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Scoliosis

Normally, when viewing a person from the front or back, the spine is straight. When the spine is curved and that curvature is greater than ten degrees, a patient is said to have scoliosis (Figure 1). Scoliosis is a spinal deformity that can affect all age groups, from new born infants to the elderly. There are many types and causes of scoliosis, but for the purpose of this article, we will discuss the condition commonly known as Adolescent Idiopathic Scoliosis(AIS).

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AIS is one of the most common forms of scoliosis and its cause is unknown. It is much more common in young, slender, and rapidly growing girls but can certainly affect males as well. This problem often begins manifesting itself in the middle school and early high school years and school screening exams have been introduced at most schools to try to detect early cases. Screening is done by performing the Adams Forward Bending test and looking for an Asymmetric Trunk Rotation (ATR). This is seen because most cases of scoliosis also involve a rotation of the trunk causing a so called “rib hump” (figure 2). A scoliosis curvature, if caught early enough, can be successfully treated non-operatively greater than 80% of the time.
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Treatment for scoliosis is based entirely upon the age of the patient and the size of the curvature. Most patients with scoliosis can continue all activities without restriction, including contact sports. There are many so called “treatments” which have been proposed and tried on hundreds of patients with scoliosis but have never been shown to have any effect on reducing the size of the curvature; these interventions include: traction, physical therapy, electric stimulation of the muscles, and massage. Mild cases are simply followed for any signs of progression and more advanced cases require bracing. A small percentage of cases in which the curves are large do require surgery to prevent further curve progression. If large curves are allowed to progress, they can ultimately lead to cardiac and pulmonary compromise. If surgery is recommended by your doctor, it should be noted that there have been many advances in scoliosis surgery in the past several years. Patients are quickly mobilized and the risk of complication from scoliosis surgery in an otherwise healthy adolescent patient is less than one percent. Educating oneself about scoliosis goes a long way to resolving the anxiety that is common among patients and their families. One book that I have found to be very educational but also written in a friendly, understandable way by a young girl diagnosed with adolescent scoliosis is Scoliosis: Ascending the Curve written by Brooke Lyons. This book can be found in most libraries and book stores and I highly recommend it to my patients with scoliosis. The vast majority of patients with scoliosis who are treated appropriately can go on to live active, productive lives with little or no restriction on their activities, even if surgery is required. If your doctor has told you that you have scoliosis, a detailed discussion about options for treatment should follow. You should also never hesitate to seek a second opinion from a physician with expertise in treating scoliosis.


Treatments for Scoliosis

As mentioned previuosly, most cases of scoliosis can be treated non-operatively. Surgery is primarily reserved for curvature that are greater than 45 degrees. The rationale for this recommendation is that curvatures greater than 45 degrees will tend to relentlessly progress and ultimately can cause severe problems including respiratory and cardiac failure. Figure 3 and 4 show Xrays and a clinical photgraph of one of my patients who was under 5 when these were taken. You can imagine that we would not take lightly the plan to do an extensive spinal surgery on someone so young; but in looking at the pictures I think you can appreciate the need to intervene before the scoliosis curve becomes any more severe. We do not take surgery lightly, however when indicated we have done surgery at our center in patients as young as three years old up until people well into their 80s. Special surgical concerns are considered in each age group. For example, in children less than 10 years old, scoliosis surgeries are done with what is known as a “growing rod” construct which allows the child to continue to grow in their spinal height despite the surgery. In the elderly subgroup, the medical risks of a long scoliosis surgery can outweigh the benefits; and so often more minimally invasive surgeries to control pain are offered these subgroups of patients. Surgical choices must be individualized for each patient. We welcome you to review some of our surgical cases in the gallery.

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Figure 1

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Figure 2

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Figure 3

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Figure 4

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