Scoliosis

What Is Scoliosis?

Everyone's spine has natural curves. These curves round our shoulders and make our lower back curve slightly inward. This is normal and not scoliosis. Some people have spines that bend and twist from side to side. Unlike poor posture, these curves can't be corrected simply by learning to stand up straight. This is a structural curve and twist in the spine. This condition of side-to-side spinal curves is called scoliosis.

On an X-ray, a person with scoliosis looks more like an "S" or a "C" than a straight line. Some of the bones in a scoliotic spine also may have rotated slightly, making the person's waist or shoulders appear uneven. In fact the normal spine usually grows straight up and down like an elevator. However in scoliosis the spine grows like a rollercoaster, twisting more than just a simple sideways bend.

Scoliosis is a descriptive term and is often used as a diagnosis. In 80% of the cases, a cause is not found and such cases are termed idiopathic meaning "of undetermined cause." This is particularly true among the type of scoliosis seen in adolescent girls. Other causes of spinal deformity are congenital spinal column abnormalities, neurological disorders, genetic conditions and a multitude of other causes. Scoliosis does not come from carrying heavy things, athletic involvement, sleeping/standing postures, or minor lower limb length inequality.

Do I Have Scoliosis?

The best person to assess whether you have scoliosis or not is done by your local doctor. An examination, forward bend test and scoliometer reading can help make the diagnosis. If your GP or physician is concerned they can refer you to Dr Balakumar who can then assess and perform X-ray to confirm the diagnosis.

The examination is done with you standing in a relaxed position with your arms at your sides. Dr Balakumar will view you from behind looking for curvature of the spine, shoulder blade asymmetry, waistline asymmetry and any trunk shift. You will then bend forward at the waist. Then Dr Balakumar will usually order initial radiographs of the spine viewed from the back and the side. If there is a scoliosis then Dr Balakumar will measure the angle between the two most tilted spinal vertebral bodies to classify the severity of the scoliosis.

What Are My Treatment Options?

Surgical Treatment of Scoliosis The treatment options for scoliosis fall into three main categories:

Observation of the scoliosis
Non-operative treatment
Surgical treatment

Scoliosis treatment is also guided by the severity of scoliosis as measure by the "Cobb" angle, the progression of the curve on sequential X-rays. It is extremely important to understand that if scoliosis is picked up early one can avoid surgery by being treated appropriately and thereby avoiding progression. Idiopathic scoliosis is usually a function of growth and therefore rapid change can occur to the curve during puberty and the growth spurt.

Mild - 10-25 degrees
Moderate - 25-45 degrees
Severe > 45-55 degrees

Observation:

Curves that have a small degree measurement when you are growing (adolescent scoliosis), or for moderate size curves (< 40-45 degrees) when you are done growing. For adults, observation and physical therapy are for those patients who have mild symptoms and have curves which are not large.

Bracing:

Scoliotic curves between 25 and 45 degrees in growing children to prevent further progression of the curve while growth of the spine remains. The goal of bracing is to prevent further progression since the brace cannot correct curves. It is not unusual for the curve to improve, however when the brace is stopped this will revert to the pre-brace angle. Compliance is the most important aspect of brace treatment, and as a result of frustration it is not unusual for patients to be attracted to alternative therapies. These therapies are not as effective

Surgical treatment:

This is reserved for curves which are generally greater than 50 degrees for adolescent patients and adults. Dr Balakumar usually likes to see serial X-rays showing progression as well. The goals of surgical treatment are to obtain curve correction and to prevent curve progression. This is generally achieved by placing metal implants onto the spine which are then attached to rods which correct the spine curvature and hold it in the corrected position until fusion, or knitting of the spine elements together.