- Learn about traditional treatments for pain relief to bridge from inactivity to physical therapy
Scoliosis (sko-lee-O-sis) occurs when the spine twists and develops an S- or C- shaped sideways curve. Of every 1,000 children, 3 to 5 develop abnormal spinal curves large enough to require treatment. Typically, scoliosis that begins between the ages of 9 and 13, whose cause is unknown, is called adolescent idiopathic scoliosis, or AIS. This is the most common type of scoliosis in adolescents, occurring more often in girls than in boys.
However, idiopathic scoliosis can affect people who have it thoughout their life. Previously stable or mild curves can progress or degenerate, causing pain or worsening deformity. This can happen either as a young adult or as an older adult.
The cause of Idiopathic Scoliosis is largely unknown, however it has been shown to run in families. It is not caused by anything that the child or the child's parents did, or did not do. Research has shown that diet, exercise, poor posture, or carrying a backpack do not cause AIS. In fact, AIS often develops in children who are otherwise healthy. Studies have shown that there may be a genetic link to the development and progression of scoliosis. If it is your child who has scoliosis, there is a painless test that your child's doctor can perform which may help you better understand whether or not your child's AIS might progress.
If you are an adult with scoliosis, there are now physicians who are experienced in the care of scoliosis throughout a person's lifetime. They can offer insight based on new information about how scoliosis progresses or affects a person with age that may help you reduce pain, prevent progression, or have a small surgery now to prevent a degenerating or progressing curve from causing a larger surgery later in life.
AIS rarely causes pain in children and adolescents. In fact, AIS often goes undiagnosed until the curve has progressed and is more visibly noticeable. However, untreated curves may progress in young adults, causing pain or worsening deformity. In older adults, the curves may progress additionally.
The most current classification for adolescent idiopathic scoliosis is the Lenke Classification, which takes into account much of the complexity of the various, subtle, variations in idiopathic scoliosis. It also helps in the surgical planning. However, research continues on the various subtypes, with additional research regarding subtypes being performed every year. One example of this is the classification of Lenke 1A curves into 1ARight and 1ALeft. A center's experience and attention to detail regarding these classifications differences is an important factor in achieving high reliability surgical correction and treatment.
Often in children under 7, curves are observed unless large or progressing. Priority for any treatments in this age group is given to preserving spine and thoracic (rib) cage growth in order to preserve future function of lungs and breathing. Bracing and casting are conservative options, but often involve using the cast or brace to push on the rib cage, which may impair the important development of lung function. Certain patients may benefit from growing rods, Shilla constructs, or other growth preserving techniques.
For patients 8 to 10 years old, again curves are observed unless large or progressing. Again, priority is given to preserving spine and rib cage growth. However, some patients may benefit from bracing, grow constructs, vertebral body stapling, minimally invasive reconstruction, or, rarely, open reconstruction. A simple genetics test using saliva (see Genetics Test for Scoliosis) may help your physician decide the best treatment for your child.
For patients 9 and older, again observation is the rule. If your child is 9-13 years old, they may be a candidate for the genetics test for scoliosis (see Genetics Test for Scoliosis), which may help avoid treatment your child does not need, or in cases in which the test predicts a severe curve, move to innovative, less invasive treatments to avoid open spinal reconstruction. Occasionally bracing may be of benefit. In these cases, the Boston Brace is used for thoracic and double curves, and the Charleston Brace can be used initially for lumbar located curves.
In patients with significant growth potential (8-12 skeletal age) with progressing curves, a high genetics test score, and curves 20-40 degrees, may benefit from vertebral body stapling, in which minimally invasive approaches are used to deliver a nitinol staple (see Vertebral Body Stapling). This procedure uses the spine's remaining growth to correct the scoliosis.
In large curves, over 40 degrees for lumbar curves and over 45 degrees for thoracic curves, surgery may be indicated. Preference is given to minimally invasive scoliosis reconstruction (see Minimally Invasive Approaches) when advisable.
Skeletal maturity was once used as the benchmark for ending the treatment of idiopathic scoliosis. However, it is now recognized that curves over 30 degrees in the lumbar spine and 40 degrees in the thoracic spine have continued potential for progression. This progression can lead to worsening spinal deformity, pain, and accelerated degeneration of the spine around the scoliosis in the young adult.
Conservative treatments such as physical therapy and injections can often help with the pain issues. An opportunity may exist for a minimally invasive surgery addressing the scoliosis, which can correct the scoliosis, prevent further progression, and thus preventing degeneration of the spine below the scoliosis. This can prevent further pain and disability, and thus a larger, salvage surgery or progressive disability later in life.
Stacy - Young Adult Scoliosis
It is not uncommon in older adults, especially those with lumbar scoliosis, to get accelerated progression and degeneration of their spine below the scoliosis. This can result in a Collapsing Spine Syndrome with progressive back pain, spinal stenosis, and spinal imbalance. Conservative treatments may focus on using bone restorative medicines for treating any existing osteoporosis (such as Forteo/teriparatide), physical therapy when indicated, and injections targeted at the areas of dysfunction.
As a last resort, surgery may be necessary. In these cases, often the most technically difficult given the fragility of the aging spine and aging patient, a range of expertise is necessary. The desire for minimally invasive approaches must be balanced with sound surgical planning.
Marcia - Older Adult Scoliosis