Luhmann SJ , Smith JC.


BACKGROUND:  Surgical-site infections are one of the most concerning complications in patients treated with growing rods (GR). The purpose of this study was to evaluate the use of preoperative screening for Staphylococcus aureus (SA) for all growing spine procedures, and if this would permit alteration of prophylactic antibiotics to cover the identified resistances.

METHODS:  All patients were identified who had SA screening during the course of GR treatment. In total, 34 patients [23 neuromuscular (NMS), 4 congenital, 4 idiopathic scoliosis (IS), and 3 syndromic] were identified who had 111 preoperative screenings [79 lengthenings, 23 insertions, 6 revisions, and 3 conversions to posterior spinal fusions (PSF)]. Mean age at GR insertion was 5.5 years (2 to 11 y).

RESULTS:  There were 11 methicillin-resistant Staphylococcus aureus (MRSA) “+” screenings in 6 patients (5 NMS, 1 IS): 3 in 3 patients before GR insertion and 8 in 3 patients (all 3 were negative at GR insertion screening) at subsequent surgeries. There were 23 methicillin-sensitive Staphylococcus aureus (MSSA) “+” screenings in 12 patients (7 NMS, 2 congenital, 2 IS, 1 syndromic): 2 in 2 patients before GR insertion and 21 in 10 patients at subsequent surgeries (18 lengthenings, 3 revisions). Overall, 13 patients (3 MRSA+10 MSSA) were initially negative but screened positive for the first time at a subsequent surgery (12 lengthenings, 1 GR to PSF). All patients (n=5) with positive screenings before GR insertion were in patients with NMS (3 MRSA, 2 MSSA). On the basis of sensitivities, 9 patients demonstrated SA resistance to cefazolin (8 MRSA and 1 MSSA) and 6 to clindamycin (5 MRSA and 1 MSSA). Hence, if cefazolin was routinely used for all patients 26.5% of patients (9/34) would have been inadequately covered at some point during their GR treatment; clindamycin, 17.7% (6/34).

CONCLUSION:  The use of SA nasal swab screening in GR patients identified 9 patients (26.5%) whose prophylactic antibiotics (cefazolin) could be altered to permit appropriate SA coverage.

LEVEL OF EVIDENCE:  Level IV-retrospective case series.

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Good Morning America anchor George Stephanopoulos and his wife, Ali Wentworth, revealed on social media that their 14-year-old daughter has scoliosis.

The couple both shared posts to their individual Twitter accounts on Monday morning writing that they are proud of their daughter, Elliott, for wearing her brace everyday.

‘So proud of my daughter wearing her brace every day! #LeaningUp #NationalScoliosisAwarenessMonth’, the 52-year-old actress tweeted.

Her father tweeted a similar message and wrote: ‘So proud of my daughter Elliott. Wearing brace every day. #NationalScoliosisMonth’.

In revealing the information about Elliott, the couple of 16 years posted the same photo collage of the teen standing outside wearing the brace, which usually helps the curve from worsening those who are affected.

Elliot is the couple’s oldest child, as they also have another daughter, Harper, who is 12 years old.

Many Twitter users sent the couple well wishes of support and encouraging the teen after they shared the information about her in an effort to raise awareness.

‘She’s absolutely gorgeous! Proud of her for knowing her health is most important. She’s someone for kids her age to look up to’, one Twitter user wrote.

Many Twitter users sent the couple well wishes of support and encouragement to Elliott. She is pictured above left in 2016 and right in 2010 cutting a cake as her dad holds her younger sister

Another person tweeted, ‘Rock on Elliott! Not easy, but worth it. I had one for two years in middle school. Much love! #NationalScoliosisAwarenessMonth’.

Scoliosis is a sideways curvature of the spine that happens most often in teens during the growth spurt right before puberty, according to the Mayo Clinic.

The cause of most scoliosis is unknown, but it can sometimes be linked to conditions such as cerebral palsy and muscular dystrophy.


Often times the cases of scoliosis are mild, however, some children can develop spine deformities that continue to become severe as they grow.

It seems as though the couple shared the information about Elliot in an effort to raise awareness for scoliosis. The family is pictured above in 2014 at the ‘Penguins of Madagascar’ premiere

Severe cases can become disabling, as it can reduce the amount of space within the chest making it hard for the lungs to function properly.

