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When viewed from the front or back, the normal spine appears straight. When taking x-rays, this is referred to as the anterior-posterior, or AP view. Sometimes the spine develops a side to side curve in the AP view, and this condition is termed scoliosis. Simply put, it is a crooked back. Scoliosis can be in the form of a “c” or an “s.”
Most individuals possess a slight scoliosis curve of one type or the other, but when the curve progresses to an extreme degree, it becomes a matter of concern. A curve that becomes too severe causes not only cosmetic problems but interferes with the functioning of the internal organs. Scoliosis curves may also cause back, hip, and leg pain. Conservative treatments usually provide relief of pain, but under certain conditions surgery becomes the best available option.
Scoliosis may be classified as congenital, idiopathic, or secondary to a neuromuscular condition, such as cerebral palsy. Congenital scoliosis is present at birth, and idiopathic scoliosis develops later in life, usually during the pre-teen years, and the cause is unknown. Late onset idiopathic scoliosis occurs later in life and usually requires no treatment, for it is self-limiting. The majority of cases are idiopathic.
The most common signs and symptoms of scoliosis are cosmetic. One shoulder or one hip may be higher than the other, causing clothing to be ill fitting. When the individual bends forward, a prominence will be noted on one side of the back. This is called the adams test. Shortness of breath and fatigue may result from crowding of the lung and/or heart. Because one hip is higher than the other, the balance of the entire musculoskeletal system is skewed, and the individual may experience back and leg pain due to an attempt of the body to right itself into a normal position. Scoliosis often becomes worse during adolescence, because it is a time of rapid growth. It is more common in females than males.
Scoliosis is diagnosed by a positive adams test. The shoulders are also checked on the patient to see if they are level. If these symptoms are present, x-rays are usually taken, and the Cobb angle is measured, which is a method for measuring the curves. X-rays are taken of the AP or coronal view, and the lateral or sagittal view. The lateral view enables the surgeon to determine if the thoracic spine has a normal kyphotic curve and whether the lumbar spine has a normal lordosis. X-rays are taken every three to six months to follow the curve progression. If the curve is progressing, surgery is a more likely option. Once a child stops growing the curve usually stops progressing, although later in life osteoporosis may cause an increase in the curve.
Treatment mainly consists of observation, physical therapy, and bracing. If these measures fail, surgery is performed. Bracing and physical therapy are usually the preferred methods of treatment when the patient is still growing. During this time there is hope that by bracing, the progression of the curve can be halted. The brace utilized for a child or adolescent is a metal structure that extends from the neck to the pelvis. It is usually worn 22 hours a day and is a difficult adjustment for the child.
Therapy consists of exercises that strengthen the muscles of the back. One form of therapy is the Schroth method. It is based on the concept that scoliosis is a result of complex muscular asymmetry in the muscles of the back. This method claims to stop the progression of the curve. It has been reported to be effective in eliminating pain.
Surgery is performed when the curve reaches 30 to 40 degrees. The purpose of the surgery is to stop progression of the curves and to hopefully straighten at the back. This is accomplished by spinal fusion. Screws and rods are placed on either side of the spine, and bone graft material is placed between the vertebrae to cause the spine to fuse into a straighter, rigid position.
During spinal fusion, care is taken to not only straighten the side to side curve but to maintain the the upper thoracic and lumbar curves. In the past, the lumbar curve was not preserved, and the patient was unable to stand up straight, because a properly placed lumbar curve is necessary to maintain an upright posture. Postoperative rehabilitation includes exercises to strengthen the core abdominal muscles and walking.
Scoliosis is usually a self-limiting condition that requires no treatment. In the event it does require treatment, physical therapy is usually sufficient to strengthen the back muscles and relieve pain. In the event surgery is required, careful thought is required. Spinal fusion is different from other joint surgeries, for it removes the normal movement of the spine. Depending on the placement of the fusion, the individual may no longer be able to bend at the waist.
Many activities of daily living are limited. In choosing a scoliosis surgeon, one should be chosen who is board certified in spinal surgery and who has gone through a special fellowship in complex spinal deformity. It is wise to choose a surgeon who does only scoliosis surgeries, and geographical distance should not be an obstacle. Only the best possible surgeon should be chosen, for a scoliosis surgeon re-creates the spine.
Hopefully, when the surgeon forms this new spine, he will create a spine that results in an improved quality of life for his patient.
If you are suffering from scoliosis, contact Georgia Spine and Neurosurgery today.