Remember how, back in fifth or sixth grade, the school nurse checked each of us for scoliosis, a sideways curvature of the spine? Some kids unlucky enough to have this condition spent their early teen years in chest-to-hip braces to stop the curvature from worsening as they grew.
Well, you may be surprised to learn that scoliosis is not just a childhood problem. Daniel E. Gelb, MD, codirector of the Spine Center at the University of Maryland Medical Center, told me that scoliosis can…
- First develop in middle age or later as the shock-absorbing, gel-filled disks between the vertebrae dry out and shrink. If the spine then collapses asymmetrically, the result is degenerative scoliosis. It most often occurs in the low back and is strongly influenced by genetics.
- Unpredictably worsen with age in patients who were diagnosed and treated when young.
- First become obvious in midlife or beyond in people whose childhood scoliosis went undetected.
Up to 50% of people eventually develop some degree of scoliosis. Yet because the early warning signs often are overlooked, adult scoliosis can go undetected until significant pain and/or deformity sets in. This means that you or I could have scoliosis — and not know it!
Worrisome: Untreated scoliosis can lead to pain-inducing posture problems… arthritis of the spine… and, rarely, cardiovascular and respiratory complications as the twisting spine and ribcage place pressure on the heart and lungs. Although mild scoliosis affects both genders equally, the condition is eight times more likely to progress in females.
Check yourself: Dr. Gelb suggested, “Facing a full-length mirror, consider whether one shoulder or hip is higher than the other. For instance, your blouse might not hang correctly or your skirt hem might seem crooked. Also, measure how tall you are to see whether you’ve lost much height. If you notice such symptoms or often have back or hip pain, ask your doctor to refer you to an orthopedist.”
NONSURGICAL HELP FOR SCOLIOSIS
A scoliosis diagnosis is based on a physical exam and X-rays that reveal the location and degree of curvature. Treatment typically depends on the severity of the curvature.
Mild scoliosis, a curvature of 10 to 20 degrees, typically causes only occasional pain and requires no treatment. You may be advised to…
- Exercise. Core-strengthening moves (Pilates, yoga) target the muscles that support the spine and promote flexibility.
- Maintain a normal weight. “Excess pounds hasten degenerative changes and increase pain by putting stress on damaged disks,” Dr. Gelb explained.
- Visit your orthopedist yearly to monitor the condition.
Moderate scoliosis, a curvature of about 20 to 50 degrees, typically warrants treatment. “The primary purpose is to relieve back pain. It’s hard to know whether we can actually limit curve progression,” Dr. Gelb said. For moderate scoliosis, the benefits of surgery generally do not outweigh the risks… and bracing is not effective in adults since growth has stopped. Instead you may be told to…
- Undergo physical therapy (PT). Dr. Gelb explained, “PT helps patients develop the most appropriate exercise program, while treatments such as massage or transcutaneous electrical nerve stimulation [TENS] may reduce pain and muscle spasms.”
- Try chiropractic care. This can relieve pain (but not prevent curve progression).
- Consider epidural steroid injections if nonsteroidal anti-inflammatories, such as naproxen (Aleve), do not ease pain sufficiently. Side effects may include brief discomfort, muscle spasm and, rarely, headache.
- See your orthopedist every four to six months. If the curve progresses, you may need surgery.
ADVANCES IN SCOLIOSIS SURGERY
When a curve approaches or exceeds 50 degrees, especially if it causes persistent pain, surgery may be recommended. The basic goals are to manipulate the spine into a straighter position… affix hardware (such as titanium rods and screws) to hold vertebrae in place… and apply grafting material that will grow into the bone and fuse the area.
Traditionally, surgery involved making large incisions in the back and/or abdomen and taking bone grafts from the pelvis. But thanks to recent advances…
- Plastic or metal cages can be inserted between vertebrae to replace disks that have degenerated. This straightens the spine more naturally, disk by disk, without the forceful manipulation of traditional surgery.
- Hardware can now be affixed through small incisions in the back, minimizing blood loss, muscle injury and recovery time.
- Genetically engineered material that helps grow bone and fuse vertebrae is now commonly used for older scoliosis patients whose pelvic bones are not dense enough to provide bone for grafting.
Recovery: Patients typically are walking a day or two after surgery…resume normal activities within eight weeks… and experience a significant reduction or elimination of back pain. Dr. Gelb said, “When surgery is done well, it is very rare for additional curves to develop later. Basically, once the spine is fused, the progression of scoliosis is halted forever.”