Scoliosis: What’s it all about?

  Scoliosis is a condition involving rotation and curvature of the spinal vertebrae. This condition can affect children, adolescence, adults, and the elderly. Upward to five percent of the United States population has it.

Causes

  Many different conditions can cause scoliosis. In infants and young children, when vertebra are misshaped from development, this is called congenital scoliosis. Scoliosis occurring in young children without other diseases is sometimes considered “infantile” or “juvenile”, depending on the age of the child. In these cases, the cause of the scoliosis is unknown. One of the most common types of scoliosis occurs during the adolescent years. When it occurs in otherwise healthy teenagers, it is termed adolescent idiopathic scoliosis. The term idiopathic simply means that we don’t know what causes the curve. Scoliosis does seem to be associated with certain diseases and syndromes, such as cerebral palsy, spina bifida, and neurofibromatosis, and others.

  When a teen-ager with scoliosis moves on to adulthood, arthritis can cause the scoliosis to progress. Some curves progress due to their large size. The spine loses its ability to remain straight under the stress of gravity and degenerative changes. Curves can slowly progress as a result. Advancing arthritis can also cause the lower or lumbar spine to curve where it was previously straight. This is usually termed degenerative scoliosis.

Signs and Symptoms

  Common signs of scoliosis include an asymmetry in the shoulders or the pelvis. There may be the appearance that one leg is longer than the other when in fact they are equal. When people with scoliosis bend forward, there is often a prominence on one side of the back compared to the other. Often clothes fit differently and this is one of the first signs of the spinal curvature in teenagers and adults.

  Symptoms of scoliosis vary depending on the age of the patient, the amount of arthritis involved, and the area of the spine affected by the curve. In children and teenagers, spinal curvature does not cause pain. Scoliosis in adults can lead to premature arthritis in the low back and back pain. Pain is a common feature in patients with degenerative scoliosis. This is secondary to the arthritis, nerve compression or pinching, and spinal instability. Pain can also come from muscle spasm that occurs along with the arthritis, and when the curve shifts the spinal posture to one side or forward.

Conservative Treatment

  For most patients with scoliosis, conservative care is all that is required. We see considerable benefits from physical therapy in treating patients with back pain. For children and teenagers with idiopathic scoliosis, a brace is often recommended while the child is still growing.

  After full growth has been achieved, a back brace is no longer effective at controlling the curve. A back brace can also be used in degenerative scoliosis to help with back pain related to arthritis.

How scoliosis is measured

  The severity of a scoliotic curve is measured from full length standing spine x-rays. These are the best type of x-rays for reproducible and reliable measurements of the spine’s actual alignment. These x-rays are then repeated at regular intervals to check whether the curve has progressed. Curves less than twenty degrees are usually considered mild. Curves between twenty and forty degrees are usually considered moderate. Curves greater than forty degrees are usually considered severe.

Reasons for surgery

  Surgery is considered when a curve is progressing, when pain is present and does not improve, when the spine is out of balance, when there is nerve root or spinal cord compression, or when the curve is large enough that continued progression is likely. Each of these five reasons can be applied to most any type of scoliosis. As with all diseases, specific considerations for specific patients always enter into the discussion and medical treatment is tailored to the individual.

  The goals of surgery are usually to correct the spinal deformity, and provided a balanced spine, eliminate pain, and stop curve progression.

Surgical options

  There are many surgical options depending on the type of curve, severity of the curve, and placement of the curve within the spine. Other factors such as bone spurs and nerve compression play a role in surgical planning. The surgical options may include surgery from the front part of the spine, surgery through a scope in a minimally invasive type of approach, and surgery from the back part of the spine over a few or many segments. Surgery typically involves placement of spinal instrumentation to correct the curvature and hold it in its new straightened posture. The spine is then fused in the new posture. There are new bone graft techniques which allow more reliable fusion with fewer failures and much less operative pain. Chief among these is the use of bone morphogenic protein (BMP), something that has revolutionized the way that we approach spinal fusions.

Surgical techniques to correct scoliosis

  We have been involved with researching new techniques for correcting spinal deformity including scoliosis. We have investigated new techniques for obtaining improved results, and participate in study groups with other committed surgeons to try and improve the outcomes for the procedures we do.

  One of the most exciting things we have been working on for the past 8 years is the development of a new spinal instrumentation system that allows simultaneous correction of the side to side and front to back deformity involved in scoliosis in a way that has not been possible up to now. This new instrumentation is now FDA approved and we have several years’ history with the approach and continue to refine it. We continue to present the results of our research at several national and international Spine Surgery meetings every year and continue to follow our patients closely.

What to expect from surgical correction

  Correction of scoliosis typically achieves improvement of at least 50% and sometimes upwards to 100% of the spinal curvature. Stated simply, we straighten the spine as much as we can safely straighten it. Safety during surgery is always our primary concern and we never compromise there. We would rather leave the spine with a slight curvature than straighten it perfectly and have a complication.

  Patients with corrected scoliosis typically stand taller with much better posture, sit, stand and walk with more ease and less discomfort, and can function in their activities of daily living at a very high level. In some cases, patients can return to non-contact sports including swimming, basketball, golf, tennis, hiking and other activities. The success rate with correcting each individual curve, each individual type of scoliosis, in each individual area of the spine, in each individual patient is of course individualized.

The Future

  The future for spine surgery including scoliosis correction continues to be very bright. Look for continued improvements in our ability to achieve correction, with fewer complications, with more reliable fusions, ending up with happier patients. It is not uncommon to have mother and daughter both in the office with scoliosis. When the mother hears how successful and non traumatic surgery can be for her daughter’s scoliosis, she is often amazed, comparing it to the traumatic experience she went through in the 1960’s-1980’s. I expect that when her daughter has children of her own, she will be equally amazed at how much better we have become from her experience. Science continues to advance and we will remain on the leading edge of that, contributing with our own research and ideas for the betterment of our patients.