Scoliosis is a disorder that causes an abnormal curve of the spine, or backbone. The spine has normal curves when looking from the side, but it should appear straight when looking from the front. Kyphosis is a curve in the spine seen from the side in which the spine is bent forward. There is a normal kyphosis in the middle (thoracic) spine. Lordosis is a curve seen from the side in which the spine is bent backward. There is a normal lordosis in the upper (cervical) spine and the lower (lumbar) spine. People with scoliosis develop additional curves to either side of the body, and the bones of the spine twist on each other, forming a “C” or an “S” shape in the spine.
About 3 out of every 100 people have some form of scoliosis, although for many people it’s not much of a problem. For a small number of people, the curve gets worse as they grow and they may need a brace or surgery to correct it. Scoliosis is about two times more common in girls than boys. It can be seen at any age, but it is most common in those over about 10 years of age. Scoliosis is hereditary in that people with scoliosis are more likely to have children with scoliosis; however, there is no correlation between the severity of the curves from one generation to the next.
In most cases, scoliosis is not painful, but there are certain types of scoliosis than can cause back pain, rib pain, and abdominal pain. If the scoliosis is more severe, it can make it more difficult for the heart and lungs to work properly. This can cause shortness of breath and chest pain.
If someone thinks he or she has scoliosis, they will need to see a doctor for an examination. The doctor will ask questions, including:
- Is there a family history of scoliosis?
- Is there any pain, weakness, or other medical problems?
The physical examination involves looking at the curve of the spine from the sides, front, and back. The person will be asked to undress from the waist up to better see any abnormal curves. The person will then bend over trying to touch their toes. This position can make the curve more obvious. The doctor will also look at the symmetry of the body to see if the hips and shoulders are at the same height. Any skin changes will also be identified that can suggest scoliosis due to a birth defect. A doctor may check your range of motion, muscle strength, and reflexes.
There are three main scoliosis treatment options for adolescents:
The orthopedic surgeon may order an X-ray of the spine and use the Cobb method an extremely accurate measuring technique – to calculate the curvature of the spine and its progression. If the curve progresses less than 5 degrees during a specified period of observation, the physician may determine that the curve is not worsening rapidly enough to cause deformity, and treatment may not be necessary.
A back brace does not straighten the curve that is already present. Instead, the goal of a back brace is to stop the progression of the spinal curve as the child continues to grow. The child will continue to wear the brace until he or she reaches skeletal maturity. Once the individual stops growing, there is little likelihood of progression of a curve. Working under the direction of an orthopedic surgeon, an orthotist will fit a custom brace to the individual. The braces usually are made of molded plastic and fit tightly around the body and are worn under the clothes every day.
There are two general approaches to the scoliosis surgery – a posterior approach from the back of the spine and an anterior approach from the front of the spine. Specific surgery is recommended based on the type and location of the curve.
Scoliosis Surgery from the Back (Posterior Surgical Approach)
This approach to scoliosis surgery is done through a long incision on the back of the spine and the incision goes the entire length of the thoracic spine. After making the incision, the muscles are stripped off the spine to allow the surgeon access to the bony elements in the spine. The spine is then instrumented which means that screws are inserted and the rods are used to reduce the amount of the curvature. Bone is then added either the patient’s own bone, taken from the patient’s hip, or cadaver bone, inciting a reaction in which the bones in the spine begin fusing together. The bones continue to fuse after surgery is completed. The fusion process usually takes about 3 to 6 months, and can continue for up to 12 months
Scoliosis Surgery from the Front (Anterior Surgical Approach)
For curves that are mainly at the thoracolumbar junction, the scoliosis surgery can be done entirely as an anterior approach from the front of the spine. This approach to scoliosis surgery requires an open incision and the removal of a rib usually on the left side. Through this approach, the diaphragm can be released from the chest wall and spine, and excellent exposure can be obtained for the thoracic and lumbar spinal vertebral bodies. The discs are removed to loosen up the spine. Screws are placed in the vertebral bodies and rods are put in place to reduce the curvature. Bone is added to the disc space either the patient’s own bone, taken from the patient’s hip, or cadaver bone, to allow the spine to begin to fuse together. This fusion process usually takes about 3 to 6 months, and can continue for up to 12 months.
If you need help treating scoliosis contact Dr. Vivek Kushwaha. He is a board certified Orthopedic Surgeon specializing in Spine Surgery. To learn more about his procedures or to schedule an appointment please call us at (713) 587-6263.