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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.

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Renown Health is proud to debut our newest commercial spot, Days, on Thanksgiving Day 2022. This commercial features members of the greater northern Nevada community, former Renown patients and employees. Chris and Ann Cook are some of these community members, and we are grateful we get to tell their story. Family is everything for Chris and Ann Cook. Their loved ones span across the United States and even farther to Germany, so time spent with their children and grandchildren means the world to them. When Chris went to the emergency room for a persistent headache and drooping eye over twenty years ago, they could have never predicted the number of hours their family would spend at Renown care facilities in the coming years. “Whenever we step inside a building with that purple logo, we know right away we will be supported by friends, family and Renown staff. Our family has turned countless hours inside hospital walls into memories of gratitude for the care we receive.” Chris Cook said. “It is these memories that make us appreciate the health of our family today.”   A Relationship with Renown that Spans Decades The Cooks can remember a time before Renown Regional Medical Center’s inception when Washoe Medical Center (Washoe Med) stood in its place. It was at Washoe Med that Chris received emergency brain surgery after a visit to the emergency room over 20 years ago. Immediately following a CT scan, Chris was transported to Washoe Med, now Renown Health, for emergency brain surgery and eventually to treat a hematoma. Doctors close to his case were amazed by his survival, considering Chris’ divergent situation resulting from a raisin-size colloid cyst and dissected corotated artery. He spent three weeks in the ICU recovering at the hospital, his spirits lifted by the amazing staff who brightened his day with gestures of kindness. From there, he was supported by countless friends and family members over the next three months while recovering at home. A Home Away from Home Later, the Cooks’ daughter received cancer care at Renown at the William N. Pennington Cancer Institute. Ann, Chris and their daughter found small comforts when running into the familiar faces of their daughters' past schoolmates, who are now Renown employees, in the hallways. The family became well-acquainted with the food options at Renown Regional’s Sierra Café, even finding favorites like the sushi bar. Reliable Care, Close to Home  The Cooks have also experienced many happy and comforting memories at Renown and Washoe Med over the past twenty years, including the births of three of their seven grandchildren. And when Chris needed an emergency appendectomy on a Friday night four years ago, they felt confident that the best care would be received at Renown Regional Medical Center.    From lab work to routine procedures or visits to urgent care, the Cooks feel rest-assured knowing Renown will be the place they can consistently trust for care with many locations close to their home in Sparks, Nevada.  After spending many hours within Renown walls, Chris and Ann remarked how impressed they were by Renown Regional Medical Center’s growth in the past decade from their first encounter over twenty years ago. With a deep appreciation for the care received at Renown facilities and the technology used to help treat patients, Chris and Ann said, “We really feel confident that if something bad were to happen, you’d want to be in the care of Renown.”  Family, Health and The Future "Our care at Renown has changed the course of our family’s lives and led to the success of who we are today. So, when the team at Renown approached us about participating in the commercial shoot, we knew this was meant to be the next piece in our Renown story." Chris and Ann said. "Of course, it was nice to be back at Renown, not as a patient this time, but to help the team create something great."

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