Doctors monitor children who have mild scoliosis cases closely with X-rays to determine if it is getting worse.

Most cases require no treatment, but some who are affected are required to wear a brace to stop the curve from worsening.

More severe cases require some to undergo surgery to keep it from worsening.


Scoliosis is a sideways curvature of the spine that occurs most often during the growth spurt just before puberty.

While scoliosis can be caused by conditions such as cerebral palsy and muscular dystrophy, the cause of most scoliosis is unknown.

Most cases of scoliosis are mild, but some children develop spine deformities that continue to get more severe as they grow.

Severe scoliosis can be disabling. An especially severe spinal curve can reduce the amount of space within the chest, making it difficult for the lungs to function properly.

Children who have mild scoliosis are monitored closely, usually with X-rays, to see if the curve is getting worse. In many cases, no treatment is necessary.

Some children will need to wear a brace to stop the curve from worsening.

Others may need surgery to keep the scoliosis from worsening and to straighten severe cases of scoliosis.


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Local Ooltewah teen Kaitlyn McAfee, has reached out to Governor Bill Haslam

for the last four years to ask him to proclaim June as National Scoliosis

Awareness Month.


Ms. McAfee, diagnosed with scoliosis at age 12 has been an advocate for

scoliosis awareness since her own diagnosis. Since her spinal fusion surgery,

she founded Color the Curve the official fundraising event of the National

Scoliosis Foundation, donating nearly $60,000 for scoliosis research. She

created The Curve Scoliosis, the official statewide support group for scoliosis.

Ms. McAfee serves on the National Scoliosis Foundations Angel Brigade, as

Cofundraising director for the National Scoliosis Foundation and plans to offer

free scoliosis screenings to middle school age children this fall.


“Early detection of scoliosis is important and schools in Tennessee are no

longer required to screen for it,” officials said. “Kaitlyn is a strong advocate for

early detection and supporting anyone facing a scoliosis diagnosis.”


For more information visit


The next Color the Curve event will be a glow run held on June 30, 2018 at Coolidge Park. Participants from all over the world are expected to participate. Scoliosis is a sideways curvature of the spine. Severe scoliosis can be disabling.

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Letting scoliosis interfere with practicing yoga, riding her bicycle or rollerblading wasn’t an option for Jamira Bucknor, who was born with the spine-curving condition.  She resisted wearing a brace, even though a pediatrician recommended one. Her parents agreed to delay the brace and practice watchful waiting.
“We kept getting (her back) x-rayed,” said Sharie Hoo, Jamira’s mother. “We knew it would start to bend a little but we were hoping, her dad and I, it would stabilize.“
The Lakeland girl did fairly well until she was about 8. Then she began leaning more and complaining about being uncomfortable. X-rays showed more curvature of her spine.  “She was secure in her identity, but it made her a little more self conscious about things she wore and standing next to her sister,” said Hoo, an ultrasound technician.  “She used to be straight and tall like her.“
Once curvature reached a certain point, Jamira’s doctor warned, her whole body would spin to the side.
“You don’t want to go to school,” said stepfather Chris Hoo, who is with the Lakeland Police Department.  “Being spin-ly,” said Jamira, finishing her stepfather’s thought. Jamira is now 11.
For most people who have scoliosis, it’s mild enough not to need active treatment. Monitoring will suffice. Others need braces or surgery to stop or
significantly reduce the rate at which the spine curves.

Dr. Chukwuka C. Okafor, an orthopedic spine surgery specialist in Lakeland, implanted rods in Jamira’s back a year ago to stabilize her spine. The surgery took 4 hours, 25 minutes, but to Jamira’s mother it felt more like eight or nine.  There were a couple of hours for preparation and a couple more for recovery.  Jamira was under anesthesia.

Implanting rods can be a one-time procedure for adults. It’s more complicated for children and teens whose bodies keep growing. They need frequent
adjustments of the rods to allow for growth in the chest cavity. In the past, those adjustments meant repeat surgeries, Okafor said. Adjustment surgeries, although less intensive than the first, still needed anesthesia.  A different system used for Jamira can make those adjustments less arduous. It’s called MAGEC, for magnetic expansion control, a non-invasive growth modulator.

