What is Scoliosis?
Scoliosis is an abnormal curving of the spine. While all spines have a natural curve, patients with scoliosis have excessive spinal curving. Usually, scoliosis develops during the growth spurt before puberty, between the ages of 9 and 15. Although some cases are congenital, and some are the result of underlying neuromuscular conditions, such as cerebral palsy or muscular dystrophy, most cases of scoliosis are idiopathic, meaning their cause is unknown. Both girls and boys can develop scoliosis, but cases in females are more likely to require treatment. In some cases, scoliosis appears to be hereditary.
What Causes Scoliosis?
Some believe that scoliosis can occur if a person has poor posture or frequently carries heavy objects. This is not the case. Statistics suggest that more than 80% of scoliosis cases have no known cause. The term for this is idiopathic scoliosis. Less common types of scoliosis include:
- Syndromic scoliosis which is caused by a primary disease or genetic condition. Examples include spinabifida, connective tissue disease such as Marfan syndrome, and genetic conditions such as dwarfism.
- Neuromuscular scoliosis is caused by primary conditions such as cerebral palsy or traumatic spinal cord injury.
Patients with mild cases of scoliosis have no symptoms apart from the irregularity of their appearance. If the curve of the spine worsens, however, and the spine twists, patients may experience:
- Low back pain
- Extreme fatigue after sitting or standing
- Difficulty breathing (in severe cases)
- If symptoms of scoliosis worsen, treatment may become necessary.
- Diagnosis of Scoliosis
In addition to a physical examination of the back, shoulders, waist and hips, patients suspected of having scoliosis typically undergo neurological examinations to evaluate muscle strength, reflexes, and areas of numbness. Imaging tests are also administered to determine the severity of the problem and to rule out other possible reasons for the curvature of the spine, such as tumors. Diagnostic imaging tests may include CT, MRI and bone scans. A spinal curve measurement, using a device called a scoliometer, will also be taken.
Why Is Early Intervention Important?
Early intervention of scoliosis can achieve a few goals. First, the earlier that an accurate diagnosis is made, the more opportunity a patient may have for non-surgical treatment (bracing). The more a curve progresses, the more likely it is that surgical intervention will be necessary.
A worsening spinal curve also presents daily physical challenges. The patient with scoliosis may suffer back pain when they sit or stand for a period of time. Range of motion may become affected, and quality of life may degrade.
Scoliosis Treatment Options
Observation may be the initial course of action if a patient is still growing physically and has a milder curve. Observation may also occur if a patient has stopped growing and has a curve of no more than 45 degrees. This treatment protocol may coincide with physical therapy to reduce the physical symptoms of the spinal curvature.
Non-surgical treatment typically involves bracing the back. This care may be appropriate for patients who are still growing and have a spinal curve between 25 and 45 degrees. A brace is not intended to correct the curve, but to keep it from progressing. Bracing is a customized treatment that is developed based on factors including the location of the curve, the number of curves, the flexibilty of the curve, and the condition of the vertebrae.
Treatment of scoliosis varies a great deal depending on the severity of the condition.
Mild cases of scoliosis may require no treatment beyond periodic medical examinations. Cases of scoliosis affecting the following groups bear especially careful monitoring:
- Girls, who have a higher rate of progressive scoliosis
- Individuals with larger or double (S-shaped) curves
- Individuals whose abnormal curve is in the thoracic spine
Once patients have reached maturity, and their bones have stopped growing, as assessed by the onset of puberty and tests to assess bone growth, there is very little risk of worsening scoliosis.
Moderate to Severe Scoliosis
When treatment for moderate scoliosis is necessary, it most often takes the form of a back brace. While the brace will not cure the condition, it will prevent it from exacerbating. Braces for scoliosis are only used in children whose bones are still growing. More serious cases of scoliosis may require surgical intervention.
In most cases, the surgery performed to treat this condition is spinal fusion, during which two or more vertebrae are connected with bone grafts or artificial materials. During spinal fusion procedures, metal rods are installed to stabilize the area until the bones grow together. Although such surgery is normally done after the patient has finished growing, when the scoliosis is progressing at a dangerous rate, an adjustable rod may be inserted which can be lengthened every 6 months to accommodate the child’s growth.
Most patients with scoliosis, even if it becomes severe, are able to be successfully treated and to lead normal, productive lives.
Surgical Scoliosis Treatment
Dr. Girardi may recommend surgery if the spinal curve is greater than 50 degrees. Sometimes, surgery is appropriate for the correction of smaller curves that are causing persistent symptoms that do not improve with physical therapy and other modalities. Scoliosis surgery involves fusing certain vertebrae in the spine and stabilizing the straightened spine with appropriate fixtures until the bones heal together.
Recovery from Scoliosis Surgery
Patients will come in for a follow-up visit approximately 10 to 14 days after surgery, at which point Dr. Girardi will check on the progress of recovery, answer questions, and discuss the next steps. Patients may be able to return to school, work, and light activity within four to six weeks of surgery.
For several weeks, car rides are limited to doctor’s visits because road conditions can cause unintentional twists or bumps. Riding in a vehicle is an activity that is gradually cleared as recovery progresses. Patients will have a final x-ray taken between 6 and 12 months after scoliosis surgery to confirm full fusion of the spine. At this time, the patient may be completely released to return to normal activities. Patients should keep the following in mind during their recovery from surgery.
- Pain management: Initially, a patient will take prescribed pain medication to maintain comfort. Narcotic medication should be taken for limited durations, so patients are transitioned to over-the-counter or non-narcotic pharmaceuticals as quickly as possible without impeding recovery. This transition usually occurs at the 2 to 4-week mark after surgery.
- Incision care: Surgical incisions need to be kept clean and dry. It is possible for the patient to shower, but the incisions must be covered with a dressing that prevents the skin from getting too wet. After showering, the area around incisions should be patted dry. No powders, creams, or ointments should be used.
- Rest: Scoliosis surgery and pain medication can combine to create extreme fatigue. Outside of the recommended movement to prevent blood clots, patients who undergo scoliosis surgery will need plenty of rest. When the patient does get up to move around or use the bathroom, they will need assistance to prevent accidents and unnecessary movements. Patients should avoid all movements that involve bending, lifting, or twisting.
What If Scoliosis Is Left Untreated?
90 percent of scoliosis cases do not require anything more than periodic monitoring of the spinal curvature. If an increase in spinal deformity is observed on x-rays, we discuss the potential for active treatment.
Untreated scoliosis may get worse in some cases. Factors that predict this include the age of the patient and the extent of the curve at the time of diagnosis. Studies suggest that a child under the age of 10 who has a curve greater than 35 degrees is vulnerable to worsening if treatment is not conducted. When the diagnosis is made after a person has stopped growing, the likelihood of rapid progression in the spinal curve is very low. The exception is a curve greater than 50 degrees. This extent of curvature could progressively worsen by a few degrees each year if treatment is not obtained.
At a Glance
Dr. Federico Girardi MD
- Triple fellowship-trained spinal surgeon
- Performs over 400 spinal surgeries per year
- Professor of orthopedic surgery at Cornell University
- Learn more