Additional tests may be ordered if there is evidence that the patient's lung function breathing is being affected by the scoliosis. In rare cases, patients with a severe scoliosis deformity may develop pulmonary heart disease, which will require evaluation and treatment by additional medical specialists.
Boachie, who adds that this information also helps guide treatment choices. Figures Photo and X-ray of patient with severe curve progression and restrictive pulmonary disease. Whenever possible, scoliosis in adults is treated non-operatively through physical therapy, medications and other methods.
Steroid injections may also help some patients. Surgery may be warranted in patients who have curves that exceed 50 degrees, are not responding to nonsurgical methods or experience other complications. Find the best scoliosis doctor at HSS for your age, condition, location and insurance. Many patients experience significant relief of their pain from non-operative measures that may include:. Patients who continue to experience nerve pain may benefit from steroid injections in the facet joints where the vertebrae meet at each level of the spine.
Steroids, which reduce inflammation, may also be administered by an epidural , in which the injection needle is inserted into the spinal canal to deliver the drugs directly to the affected nerve root.
In some patients experiencing muscle spasms, the doctor may prescribe a brace to be worn on a short-term basis. However, their usefulness is limited since the support they provide gradually weakens the muscles in the trunk and spine.
The most common type of surgery in adults is a posterior spinal fusion with instrumentation artificial implants. In this procedure, the orthopedic surgeon makes an incision from the back, places screws to correct the scoliosis and then essentially "welds" the vertebrae together using bone chips.
The healing process may take six months to one year or longer, although the recovery from surgery itself is usually four to six weeks. Rods, screws or other implants may be used to hold the spine in alignment during this period.
Once the fusion is complete, these implants no longer serve a function but are left in place to avoid the need for additional surgery. It develops mostly in the preteen and teen years. It often runs in families. Nonstructural functional scoliosis involves a curve in the spine that is reversible because it is caused by a condition such as:.
Structural scoliosis involves a curve in the spine that is irreversible. It is usually caused by an unknown factor idiopathic or a disease or condition such as:.
In children and teens, scoliosis typically does not cause symptoms and is not obvious until the curve of the spine becomes moderate or severe. It may first become noticeable to a parent who observes that the child's clothes do not fit right or that hems hang unevenly.
The child's spine may look crooked, or the ribs may stick out. Most of the time scoliosis does not cause pain in children or teens. When back pain is present with scoliosis, it may be because the curve in the spine is causing stress and pressure on the spinal discs, nerves, muscles, ligaments, or facet joints.
It is not usually caused by the curve itself. Pain in a teen who has scoliosis may be a sign of another problem, such as a bone or spinal tumor. If your child has pain with scoliosis, it is very important that he or she see a doctor to find out what is causing the pain. Some other conditions, such as kyphosis , cause symptoms similar to scoliosis. Idiopathic scoliosis, the most common type, does not have a known cause. Children who have this type of scoliosis usually first develop symptoms in the preteen years.
Most cases of scoliosis are mild, involving small curves in the spine that do not get worse. Small curves usually don't cause pain or other problems. Usually a doctor examines the child every 4 to 6 months to watch for any changes. In moderate or severe cases of scoliosis, the curves continue to get worse. During periods of growth, such as during the teenage growth spurt, the curves may get worse.
Mild to moderate curves often stop progressing when the skeleton stops growing. Larger curves may get worse throughout adulthood unless they are treated. Things that may point to the potential increase in a spinal curve include:. As scoliosis gets worse, the bones of the spine move toward the inside of the curve. If it happens in the upper part of the spine, the ribs may crowd together on one side and spread apart on the other side.
The curve may force the spinal bones closer together. The spinal bones on the outer edge of the curve may also get thick. Although it is uncommon, babies can be born with scoliosis congenital or can develop it during the first 3 years of their lives infantile scoliosis. Scoliosis that is present at birth or that develops in infants may be worse in the long run than scoliosis that develops later in life.
This is because the more growing the skeleton has to do, the worse the curve may get. But in some cases congenital curves do not get worse. And some curves that are present during infancy get better on their own without treatment. If you suspect that your child has a spinal curve, ask a health professional to look at it.