The surgery was done with two incisions, each 1.75 inches. Remote-controlled rods 235 millimeters ( 9 and quarter inches ) long were implanted.
The rods still need lengthening as she grows but instead of going into a hospital for surgeries Jamira comes to Okafor’s office and lies on the exam table. An external remote control, containing magnets, interacts with magnets within the rods to extend their length.
“Before this, every six months the patient went back to surgery to open the spine and remove or replace the rod,” Okafor said.
“The great advantage of this novel and cutting edge treatment is that it allows (a patient) good deformity correction and good spinal stabilization without need for return to surgery.“
Jamira recovered quickly, asking to go home from South Florida Baptist Hospital in Plant City the day after surgery.
She had to stay five days to get physical therapy and make sure the rods were working. Back at school within a couple of weeks, she quickly shed the brace she was given for added protection.
“I can stand up straighter,” Jamira said. “I know I’m not leaning over…I can touch my toes.“
She’s still working on being as tall as her older sister, Janorie, but she said she’s happy she doesn’t slump standing beside her. Once her growth is complete, Okafor will have a final surgery to correct the spine.

What is scoliosis?

Jamira has congenital scoliosis, something she was born with. A section of vertebrae that should have been shaped like a cube instead was a triangular
shape, Okafor said.
Some scoliosis is neuromuscular, associated with neurological diseases like spina bifida and cerebral palsy. About 80 percent are idiopathic, from unknown causes, with adolescent idiopathic scoliosis the most common.  If found early, scoliosis often can be treated with a back brace, said Tammy Durden. director of nursing and community health for the Florida Department of Health in Polk County. Braces can prevent pain and surgery while a child is growing, she said. Some newer, slim-line brace designs can be worn under clothing, said Deanna Kirkland, the department’s school health program supervisor.

Surgery gets employed when curvature is too great, threatening to endanger the functioning of the lungs and heart. Without the right treatment, patients can get severe pain as their scoliosis gets worse, Okafor said.
“It’s a very personal decision,” Sharie Hoo said. “I would say ’Pay attention to what your child (is feeling) and your mommy gut feeling.’“
Scoliosis most commonly occurs in children ages 10-15. Florida requires scoliosis screening in sixth grade. The Health Department does that screening at public and some charter schools, Durden said.
Children bend over at the waist for screening. They’re asked to put their chins on their chests and be very loose and relaxed. Using a scoliometer, a device like a level, nurses measure the highest point of the curve in a child’s back.
If one side is higher than the other when your child bends from the waist, and there appears to be a hump on the back, that’s something to check, Durden said.

About 10 percent of slightly more than 7,000 Polk sixth graders screened have enough curvature that parents or guardians are advised to consult pediatricians, she said, although not all will be found to have scoliosis.
“Some doctors elect to watch and wait,” Durden said. “Others are referred to an orthopedic (specialist) or to Shriners.“
She generally recommends Shriners Hospitals for Children, which provide free care, if parents want a specialist referral, Durden said.

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Tristan was about 4 months old when his mom Nikki thought his spine
looked a little crooked and mentioned it to her husband Pat. “He’s a baby,”
Pat said. “They all lean to one side. Don’t worry so much.”

But a few weeks later, a daycare worker noticed a lump on Tristan’s back. His parents took a
closer look and knew something was wrong.

The family’s pediatrician agreed Tristan’s spine was curved, but believed the baby would grow
out of it. He said it would be extremely rare for an infant to have scoliosis, a spinal deformity
that typically affects adolescents and teens. But because Tristan’s parents were so concerned,
the pediatrician referred the family to the Spine Program at Children’s Hospital of Philadelphia

Finding experts

In December 2015, Tristan’s family met with Patrick J. Cahill, MD, a Pediatric Orthopaedic Surgeon with expertise treating children with
complex spine conditions, and Susanne Manzoni, RN, at CHOP Specialty Care & Surgery Center in Bucks County, near the family’s
home in Warrington, PA.

