After going through her school's scoliosis screening program, Sha was surprised to learn she had a spinal curve. Today, the teenage dancer is a great example of how early detection of scoliosis, along with careful monitoring and treatment, can make a difference in a young person's future.
When Sha (pronounced "Shay") entered the school nurses' station for her first scoliosis screening, neither she nor her mother suspected anything was wrong with her spine. After all, she'd been dancing almost since she could walk, and between her church and school dance troupes, she spent almost every afternoon perfecting her routines with no apparent problem.
When the curve in her spine was discovered, Sha had joined the ranks of the roughly 100,000 new patients diagnosed with scoliosis each year.1 Today, she's a shining example of how early detection — and continuous, careful monitoring and treatment — of scoliosis can make all the difference in a young girl's life.
Scoliosis is a condition in which the spine develops one or more abnormal, side-to-side curves that in turn may affect the body's overall balance and alignment, as well as possibly lead to other physical and health problems. An estimated 2.8 million Americans have some degree of spinal curvature.2 The condition is more prevalent in females (2%) than in males (0.5%),3 and of those diagnosed each year, some 27,000 have curves severe enough to warrant corrective spine surgery.1 Although the condition can develop at any age, it is most commonly identified between the ages of 9 and 15.
Early detection of scoliosis is critical. Catching a spinal curve early can help minimize its long-term impact on health and quality of life and maximize the potential for correction. Because the condition is common in adolescents, scoliosis screening programs are offered in schools — including Sha's Lancaster, Texas, middle school — throughout the United States. "Until I found out I had it, I didn't even know what scoliosis was," Sha says. "But I looked it up on the Internet and learned a lot. I thought I might be sad about it but I wasn't. Actually I was pretty okay with it."
Sha's screening included a visual exam of her back, as well as a standard physical exam called the Adam's Forward Bend Test. During the test, Sha was asked to bend over at the waist and touch her toes while the nurse checked the alignment of her spine and whether one side of her back appeared higher than the other. Sha's test revealed a very slight curve, one that was so small neither she nor her mother had a clue it was there, since she never showed any of the common outward signs of spinal misalignment, such as uneven shoulders or hips, or clothes that no longer fit right.
After the exam, school officials notified Sha's mom, Gail, who promptly took Sha to see the family doctor. Confirming the diagnosis of scoliosis, Sha's doctor referred the family to Texas Scottish Rite Hospital for Children (TSRHC) in Dallas. TSRHC is one of the nation's leading pediatric centers for the treatment of orthopaedic conditions, such as scoliosis, as well as certain related neurological and learning disorders, such as dyslexia. There is no charge for treatment, and admission is open to Texas children from birth to 18 years.
Treatment of scoliosis depends on the severity of the curve, along with other factors such as the patient's age and physical condition. Non-surgical treatment options, such as observation and bracing, are the first line of defense, and many scoliosis curves never progress to the point where surgery is necessary. Sha's doctor at TSRHC, Chief of Staff Dr. J. A. "Tony" Herring, re-examined Sha's spine, took x-rays, and initially recommended a "wait-and-see" approach to treatment, which included regular follow-up visits to keep a close eye on her curve.
After only two months, Sha's curve had progressed to the point Dr. Herring believed bracing to be the best next step. Working with TSRHC's orthotics department, Sha was fitted with a Boston brace, which she wore for two years. "I had to wear it 18 hours a day," Sha says, "when I was sleeping and at school, which was kind of hard." Dr. Herring continued to monitor her spine, but during the next several months her scoliosis progressed to the extent he finally felt surgery was necessary. At 57°, Sha's curve had started to affect her appearance and mobility, and was also causing her some pain. "Now you could see it; one shoulder was higher than the other and I felt like I had to kind of walk sideways," she says. "My back didn't hurt, but I started to feel some pain in my side, kind of like under my ribs."
Surgery—specifically, spinal fusion—is recommended for severe curves and for curves that have not responded to nonsurgical treatment. Ultimately, the goal of the surgery is to halt the progression of the curve and reduce spinal deformity, to the extent possible, restoring proper spinal stability and alignment. The surgery involves implanting instrumentation, such as screws, rods, hooks and cages, along the treated area to create an "internal cast" to support the vertebral structures and redirect stress properly along the spine during the healing process. During the surgery bone graft material is placed between the affected vertebrae to encourage them to fuse, or join together in the newly aligned position.
Initially, both Sha and her mom were reluctant to take what seemed to them such a drastic step, but because they had worked with Dr. Herring and his staff for so long, they trusted his judgment. "At first I was scared, because I'd never had surgery before," Sha says. "But after Dr. Herring talked with me about it, I knew it was something I needed to do so my curve wouldn't continue to get worse. My mom thought it would be a good idea, too."
Gail, however, recalls hiding her real feelings about surgery from her daughter while she learned more about what her child would be facing. "Sha didn't know it, but I really had a difficult time with the decision," Gail admits. "But I went online and did a lot of research about scoliosis and scoliosis surgery. I was really nervous about the fact that it was her spine. I had questions: Would she lose function? Would she be able to walk afterwards? That kind of thing. I learned a lot online, and I called Dr. Herring's nurse coordinator, Gwen (Monahan), quite often."
Seeing former TSRHC patients also helped allay their fears, Gail says. "Gwen showed us videos of other young ladies who'd had the surgery, and whose surgeries were a success. But I knew every one was different, so I did my research, too."
