Search

Posture is important, but for those children diagnosed with scoliosis (spinal curvature) it can be a difficult issue. The Washoe County School District Student Health Services Department screens 7th grade students for scoliosis as growth spurts often reveal the condition and, if diagnosed early, scoliosis can stop progressing. We asked Michael Elliott, MD, head of the Department of Pediatric Orthopedics and Scoliosis to answer some frequently asked questions about scoliosis. What is scoliosis? There are many types of scoliosis: early onset (occurs before age 10), congenital scoliosis is when the bones of the spine do not form correctly, neuromuscular scoliosis which is due to children’s neurologic and muscle disease, and the most common is Adolescent Idiopathic Scoliosis. The term “idiopathic “ means the exact cause is unknown, although we do know it runs in families. This type of scoliosis occurs in 2-3 percent of adolescents and is mainly seen during their growth spurt. This is why middle school screenings are recommended. Both genders get scoliosis but girls are 8 times more likely to have their curves progress and become larger. What are the signs that my child may have scoliosis? A few signs for parents to watch for are: One shoulder might be higher than the other. One leg may seem longer. A hip may be higher or look more prominent. The waist may not look the same from side to side (asymmetry). The trunk or rib cage may be more prominent on one side or shifted. When they bend forward they may have a bump on their back. How is scoliosis diagnosed? It can be noticed by a pediatrician at a physical, school screening nurse, PE teacher or parents. Once the curve is suspected the child is usually referred to a pediatric orthopedic surgeon scoliosis expertise. At the initial visit the doctor will perform a thorough physical including a complete neurologic exam to assess the amount of curvature. Once the exam is completed the physician will determine if a spinal x-ray is needed. The curve on the x-ray is measured utilizing the cobb angle (a measurement in degrees) which helps guide the treatment. What are common treatments for scoliosis? The treatment depends on the size of the spinal curve and the amount of growth the child has remaining. An x-ray of the child’s hand is used to determine the amount of growth remaining. This allows the determination of the child’s bone age, and based on the hands growth plates it can determined if the child is in their rapid phase of growth. Treatments include: Observation - For curves less than 20-25 degrees. This entails visits every 6-9 months with a repeat scoliosis x-ray. Since scoliosis curves increase only 1-2 degrees per month, and variations in measurements can be 3-5 degrees, an x-ray is not recommended before 6 months. If the curve remains less than 25 degrees the child is followed until their growth is completed (usually age 16-18). Progressing Curve - If growth is finished and the curve is less than 40 degrees, the risk of more curvature into adulthood is small. If growth is completed and the curve is over 45 degrees, the child is followed for several years as these curves can progress into adulthood. If the patient is still growing and the curve has progressed greater than 25 degrees but still in the non-operative range (less than 45-50 degrees) bracing is used to stop the progression of the curve. Bracing - Indicated for curves over 25 degrees but less than 45 degrees. If a brace is required you will be referred to an orthotist (bracing specialist). The orthotist assesses your child, reviews the x-ray and then fits the brace. (Having a brace made usually takes 2-3 weeks.) Once the brace is fit, your child will visit the scoliosis specialist for an x-ray in the brace to ensure it fits correctly. The primary goal of bracing is to halt progression of the curve and prevent the need for surgery. The brace must be worn for about 16 hours per day to be effective. In a recent bracing study 72% of the patients who wore their braces as prescribed prevented the need for surgery compared to the group who did not wear their brace. Surgery: When a curve reaches 45-50 degrees, and a child is still growing, surgery is usually recommended because the curve is likely to continue progress. If a curve is over 50 degrees and the child is done growing surgery also may be recommended. This is because when curves are over 50 degrees they tend to increase 1-2 degrees per year for the rest of your life. As curves get larger the amount of lung function tends to decrease which could cause breathing problems later in life. The goals of surgery are to stop the progression of the curve and safely correct any misalignment. This is accomplished by attaching implants (rods, screws, hooks and bands) to the spine. Bone graft is then placed around the implants to encourage the spine to fuse (grow together). This then forms a solid column of bone with metal rods in place, preventing the curve from changing. Most patients are back to their regular sports and activities six months post surgery.

Read More About Ask the Expert: What is Scoliosis?