Dr. Cahill noted that Tristan was leaning abnormally to the right and his ribs appeared to protrude on his left side — strong indicators of

Dr. Cahill explained scoliosis often has no known cause, and early-onset scoliosis — which he believed Tristan had — can affect very young children. An X-ray showed that Tristan had a 36-degree spinal curve and a 23-degree spinal rotation. To achieve the best outcomes for Tristan,
treatment should begin immediately, Dr. Cahill advised.

Infant scoliosis treatment options

Two treatments were possible at Tristan’s young age: traditional bracing and serial body casting. Dr. Cahill informed the family about
both options, but said the ultimate decision was theirs.

Back bracing has been around for generations and has proved to be very successful in halting the progression of scoliosis. Custom-made
back braces reduce pressure on the lower back and help prevent a child’s condition from worsening. However, many children who
receive this non-invasive treatment will later require spine surgery to permanently straighten the spine.

Serial body casting is a treatment becoming more widely adopted that is often recommended for children between the ages of 6 months and 6 years with X-ray measurements that indicate their spinal curve will likely get worse. Unlike a brace, the cast has the potential to partially or
completely straighten the curve, which could delay or prevent the need for later spine surgery.  In order for the cast to be applied, the child must go under anesthesia, which can be frightening for parents.

“We knew Tristan was going to need casting eventually but we didn’t know if we should wait
until he was a year or 18 months old to start,” Nikki says.

But Tristan’s parents kept thinking about what Dr. Cahill had said about casting: the sooner it started, the better the outcome. And, casting offered something bracing didn’t — the possibility of a cure. They decided to start serial casting at Children’s Hospital of Philadelphia with Dr. Cahill when Tristan was 6 months old.

Casting at 6 months old

In February 2016, Tristan’s family came to CHOP’s Main Campus for his first casting procedure. Board-certified pediatric anesthesiologists with special training in the effects and dosages of anesthesia in children administered Tristan’s medication. Surgeons then used the elongation-derotation-flexion technique to gently manipulate Tristan’s spine into a straighter position.

Once his body was being held in the proper position, a custom-built body cast (known as a Mehta cast) was formed around his torso. The plaster cast covered Tristan’s trunk from his arm pits to his pelvis, and had a cutout for his belly. The procedure took less than 45 minutes, and Tristan was able to go home the same day.

For a few days after the procedure, Tristan was a bit cranky and uncomfortable as his body adjusted to the new position of his spine, his mom says. But the baby quickly returned to his normal, bubbly self.

Path to a cure

Every six weeks, Tristan returned to Children’s Hospital to have the old cast removed, X-rays taken and a new cast applied. Because Tristan was so young, his spine was very flexible —making him an ideal candidate for the serial Mehta casting that was slowly straightening his spine.

Weekly physical therapy sessions helped Tristan adjust to the bulky cast and reach developmental milestones like crawling and walking.

On Dec. 4, 2016, the final cast was removed. X-rays confirmed the therapy worked: Tristan’s spine curvature was less than 10 degrees — within normal range. He no longer has scoliosis.

“Fifteen years ago, Tristan wouldn’t have had this opportunity,” Pat says. “He wouldn’t be cured by age 2.”

A bright future

Today, Tristan wears a temporary back brace to ensure his spine curvature doesn’t return as his spine continues to grow and harden. The brace has a hard shell and soft lining like the cast did, but it’s less bulky and can be removed for an hour each day.

Under the care of Dr. Cahill and Jason Smith, PA, Tristan will be gradually weaned off the brace, decreasing the number of hours he wears it each day until it is no longer needed.

For now, Tristan is just enjoying being a toddler. He loves running around, going down the slide at the playground, watching Elmo, and spending time with his 4-year-old brother Brayden and 8-month-old sister Charley.

“Tristan is a really happy kid,” Nikki says. “He’s very affectionate and very determined. He doesn’t let anything slow him down.”

Paying it forward

Tristan’s family says they had a “great experience” at Children’s Hospital of Philadelphia. “Dr. Cahill and Susanne were very
knowledgeable and accommodating,” Nikki says. Pat adds, “We could not have received
better care.”

The family was so grateful to CHOP for the care they received that they have organized an Early-onset Scoliosis Awareness Day with the
Philadelphia Phillies.