Instrumentation is a critical component of spinal fusion surgery for the treatment of scoliosis. For Sha's procedure, Dr. Herring used the TSRH® SILO™ 5.5 Spinal System, a versatile, side-loading implant system that allows surgeons to perform very powerful curve derotation maneuvers to address the curve in all three planes — the coronal (front and back), sagittal (left and right), and axial (upper and lower). This is called three-dimensional correction and its ultimate goal is to optimize the potential for curve correction and spinal stability. The TSRH® SILO™ 5.5 Spinal System should be used in sketally mature patients and is a part of Medtronic's TSRH® family of products, so-named because they were developed in collaboration with Texas Scottish Rite Hospital for Children surgeons and biomedical research scientists, including Sha's surgeon, Dr. Herring.
After Sha and Gail decided that the surgery was the best option, Gail made sure to talk with Dr. Herring about the specific risks associated with the TSRH® Spinal System. Dr. Herring told her the potential risks included, but were not limited to, tissue or nerve damage caused by the improper positioning and placement of the implants or instruments, disassembly, bending, and/or breakage of any or all of the components or nonunion (or pseudarthrosis), delayed union, or mal-union. Postoperative change in spinal curvature, loss or correction, height, and/or reduction or pressure on the skin from component parts is possible in patients with inadequate tissue coverage over the implant, possibly causing skin penetration, irritation, internal scarring, tissue death, and/or pain.
Sha and Gail checked into TSRHC on a Monday in late August. Her surgery was scheduled for the following day. "Before we checked in, I really wasn't thinking about it," Sha says. "But then it hit me — I was going to have surgery! The first day, they took some more x-rays, and I was able to talk to the people who would be doing my surgery. That really helped. They comforted me and I wasn't as scared after that."
On Tuesday morning, Sha was prepared for surgery. She was put to sleep with general anesthesia for the duration of the procedure, which took several hours. Her instrumentation extended from her T4 to L1 vertebrae. Postoperatively, her spinal curve measured 21°. "After my surgery, my back hurt, but they gave me medicine for the pain, which helped," she says. "I know I slept a lot. At first I was hurting, so I didn't really want to talk or anything."
On Wednesday, Sha got out of bed to walk for the first time. That Friday, she was cleared to go home. "It took me a little while to walk normally again," she recalls. "Because of my curve I had gotten used to kind of walking sideways, so it was a few weeks before walking straight felt right to me again." Bending over was difficult for about three months. "If I wanted to pick something up I dropped, or to put on my pants, I'd have to squat rather than bend over," she says. "That was hard to do."
By the first week in October, Sha was cleared to return to school. But what she was really ready to do was start dancing again. "I was in a praise dancing group at church, and I also danced at school," she says. "It was really hard to sit out. I've been praise dancing since I was little, and I've been taking dance classes at school since the 2nd grade. We do all kinds — modern, jazz, ballet, hip-hop. And I like it all." After Christmas break, Dr. Herring gave her the go-ahead to ease back into her dance shoes — gently. "I took it easy at first, I didn't want to do anything to hurt my back, but it didn't take me too long to catch back up."
During her recovery, Sha no longer needed to wear her brace, even during the months her spine was healing. One of the benefits of corrective surgery with TSRH® technology is that it eliminates the need for external stabilization. Until a few decades ago, scoliosis patients often spent months encased in plaster casting and strapped into a brace or frame after their procedures.
One year after surgery, Sha has no problem keeping up on the dance floor. "I'm back to doing it all now, but I'm still careful," she says. "I'm happy I had my surgery. Looking back, I don't know why I was so scared. I'm dancing again and I feel really good. Now, if I dance too hard, my back may hurt a little bit, but my side not at all." She's also surprised and pleased that she can't feel the instrumentation placed along her spine. "I can feel the crease in my back, but not anything else. It feels good."
While nobody wants their child to have to go through surgery, Gail says that today she's both relieved and very pleased with her daughter's outcome. "Looking back, I'd say that overall, it was a wonderful experience," She says. "And when I see how well Sha's doing, that really makes it all worth it. As a matter of fact, Sha danced just this last Sunday and did a really superb job."
Both Gail and Sha also are grateful Sha's spinal curve was caught early through her school scoliosis screening program. The smaller a curve is when it's identified, the sooner it can be monitored and the greater the potential for correction and management through non-surgical means. "Initially, I felt like I was the worst parent in the world, because I didn't even see it," Gail admits. "I asked Dr. Herring, 'What did I do? And how could I fail to see it' And he said there's nothing I could have done to prevent it, and that it's easy thing for anyone — including a parent — to miss."
Remembering how much TSRHC's patient videos helped her and Sha with their decision to undergo scoliosis surgery, Gail donated a video of one of Sha's performances to the hospital's collection. "Seeing those videos meant so much to us," she says. "We'd just like to do anything we can to help others going through the same thing."
1. National Inpatient Profile. Chicago, IL: SMG Marketing Group, Inc; 2000.
2. U.S. Census Bureau population/demographics 2000 estimate, Medical Data International Incidence Rates.
3. "Questions and Answers About Scoliosis In Children and Adolescents." National Institute of Arthritis and Musculoskeletal and Skin Diseases. October 1998. http://www.nih.gov/niams/healthinfo/scochild.htm.
After reading this please keep in mind that all treatment and outcome results are specific to the individual patient. Results may vary. Complications, such as infection, blood loss, or nerve damage are some of the potential adverse risks of spinal surgery. Please consult your physician for a complete list of indications, warnings, precautions, adverse events, clinical results, and other important medical information.
When used as a pedicle screw fixation system of the non-cervical posterior spine in skeletally mature patients, the TSRH® Spinal System is indicated for one or more of the following: (1) degenerative disc disease (defined as back pain of discogenic origin with degeneration of the disc confirmed by patient history and radiographic studies), (2) degenerative spondylolisthesis with objective evidence of neurologic impairment, (3) fracture, (4) dislocation, (5) scoliosis, (6) kyphosis, (7) spinal tumor, and/or (8) failed previous fusion (pseudarthrosis).