What is Scoliosis?
Scoliosis is a disease that involves an abnormal curving of the spine. It comes from a Greek word which means "crooked".
The human spine is made up of individual vertebrae stacked like blocks upon each other to form a column. The simplest or single curve scoliosis would be shaped like a C. A double curve would be S-shaped and even double curve scoliosis can exist.
About 1 out of every 10 patients has some small amount of scoliosis and only 1 in 50 or less will ever require treatment. Scoliosis is something that the patient is born with, but often does not become significant until the growth spurt in the early teen years. There is approximately the same frequency of scoliosis in men as there are in women, but it is much more common for women to require therapy for the disease.


What Causes Scoliosis?
The reason that most people develop scoliosis is not known. Although scoliosis may occur more commonly in families, it can occur without any other members ever having the disease. Scoliosis is in no way contagious. Some people feel scoliosis is an abnormal muscle tone of the muscles that parallel the spine. If one side pulls harder than the other, a curve then exists.
In certain muscular conditions such as cerebral palsy, spina bifida or spinal cord injuries, scoliosis can develop due to nerve damage to the back muscles.


How Does Scoliosis Present?
One must look closely for scoliosis if a patient comes in with any one of a number of findings or complaints. These might include difficulty in bending, complaints of chronic back pain or poor posture. Scoliosis should be considered if it appears that one shoulder is higher than the other, or a hip is more prominent than the opposite side. The rib cage can protrude and one leg can often be shorter than the other and one shoulder blade can be more prominent than the other side. When the patient bends over it might appear that one side of the back looks higher than the opposite side.


How Does One Diagnose Scoliosis For Sure?
In most cases the diagnosis is confirmed with x-rays of the spine. Only by doing x- rays over a period of time can one determine if the scoliosis is progressive. X-rays can often be taken every three to six months after the initial diagnosis to determine how progressive the scoliosis might be. As mentioned earlier, the progression of scoliosis is more common in women and the more severe the scoliosis the higher the chance for progression.


How Is Scoliosis Treated?
There are three major treatment options for scoliosis. Observation is waiting to see if the scoliosis progresses. If the curve is mild and for 80% of all patient who are found to have scoliosis, no treatment will be required. For moderate progressive scoliosis a special brace can be worn, and in the most severe cases surgical repair is often necessary.


What Else Can Be Done For The Treatment Of Scoliosis?
Unfortunately, exercise will not stop the scoliosis that is already present, but some exercise may improve the pattern and keep the back muscles strong enough to prevent other orthopedic problems.


How Effective Is Bracing For Patients With Moderate Scoliosis?
The brace is worn around the upper body and helps prevent further curvature by bracing the body in a more upright or straight position. The brace is ordered by an orthopedic physician and a special brace maker is able to ensure that the brace is fitted properly. The brace is something that is dynamically fitted with the initial period being most difficult where constant adjustments need to be performed. As soon as the brace is comfortable, then adjustments will be needed as the spine straightens out. Also, as the patient grows further refinements of the brace will need to be made. Using the brace the patient will need to be seen every three to six months for repeat x-rays to see how effective the bracing has been. The brace will be worn through the entire adolescent period until the patient stops growing, and then the weaning from the use of the brace can be done. This weaning must be done slowly and may take as long as a year to do. While wearing a brace most patients can enjoy most activities, although there will be restrictions to some contact sports or exercises which might incur severe bending such as tumbling or wrestling.


When Is Surgery Needed For Scoliosis?
Surgery is required in those patients with the most severe scoliosis or if the scoliosis has matured and cannot be handled by a brace during the growth spurt. Surgery that would be performed is called a spinal fusion, and it is done to fuse the bones in a straighter position. This will help prevent progression of spinal fractures and arthritis, which can cause constant back pain and possible problems with restrictions in chest movement and frequent bouts with pneumonia. Surgery can be done in multiple stages and may include approaches from both the back and the front to provide stabilization.