Hundreds of families will attend a game to celebrate children with early-onset scoliosis, raise funds to support scoliosis care and research at CHOP, and help build a local early-onset scoliosis support network in the greater Philadelphia metropolitan area.

“We want to celebrate kids like Tristan and publicly recognize all they’ve been through,” Nikki says. “We wouldn’t be here today without the Children’s Hospital of Philadelphia.”

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For the first time, students at the Loudoun Academy of Engineering and Technology have worked with Leesburg-based
K2M Group Holdings, a global pioneer in developing innovative solutions for spine surgery, to practice real
world problem-solving skills and teamwork.

In a “Shark Tank”-style competition over several weeks, teams of five and six students focused on how to improve
diagnosis and treatment of scoliosis in adolescents. For the top eight competitive teams, three months of hard work
both in and outside of school culminated with Wednesday’s final project presentation and awards at K2M’s campus in

The first place project, “ScanScoli,” suggests utilizing technology from Google’s Project Tango, including specialized
camera hardware that can scan and dimension patient torsos through photography, rather than X-rays.
The project would expedite custom back brace fitting and enable the early detection necessary to eliminate a patient’s need for a
brace. Members of this team included Lina Alkarmi, Jay Chadha, Siva Indupuru, Pranavi Karnati and Esha Fateh.

“We were looking for the amount of creativity that went into their effort, the completeness of the project and also how
well reasoned the project was,” said Dave MacDonald, the senior vice president of operations for K2M, who was one
of seven judges and a primary organizer of the event. “All of [the projects] have commercial potential, I would say. The
ones that finished in the top three, I think all could be commercialized.”

Last February, 150 freshman students on nearly 30 teams ventured to K2M’s new Leesburg facility for a tour and an
introduction to their challenge: to research the challenges of scoliosis treatment and to develop a new product or
strategy to overcome the challenged. Eight teams were selected to present their projects to a panel of judges, all of
whom were executives and ranking officials at K2M.

Student teams primarily focused on issues surrounding the cumbersome, uncomfortable and expensive back brace
that adolescents often wear for as long as 23 hours a day for five years or more to treat scoliosis and avoid surgery.
According to student research, nearly four million Americans have been diagnosed with scoliosis, and the vast
majority of those patients are women. The back brace is most effective for adolescents, but afflicted teens often face
embarrassment and discomfort while wearing the brace to school everyday.

“When we first got the scoliosis project from them we were all super excited to start, but we didn’t really know anything
about scoliosis, and I think we did a lot of research, and the main part of our project was the research,” said Maddie
Edwards, one of the student competitors. “[The project] really taught us how to research, and it taught us how to work
with other people.”

The event, part of a pilot program by the Virginia Innovation Challenge, the Virginia Chamber Foundation and local
chambers of commerce, seeks to expand work-and-learn opportunities that prepare Virginia students with the skills
they need in today’s global economy.

For many of the students, the challenge was their first time working with real world problems and combating the
issues that people face every day throughout the world.

“I learned a lot about the design process, brainstorming, and researching,” said Mia Hagood, another student

To resolve scoliosis treatment obstacles, some teams re-imagined the back brace, revising the structure and style to
improve comfort to encourage adolescents to wear the brace.

Other teams focused on new methods of pain relief and patient spinal measurement, which aids in both scoliosis
detection and brace construction.

Second place was awarded to the “E-Fit” shirt, which would take patient measurements based on the stretch of
nanotech fibers, designed by Nikki Akula, Annie Antonov, Jackson Boran, Michael Brennan, and Manasi Srigiriraju.

The third place team proposed improvements to the existing Boston Brace design, such as comfortable gel inserts
and straps for adjustable tightness. Team members included Justin Wang, Akash Raheja, Kevin Zeng, Bilal Zahory
and Brandon Villines.

The apparent success of the event beckons high hopes for similar projects in the future.

“We’re one company, and we had 150 students trying to solve one problem. If you could take this and have it go
across lots of companies, and lots more students, that would be more beneficial,” MacDonald said. He also hopes to
see how the students progress throughout the remainder of their high school years.

