Becker's Spine Review

16 SPINE SURGEONS Patient's Husband Shoots, Kills South Bend Orthopaedics Physician Who Wouldn't Prescribe Opioids: 4 Things to Know By Mackenzie Garrity T odd A. Graham, MD, was fatally shot in the park- ing lot of at Saint Joseph Health Rehabilitation Institute in Mishawaka, Ind., after declining to prescribe opiods to a patient, the South Bend Tri- bune reports. Here are four observations: 1. Dr. Graham was a physical medicine and rehabilitation specialist at South Bend (Ind.) Orthopaedics. He saw a female patient complaining of pain on the morning of July 26. The patient sought an opioid prescription, but Dr. Graham declined to provide her one. 2. Early afternoon on July 26, the patient's husband re- tuned to Saint Joseph Health Rehabilitation Institute and engaged in an argument with Dr. Graham in the parking lot. The husband asked two witnesses to leave the park- ing lot before shooting Dr. Graham in the head. 3. The gunman fled the scene, but shot himself before the police apprehended him. 4. Dr. Graham also served as a consultant for the In- diana-based University of Notre Dame's athletic pro- gram. n How Dr. Michael Vitale is Changing Treatment for Adolescent Idiopathic Scoliosis By Megan Wood Although surgical techniques continually improve over the years, con- servative approaches are gaining steam. "In looking at how the field has evolved over the last decade or two, it's obvious that the opportunity for conservative management of scolio- sis has evolved dramatically, more dramatically than opportunities for surgical management," says Michael Vitale, MD, chief of the pediatric spine and scoliosis service at NewYork-Presbyterian Morgan Stanley Children's Hospital. Treating adolescent idiopathic scoliosis requires a unified approach, demanding a multidisciplinary, cross-functional team. Despite significant opportunity for conservative scoliosis manage- ment, dissemination of the technique's benefits has fallen behind that of surgical techniques. Dr. Vitale and other leaders in the field are, therefore, focusing their efforts on establishing best practices in scoli- osis conservative management and funneling the information into the mainstream discussion. Actively involved on the board of the Pediatric Orthopaedic Society of North America, Dr. Vitale says the organization and others are dedicat- ed to improving non-operative management of children with scoliosis. e first step is early recognition of spinal deformity through screen- ing. If spinal deformity is identified early, adolescents should first try scoliosis-specific physical therapy, says Dr. Vitale. A specialized method for scoliosis, the Schroth method, focuses on postural correction and breathing. e therapy puts patients in touch with their curve, so they understand how to alter their posture and stand in a braced position. "In a growing child, the straighter you are when you're growing, the straighter [your spine] will be," explains Dr. Vitale. He and his col- leagues investigated patient compliance's impact on Schroth therapy. e subset of patients with high compliance had much lower rates of curve progression, explains Dr. Vitale, a finding recently presented at a large international scoliosis meeting. "Just like taking blood pressure medicine, compliance is key to suc- cess for bracing and scoliosis-specific physical therapy. Bracing doesn't work if you don't do it," says Dr. Vitale. Since compliance is so critical to scoliosis conservative treatment, Dr. Vitale is helping develop an app "to get into the kids' heads." e app allows children to share their physical therapy progress via a fun plat- form — online. "We are also developing a seven-minute Schroth app, using the natural proclivity for electronics to get [the children] to do stuff," he explains. Dr. Vitale also serves as CMO for Wellinks, a wearable health technol- ogy company, unveiling Cinch — smart straps for scoliosis — this year. Cinch is connected to a compliance app that tracks information on how tightly and long a child wears the brace. "Now it's not just we're prescribing a brace, but we have tools to track brace wear with a parental version, a patient version and a physical therapy version," Dr. Vitale says. "e smart brace is a really interesting opportunity to use technology for patients in a way that is productive for their health and in their best interest." Dr. Vitale urges the population to get on board to prevent progression to- ward surgery for adolescent idiopathic scoliosis. He actively tweets about non-operative resources available for AIS using the hashtag #cureAIS. "Our aspiration is that, by working together and employing the full ar- ray of treatment options, together we can #cureAIS," says Dr. Vitale. n

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