At Renown Health, our commitment to the experience of all our patients and guests is not just a mission – it's a way of life. Our unwavering dedication to creating exceptional experiences for the communities we serve is what sets us apart. Every day, we strive to build a service culture of excellence, one that ensures that every person who walks through our doors has an extraordinary encounter that exceeds their expectations.  Renown’s Patient Experience department is the team that fulfills this mission and more. These passionate individuals intimately understand that top-of-the-line service involves the entire healthcare continuum, from the first phone call when scheduling an appointment to the final discharge and follow-up instructions and everything in between. With this collective dedication, Patient Experience is consistently on a journey to redefine what it means to leave a lasting impact in the minds of patients, setting a new standard for healthcare excellence in our community.  Our In-House Jack-of-All-Trades  It takes a village to ensure every patient and guest continues to have a positive experience at every Renown location and maintains trust in our providers and employees. Our Patient Experience team serves as the mayors of that village, encompassing four main aspects of healthcare service:  Service Excellence: Compiles, reviews and resolves patient complaints and concerns to help with service recovery and identify opportunities for improvement. Volunteer Services: Enhances the patient experience by leveraging dedicated youth, adult and college-aged volunteers in a variety of volunteer programs, including pet therapy, healing arts, hospice and more. Language Access: Provides qualified interpretation and translation services to assist our limited- or non-English-speaking populations. Data Management: Uses patient experience data, research and surveys to prioritize system, location and unit-specific service needs to improve clinical and quality outcomes.  “Because our department has many segments, no day is the same, which keeps the work week exciting,” said Shelbi Whitehead, Manager of Patient Experience. “Whether we are hosting a pet therapy parade for patients, de-escalating and rounding with upset patients to provide service recovery, offering interpretations for our Limited English Proficiency (LEP) patients, or managing data for the organization, we have one goal in mind: to enhance the experience for our patients and guests at Renown Health.”   Cultivating a sense of community and fostering trust in our health system, the Service Excellence team steps in to ensure no concern goes unnoticed and every opportunity to make a positive chance is addressed.  “My day consists of listening to patient concerns, connecting with different department leaders and providing support, and working on projects to improve processes,” said Julianne Revilla, Customer Experience Specialist. “To help enhance the patient experience, I round with patients on different floors to know more about their stay and experience with us. If they have any issues or concerns, I let floor staff know and do our best to resolve the issue in the moment.”  “My team and I have an amazing opportunity to work with multiple leaders throughout the organization to resolve any patient concerns and provide valuable feedback on how patients are doing while using services that we offer,” added Ricky Garcia Sanchez, Senior Patient Experience Specialist. “A typical day will involve calling patients, rounding with patients, communicating with leaders to resolve events, handling grievances and staying in compliance with Centers for Medicare and Medicaid Services (CMS) guidelines.”  “It’s all about hearing what is upsetting them and letting them know that we care about them,” added Shay Morgan, Customer Experience Specialist. “We ask ourselves, what is the main concern the patient has, and what is it they are seeking? From there, we do our internal investigation through Midas and send it to leadership, and then we find a reasonable and appropriate solution or response to let the patient know we are looking into their concern.”  As the only not-for-profit health system in the region, Renown depends on the dedicated service of our volunteers. Our Volunteer Services team deploys volunteers across many programs who make a significant difference in the lives of patients and their families.  “On a typical day, I may be going between the volunteer information desks assisting that team with anything that comes up while they are helping guests,” said Wendy Peukert, Volunteer Coordinator. “We find wheelchairs for departments, provide guest escorts, deliver flowers and mail to patients, locate doctors’ appointments or anything else that helps someone that walks in the door. We ensure all our programs go smoothly by planning ahead while also being flexible to be ready for anything that comes our way and by keeping communication open with our volunteers. Patients and guests being greeted by friendly, knowledgeable volunteers who show empathy and care is my goal!”  “Some of my best days at Renown are volunteering with my dog Moose, who is a certified therapy dog, and watching the healing he provides to patients and employees,” added Shelbi Whitehead.  At Renown, we believe that language should never be a barrier to receiving care. Our Language Access team ensures that this goal is realized through providing expert interpretation and translation services.  “Renown has many different resources we use to ensure LEP patients and visitors receive a positive, quality visit to our health system,” said Seth Rubin, Supervisor of Language Access. “With signage strategically placed at front desks and check-in areas, patients can point to their preferred language, and we can use the Language Line iPads, phone lines or a dual-role Qualified Medical Interpreter to communicate with the patient or visitor. Within EPIC, we can also set a patient’s preferred language indicating to Renown staff what language to use with the patient and prepare forms in that language. I always ensure all patients are provided with these proper language services, and I also help with employees taking our online interpreter certification course, as well as help when a department needs new Language Line equipment. Additionally, I enjoy meeting with community groups to stay informed on community updates, events and trends around language, immigration and more.”  Renown values and utilizes the opinions of our patients across all corners of our health system Maintaining service transparency is a promise, and that promise is fulfilled by our Data Management team, who use all the research and survey tools at their disposal.  “My daily work includes a lot of updating scorecards across the network, working with the tech teams to ensure the patient data is getting to the right places, training leaders, analyzing market data and maintaining the reports that go to every corner of Renown,” said Brooke Cyphers, Market Data Analyst. “Through a partnership with our patient satisfaction survey vendor, PRC, Renown ensures data integrity, neutrality and credibility in surveying patients in all our care areas. The data from completed surveys are compiled and disseminated to our providers and leadership at all levels with the goal of transparency and patient-centric practice. These surveys are incredibly important to process improvement directly targeted at addressing areas that have been mentioned by our patients. I love it when people reach out to dive into a particular initiative they want to track or an issue they want insights on.”  In their relentless pursuit of excellence in service across many programs, the Patient Experience team remains steadfast in their commitment to delivering the highest quality care and experiences.

Read More About Department Spotlight: Patient Experience