“I think back to what I was doing at 14, and it’s not this, it’s not this at all,” said MacDonald. “I find it to be very
inspiring, because at this age, what they’re capable of doing, I just can imagine, they’re going to be the next
generation of future entrepreneurs, leaders, difference-makers in our community. I think it’s a good thing.”

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Researchers compared a combined anterior and posterior approach to a posterior approach for
severe scoliosis treatment, in a study published in Spine.

The study included patients with idiopathic scoliosis undergoing operations with Cotrel–
Dubousset hybrid instrumentation with pedicle screw and hooks. Thirty patients underwent the
two-stage surgery and 46 underwent posterior surgery.

Here are five observations:

1. Researchers did not find significant correction differences between the two-stage
surgery group with an average correction of 69 percent and the posterior group, with an average correction of 66

2. The study revealed hospitalization time was higher for the two-stage group compared to the
posterior group.

3. Additionally, surgery duration was significantly longer for the two-stage surgery group.

4. Researchers concluded the posterior approach and the two-stage approach are “equally
effective for operative treatment of severe idiopathic scoliosis in terms of regaining good balance,
achieving maximal possible correction with minimal complications, and good long-term clinical

5. Based on the two-stage group’s longer surgery duration and hospital stay, however, the
posterior approach may be the preferred treatment method for severe idiopathic scoliosis.

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A North Augusta High student will be recognized throughout the state this month as part of a photo exhibit project in Columbia.

Elisabeth Harkins, a junior at the high school, will be part of Family Connection of South Carolina’s Look! Forward photo exhibit, which showcases children and young adults who have overcome disabilities.

Harkins, who was diagnosed with scoliosis eight years ago, was one of 50 selected throughout the state to be a part of the exhibit at the Tapp’s Arts Center and is the only person selected from Aiken County.

When Harkins first discovered she had scoliosis, she said it was by accident during a routine visit to the doctor. She said that during the visit, she bent over to tie her shoe and after her shirt lifted a tad, the doctor noticed an irregularity in her back.

“We found out by accident, which blows my mind sometimes because I was tying my shoe and they just noticed my back,” she said. “Sometimes I think what would have happened if I had never done that.”

Harkins’ grandmother Lisa added, “It kind of just blows your mind a little bit. If she hadn’t happened to bend over and do that, we might not have ever found out, and then as they grow a lot of times their curves will get worse.”

Since then, Harkins has worked to spread awareness for scoliosis, having former South Carolina Governor Nikki Haley and North Augusta Mayor Lark Jones issue proclamations in June for Scoliosis Awareness Month the past four and three years, respectively.

In addition to raising awareness to the disability throughout the state and CSRA, Harkins also founded a Curvy Girls group for girls with scoliosis in South Carolina and parts of Georgia. Curvy Girls is a national network of peer-led support groups that reduce the emotional impact of scoliosis by empowering girls through mutual support and acceptance to become leaders, make healthy lifestyle choices and improve self-esteem, according to the organization’s website.

“It has been carving who I am, kind of,” said Elisabeth. “I’m glad that I’ve been able to help the girls and to see that they’re actually improving is pretty good.”

Lisa said that since Elisabeth was diagnosed she has noticed her become more vocal about the disability, and her work in advocating for scoliosis awareness has led to her taking leadership roles in other areas of her life.

“I’ve noticed with her she’s more willing now to take on a leadership role in different things,” she said. “She doesn’t mind talking about the scoliosis. For her, it hasn’t really stopped her from doing what she does.”

Outside of her work with scoliosis, Elisabeth is involved with North Augusta’s NJROTC program and band, and also started a sign language club this school year. She also serves as the president of the Aiken County Red Cross Youth Board.

“I don’t think she would’ve taken that kind of initiative maybe five or six years ago, so in a weird way the scoliosis, even though it’s a negative thing, it has kind of had a positive impact on her,” said Lisa.

Elisabeth said that what she’s been most proud of throughout her battle with scoliosis is how she has been able to reach out to other girls with the disability and help them.

“There are people with scoliosis, but not a lot of them talk about it a lot, so for me to say something could start off everybody else,” she said. “It’s something really big and some people just mistake it for something that’s small and doesn’t mean anything.”

Elisabeth’s exhibit will be on display throughout April at the Tapp’s Arts Center, 1644 Main Street in Columbia. The Center is open 10 a.m. to 6 p.m. Tuesday through Saturday.