Early detection could lead to early treatment and could prevent a curve from getting worse. If the results of a school screening program suggest that your child may have a spinal curve, follow up with your doctor. Most curves that are found through school screening programs are normal variations in the spine or mild scoliosis, and these curves usually need only regular observation.
A doctor who specializes in surgery of the bones orthopedic surgeon may be consulted if the person has a moderate curve or if the curve is getting worse. The orthopedic surgeon will evaluate the curve and may recommend bracing or surgery.
A health professional who fits people with specially designed assistive devices orthotist can build and fit a custom brace. Scoliosis testing usually begins with a history and physical exam. This includes the forward-bending test, a simple test in which the child bends forward at the waist, arms hanging loosely and palms touching, and the examiner looks for unevenness in the child's back or ribs.
A scoliometer can be used to measure and estimate the rotation of the spinal curve. If the findings of the history and physical exam show a significant spinal curve, an X-ray of the spine may be taken to get a more precise measurement of the spinal curve.
Skeletal age, as determined by the Risser sign, is also a helpful measure to find out the risk that the curve will get worse. Neurological testing may be done on children who have scoliosis to see if they have certain disorders that are often associated with scoliosis, such as cerebral palsy or muscular dystrophy.
Screening means doing a simple test to see if more testing might be needed. Some states require screening for scoliosis by law.
But experts don't agree with whether or not to screen for scoliosis. But screening can also lead to more testing or treatment for children who would not have needed it. Some experts believe that children should be screened for scoliosis regularly throughout their preteen and teen years.
If you are concerned about screening for scoliosis, talk to your child's doctor. The goal of treatment for scoliosis is to prevent the spinal curve from getting worse and to correct or stabilize a severe spinal curve. Fortunately, few people who have spinal curves require treatment. The type of treatment depends on the cause of scoliosis. Scoliosis that is caused by another condition nonstructural scoliosis usually improves when the condition, such as muscle spasms or a difference in leg length, is treated.
Scoliosis that is caused by a disease or by an unknown factor structural scoliosis is more likely than nonstructural scoliosis to need treatment. Treatment is based on the child's age, the size of the curve , and the risk of progression. The risk of progression is based on age at diagnosis, the size of the curve as measured using X-rays of the spine , and skeletal age which can be determined by the Risser sign.
The timing of surgery for scoliosis in children is controversial. Spinal fusion stops the growth of the fused part of the spine, so some experts believe that surgery should be delayed until the child is at least 10 years old and preferably But even after surgery the rest of the spine will continue to grow normally in children who are still growing. If your child or teen has been diagnosed with mild scoliosis, it is important that a doctor check the child's spine every 4 to 6 months to see whether the curve is getting worse.
Most spinal curves do not progress to the point where treatment is needed. But it is important to check for curve progression, because early treatment can often stop it. Image E: Six months after staged posterior spinal fusion. Patient regained her pre-operative weight, is four inches taller and much happier!
Image B: A fusion of the lower portion of her spine was all that was required to correct her deformity. Notice the asymmetry of her hips. Notice how balanced her waist is compared to the pre-operative films. Even with a slight curve above the hardware patients shoulder are level. Image A and B: Patient EW has a major 61 degree right thoracic curve that was corrected by fusing the thoracic spine only. This maintains the lower spines movement. Patient has a large asymmetry at her waistline and a large left-sided rib hump with forward bending.
Image E: Two months after her posterior spinal fusion surgery, showing the hardware from the side. Image F: Six months after surgery, the scar has healed and lightened. Patient is back to full activity without restriction.
Patients with de-novo or degenerative scoliosis, will often experience constant back and leg pain which makes it difficult for them to walk or stand for any period of time. They may become aware that they cannot stand up straight and lean towards one side, this becomes more noticeable the longer they are upright.
These patients often respond well to a gentle supportive brace, which helps to keep them upright and less tilted thus they can walk or stand more comfortably for longer periods of time. Spine Aug 1;31 17 Orthopaedic ProceedingsVol. Thank you, your email has been added to the list. Home About Why us?
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