What Happens To Scoliosis If It Is Left Untreated?
Scoliosis that is left untreated and becomes severe can cause multiple deformities and defects. Obviously, the most problematic are difficulties with backache and damage to the vertebrae or spinal cord. Disfigurement because of the severe curvature can also be a social problem. The patient has reduced lung and chest capacity because of the curving of the spine around the chest and this can cause difficulty with breathing. In women with lower curvatures there is also difficulty with childbirth because of inadequate room for the baby to grow.
If you have other questions about scoliosis, please don't hesitate to ask.


What Are The Treatments For Scoliosis?
1. Exercise. Exercise will usually not correct scoliosis, but may improve the curve pattern to some degree. Because of the curve the muscles on one side of the back can become weakened and the exercises are helpful in maintaining balance.
2. Brace. Brace treatment done by a special therapist called an orthotist is effective at a time when the spine is still growing and therefore can be molded into a straighter position. Brace therapy is usually started before puberty, and is used when the patient's scoliosis is moderate. Again, the brace will not make the scoliosis go away completely, but if the curve progression can be minimized during the growth years, then no further therapy may be needed. In most cases of scoliosis the brace is worn almost continuously as many as 20- 23 hours a day. The patients who can use the brace for lesser times are usually those with lesser curvatures. Like a new pair of shoes, the brace needs to fit properly and in the beginning until the wearer becomes use to it, areas of pressure can exist. The pressured areas will appear red and sore and should be properly reported to the physician or orthotist who can make the proper adjustments. With the brace frequent visits are necessary, sometimes every three to six months with x-rays to judge progression or improvement of the scoliosis.


At What Degree Of Scoliosis Should One Consider Surgery?
Each orthopedic surgeon and patient is different. Once the curvature of the spine approaches 40-50 degrees, however, it is unlikely that any spontaneous improvement, exercise or brace will be helpful. By allowing the scoliosis to persist, later problems with lung mobility and childbearing in women could be a major problem.


What Is Done In Scoliosis Surgery?
In most cases the spine is straightened using special steel rods that are implanted. In addition to the steel as a brace, bone grafts taken from other parts of the body such as the pelvic bone are grafted to help fuse the bones solidly so that no further curvature will occur. Rods are left in permanently and in almost all circumstances these rods cannot be felt except in very thin people.
In most patients about 50% of the spinal curvature can be cured with surgery. While not perfect, this is an acceptable amount and prevents problems from occurring in the future. Absolute straightening is almost impossible because complete straightening has the possibility of pinching or stretching the spinal cord.
In most cases the surgery is straightforward if done by an orthopedic surgeon who has special interest in spine diseases. In some cases a blood transfusion may be necessary, but blood can be pre-donated to the local blood bank to prevent the risk of diseases caused by blood transfusion. In todays society and with the knowledge the blood banks have about communicable diseases, this has become a very rare occurrence. In most cases the surgical stay is about one week.
Complications of surgery include infection of the graft or rods. This usually occurs within the first 10- 14 days and may require opening of the incision and prolonged treatment with antibiotics. In some cases the rods or fusion will not take and repositioning the rods and redoing the fusion may be required. There is a small chance of nerve damage to the spinal cord with scoliosis surgery, and if identified early enough can be reversed in many cases.
In most cases the patient is able to start ambulating within a week, although with a brace. By 4-6 months unlimited activity can resume in most cases.


KYPHOSIS
Kyphosis is not scoliosis. Kyphosis is a spinal curvature that bends the back forward. Kyphosis is often termed as hunchback because of the rounded, flattened shoulders when viewed from the side. Every human has a small amount of kyphosis as much as 45 degrees. Kyphosis is not a serious problem in most patients and is certainly not as problematic as scoliosis which is a curve from side to side.
Kyphosis treatment is usually with a brace if the degree of bending is more than 50 degrees, and in very rare cases of severe kyphosis, surgical straightening with a rod and bone fusion may be necessary.
Some patients have kyphoscoliosis--a combination of both scoliosis and kyphosis with curves left and right and front and back. The treatment options are the same as for scoliosis.
Ask if you have additional questions.


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