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LANSING, Kan. — She’s lettered in swim, cross-country and power lifting, but that’s not why she’s this week’s Reaching for Excellence young achiever.

Lansing High School junior Leah Wiegers is being recognized for her determination to get mandatory scoliosis testing in schools.

The 17-year-old calls herself: “Someone who just stands up for what’s right.”

She was diagnosed with scoliosis when she was 12, and has become an advocate. Part of her treatment involves wearing a hard brace.

“Just open it up like this and then you just put it on. It was like having a shell on me for 20 hours a day for two years,” she described.

Look at her five years later, and although she is not healed, per say, she’s doing much better! Better, she believes, because doctors caught it early.

“It really empowered me to speak up for what I believe in,” she said.

And that — she did. Currently, the state of Kansas does not require schools to screen for scoliosis. Lansing Unified School District 469 does not… well, did not, until Leah spoke up.

“Leah is outstanding. She is doing the work of what really we see in college-prepared persons or really persons of myself who are doing post maters work, Ph.D work or even doctoral work,” Jill Ariagno said.

Ariagno is Leah’s nurse and has been with her from the very beginning.

“Just quite an exceptional kid,” she said of Leah.

Recently, Leah put together a presentation and met with school officials,  local medical experts, even a state senator and representative. She took her experience and findings to her school board.

“It was unanimous. They didn’t really have to vote on it because there was already a policy that allowed them to screen at our school, but nobody was doing it for the past few years,” Leah said.

Phase one of training nurses is already done. Beginning later this year, or early next — schools within her district will now screen all kids for scoliosis.

Leah wants to get an ROTC scholarship and attend a military academy. She dreams of one day following in her mother’s footsteps, and becoming an officer in a military branch.


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Madera M , Brady J , Deily S , McGinty T , Moroz L , Singh D , Tipton G , Truumees E ; for the Seton Spine
Rehabilitation Study Group.

Author Information
OBJECTIVE The purpose of this study was to provide a systematic and comprehensive review of the
existing literature regarding postfusion rehabilitation. METHODS Using the Preferred Reporting
Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, the authors conducted an
exhaustive review of multiple electronic databases. Potential articles were screened using
inclusion/exclusion criteria. Two authors independently analyzed these studies using predefined data
fields, including study quality indicators such as level of evidence and availability of accepted patient-reported
outcomes measures. These findings were synthesized in a narrative format. A third author
resolved disagreements regarding the inclusion of a study. RESULTS Twenty-one
articles with I or II levels of evidence were included in the review. The authors divided the findings of the literature
review into several groups: rehabilitation terminology, timing and duration of postfusion rehabilitation,
the need for rehabilitation relative to surgery-related morbidity, rehabilitation’s relationship to outcomes, and cognitive and psychosocial aspects of postsurgical rehabilitation. Current evidence generally supports formal rehabilitation after lumbar fusion surgery. Starting physical therapy at the
12-week postoperative mark results in better outcomes at lower cost than an earlier, 6-week start.
Where available, psychosocial support improves outcomes. However, a number of the questions could not be answered with high-grade
evidence. In these cases, the authors used “best evidence available” to make recommendations. There are many cases in which different types of caregivers use clinical terminology differently. The data supporting an optimal protocol for postfusion
rehabilitation remains elusive but, using the data available, the authors have crafted
recommendations and a model protocol, which is currently undergoing prospective study.
CONCLUSIONS Rehabilitation has long been a common feature in the postoperative management
of patients undergoing spinal fusion. Although caregivers from multiple disciplines agree that the
majority of their patients will benefit from this effort, the supporting data remain sparse. In creating a
model protocol for postlumbar fusion rehabilitation, the authors hope to share a starting point for
future postoperative lumbar fusion rehabilitation research.
CBT = cognitive behavioral therapy; LOE = level of evidence; LOS = length of stay; NASS = North
American Spine Society; ODI = Oswestry Disability Index; PRISMA; ROM = range of motion; degenerative; lumbar
fusion surgery; outcome; physical therapy; rehabilitation; systematic review
PMID: 28291412 DOI: 10.3171/2016.10.SPINE16627


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