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Scoliosis Overview
Scoliosis is a curvature of the spine that can first appear during childhood. Some people are born with it, while others develop it over time. Scoliosis can cause the spine to twist and bend in an abnormal way. The cause of scoliosis is unknown, but it does tend to affect more women than men.
It is very important to individually assess cases of scoliosis. Sometimes a back brace is used to prevent worsening of the spine curvature. Dramatic curves of the spine can place pressure on internal organs. If this happens, surgery may be necessary. If left untreated, severe
cases of scoliosis can shorten a person's life span.
In less
severe cases, scoliosis may cause the bones to twist slightly, making
the hips or ribs appear uneven. When this occurs, the problem is
more cosmetic and less of a health risk.
Scoliosis surgery is extremely complex, and a person should invest a great deal of time in choosing an orthopedic surgeon who uses the most current surgical fixation rods. If a surgeon uses improper methods during scoliosis surgery, the patient could become paralyzed.
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Causes
The exact cause of scoliosis is unknown. Only 1-4 percent of the population
has this condition. It is more common in women than men and most
often affects adolescents between the ages of 10 and 18. A child's
likelihood to develop scoliosis is much higher if their parent or
a sibling has it. Scoliosis can also develop over time in mid- to
late childhood, usually before puberty. In other cases, the disease
is congenital, meaning a person is born with a vertebral abnormality
that causes it.
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Symptoms
Sometimes, the symptoms of scoliosis are visible. For instance, the
child may have uneven shoulders, chest, hips, shoulder blades, waist,
or a child may have a tendency to lean to one side. In other cases,
there are no visible symptoms. To diagnose a child with scoliosis,
have them touch their toes. If either one or both shoulder blades
are prominent, the waist is shifted or ribs are uneven, scoliosis
may be present. For a child or teenager, your pediatrician often
screens for scoliosis. There are school screening programs as well.
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Diagnosis
Outlined below are some of the diagnostic tools that your physician
may use to gain insight into your condition and determine the best
treatment plan for your condition.
- Medical history: Conducting a detailed medical
history helps the doctor better understand the possible causes
of your back and neck pain which can help outline the most appropriate
treatment.
- Physical exam: During the physical exam, your physician
will try to pinpoint the source of pain. Simple tests for flexibility
and muscle strength may also be conducted.
- X-rays are usually the first step in diagnostic
testing methods. X-rays show bones and the space between bones.
They are of limited value, however, since they do not show muscles
and ligaments.
- MRI (magnetic resonance imaging) uses a magnetic
field and radio waves to generate highly detailed pictures of the
inside of your body. Since X-rays only show bones, MRIs are needed
to visualize soft tissues like discs in the spine. This type of
imaging is very safe and usually pain-free.
- CT scan/myelogram: A CT scan is similar to an MRI
in that it provides diagnostic information about the internal structures
of the spine. A myelogram is used to diagnose a bulging disc, tumor,
or changes in the bones surrounding the spinal cord or nerves.
A local anesthetic is injected into the low back to numb the area.
A lumbar puncture (spinal tap) is then performed. A dye is injected
into the spinal canal to reveal where problems lie.
- Electrodiagnostics: Electrical testing of the nerves
and spinal cord may be performed as part of a diagnostic workup.
These
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Left: D. Todd Rose, MD
Fellowship-Trained in Spine Surgery |
tests, called electromyography (EMG) or somato sensory evoked
potentials (SSEP), assist your doctor in understanding how your
nerves or spinal cord are affected by your condition.
- Bone scan: Bone imaging is used to detect infection,
malignancy, fractures and arthritis in any part of the skeleton.
Bone scans are also used for finding lesions for biopsy or excision.
- Discography is used to determine the internal structure
of a disc. It is performed by using a local anesthetic and injecting
a dye into the disc under X-ray guidance. An X-ray and CT scan
are performed to view the disc composition to determine if its
structure is normal or abnormal. In addition to the disc appearance,
your doctor will note any pain associated with this injection.
The benefit of a discogram is that it enables the physician to
confirm the disc level that is causing your pain. This ensures
that surgery will be more successful and reduces the risk of operating
on the wrong disc.
- Injections: Pain-relieving injections can relieve
back pain and give the physician important information about your
problem, as well as provide a bridge therapy.
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Treatment
There are roughly three tiers of treatment for adolescent scoliosis.
General scoliosis treatment options include observation, bracing,
and if the curve is large and progressive, surgery. Patients with
pain and function issues can be treated with therapy, as well as
physiatry (physical medicine and rehabilitation physician-supervised
programs). Sometimes, shoe inserts (orthotics) are prescribed for
those whose legs are uneven.
For adults, the emphasis is on function and movement.
Bracing is used only as a temporary pain relief measure; it cannot
correct the curve in an adult. Treatment focuses on medications and
physical therapy. If other problems exist that are caused by the scoliosis
(sacroiliac dysfunction, flatback, spinal stenosis, nerve root pinching),
there are many non-operative treatments for each of these issues.
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Francis Pecoraro, MD
Fellowship-Trained in Interventional Pain Medicine |
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Surgery may be required in order to correct the spinal
curve. Surgery is usually only recommended for large, progressive curves
or in those patients who have nerve pain that steadily worsens. These
surgeries can be extremely complicated, and a person should invest
a great deal of time in selecting a spine surgeon who subspecializes
in using the most current (fourth generation) corrective techniques.
As with any spine surgery, finding a doctor with experience in this
specific type of surgery is key.
As with any disease, the sooner the problem is discovered,
the more treatment options there are available to arrest the progress
of the condition.
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FAQs
How can I tell if I have scoliosis?
Your doctor will take X-rays of your spine which will reveal whether
or not scoliosis is present as well as how severe it may be.
When is scoliosis considered dangerous
to my health?
Scoliosis can be life-threatening when bones are so severely twisted
that they compress vital organs. Surgery is most likely the best option
in such cases. If left untreated, severe cases of scoliosis can shorten
a person's life span.
What are some of the nonsurgical
ways to treat scoliosis?
There are some nonsurgical ways to treat scoliosis such as physical
therapy, exercise, bracing, shoe inserts and medication. However, only
a spine surgeon can determine if any of these options might apply to
you.
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Atlantic Orthopedics includes eleven fellowship-trained orthopedic specialists. Fellowship-training represents the highest level of orthopedic medical training in the United States. Click here to learn more.
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