggests that, for boys, other genetic factors might play a part in the condition’s development. TSRHC’s findings support the notion that scoliosis doesn’t have one “blanket” cause; different children suffer from the deformity for different reasons. Wise’s data has validated researchers’ urgent need to probe gender-specific links to the disease.

scoliosis cause researchNext Steps

Ideally, doctors will use Wise’s results to evaluate female patients’ PAX1 markers and catch scoliosis in its earliest phase before surgery becomes necessary. According to the Scoliosis Research Society, children with a curvature of 50 percent often need spinal fusion surgery, a treatment process that takes four weeks or more to heal.

Similarly, scientists now know that the PAX1 gene isn’t a useful tool when it comes to predicting scoliosis in boys. Researchers can now move on to the investigation of other possible genetic culprits with confidence.

Scoliosis No More

For nearly a century, TSRHC physicians and staff have worked shoulder to better understand orthopedic conditions in children. Thanks to the work of Wise and her team, scoliosis specialists across the globe have taken a giant step forward. It is hoped that prevention measures will eventually flourish, and that scoliosis will become as obsolete as polio, the measles, and chicken pox.

5 Signs Your Injured Athlete May Need a Little Extra Help

Imagine being a 16-year-old athlete, with your whole future ahead of you. You spend all your time playing, thinking and dreaming about soccer. Then, your season abruptly comes to an end with a ligament injury and your doctor tells you there’s no soccer for 6 months, at best.

UntitledOur Sports Medicine team knows this scenario all too well. We see athletes of all kinds encounter this, and six months later, they are back on the field. They often express disappointment and anxiety early in the cycle, but their drive to conquer rehabilitation and return to sports wins in the end.

Unfortunately, we also see some athletes that can’t quite get past that anxiety about returning to sports. “If there are any additional stressors at home or school, injury recovery can be a difficult process,” according to Dr. Sandy Roland, TSRHC’s Director of Psychology. She says that being a teenager is tough, but dealing with a life-changing sports injury on top of underlying stressors like depression, family tension, or tough social environments can be too much for some to handle.

Dr. Roland works closely with the sports medicine team to identify concerning signs and symptoms in our injured athletes. Though it’s only a small part of the care we provide, it’s a critical component to pediatric sports medicine. It’s another way we are taking care of the whole athlete, and not just the injury.

Parents, you should ask your child’s medical provider for help if you notice changes in any of these:

  • Sleep patterns
  • Decreased attention or concentration in school
  • Worsening grades
  • Socialization patterns like less time with friends
  • Mood

For information about TSRHC’s Center for Excellence in Sports Medicine, please visit our website at tsrhc.org/sports. For information on TSRHC’s Psychology Department, please visit tsrhc.org/psychology.


Winter: the Dolphin with the Prosthetic Tail

wintertail copyA few of our staff members attended the Association of Children’s Orthotic-Prosthetic Clinics (ACPOC) annual conference in Clearwater Beach, FL earlier this month. ACPOC is an association of interdisciplinary professionals who are involved in providing prosthetic-orthotic care for children with limb loss or orthopedic disabilities.  We participated in the conference by presenting two clinical papers, which were very well received and encouraged valuable discussion. The hospital was even specially recognized by ACPOC for our attendance to the conference as a team!

Despite the long hours at the conference, Amanda Brown from Prosthetics and Orthotics and Jesse Kowalski from Physical Therapy managed to squeeze in some time to spend an afternoon at the Clearwater Beach Aquarium. This special aquarium is home to Winter, the famous dolphin. Winter is the only known dolphin in the world missing her tail, and was featured on the big screen in Dolphin Tales.

IMG_0295 copy

Like many of our patients, Winter has scoliosis and kyphosis, which has caused her to wear a prosthetic tail. She wears her prosthetic device during physical therapy sessions to help decrease the progression of the curvature of her spine, and has to do other types of stretching and exercise too. Her prosthesis helps keep her healthy and happy so she can do what dolphins do best… play!