Doctor's Notes on Scoliosis
Scoliosis is an abnormal curvature of the spine. There are multiple types of scoliosis, classified by age of onset and/or cause including congenital scoliosis that is present at birth, infantile scoliosis that affects patients younger than 3 years of age, juvenile scoliosis that is seen in children 3-10 years of age, idiopathic scoliosis (most common type) seen in children 11-16 years of age, neuromuscular scoliosis that is caused by associated disease processes that affect the neurologic or muscular systems, and adult-acquired scoliosis is due to acquired degenerative changes as the spine ages in patients over the age of 18.
Symptoms of scoliosis include
- the patients head appears off center and does not line up with the pelvis,
- one hip or shoulder may be higher than the other,
- the child may walk with a rolling gait,
- the opposite sides of the body may not appear level,
- the child may experience back pain or tire easily during activities that require excessive chest and belly movement,
- one side of the rib cage or lower back may seem more prominent (humpback),
- the chest may seem sunken in on one side,
- in girls one breast may seem smaller than the other, and
- the child may appear to have an uneven waist.
What Is the Treatment for Scoliosis?
Treatment for scoliosis depends on the severity and if it's likely to get worse with time. Adults and children with scoliosis are treated somewhat differently.
Children may not always need treatment because their spine may straighten as they grow. Treatment for children with scoliosis may include:
- X-rays to monitor the severity of the curve
- Exercise and physical therapy to improve muscle strength and back pain
- A plaster cast fitted around the back
- Worn constantly and cannot be removed, or
- Changed every few months as a child grows
- Back brace
- May prevent it from getting worse
- May be indicated if scoliosis worsens despite other treatments, or if scoliosis is severe and a child has stopped growing
- In younger children (usually under 10 years) surgery may involve rods inserted alongside the spine to help stop the curve getting worse as the spine grows
- In teenagers and young adults, surgery usually involves a spinal fusion to correct the curve
- The spine is straightened using metal rods, screws, hooks or wires, along with bits of bone taken from elsewhere in the body, often the hip
In adults, if scoliosis is not severe and is not causing any pain, treatment may not be needed. When treatment for scoliosis in adults is needed, it usually involves treatment for pain and may include:
- Pain medications
- Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin)
- Steroids and local anesthetic injections for pain
- Exercise and physical therapy
- Activities to strengthen and stretch the back
- Can also help people maintain a healthy weight and reduce back strain
- Back braces
- Not usually used in adults, but may help alleviate pain by supporting the spine
- Lumbar decompression surgery
- Not usually used but may be considered if:
- The spinal curve is severe or getting significantly worse
- The patient has severe back pain and other treatments have not helped
- Nerves in the spine are irritated or squashed
Must Read Articles:
Can Scoliosis Get Worse as You Age?In one 20-year study, about 40% of adult scoliosis patients experienced a progression of the condition. Degenerative scoliosis occurs most frequently in the lower back (lumbar spine) and more commonly affects adults age 65 and older.
How Bad Does a Herniated Disc Have to Be for Surgery?A herniated disc (bulged, slipped, or ruptured disc) affects the discs in the back that cushion the bones (vertebrae) of the spine, and is common in the lower back (lumbar spine). Surgery for a herniated disc is not always necessary, but it can speed up recovery time, which can take several months.
Pain After SurgeryThough pain after surgery is common, there are ways to minimize and manage this pain. Treatment for pain after surgery can include over-the-counter (OTC) medications such as Acetaminophen (Tylenol), non-steroidal anti-inflammatory drugs (NSAIDs ibuprofen [Advil/Motrin]) and naproxen (Anaprox, Aleve), and opioids (morphine [Roxanol], fentanyl [Sublimaze], oxycodone [Percolone], and levorphanol [Levo-Dromoran]).
What Are the Causes of Scoliosis?The causes of scoliosis, an abnormal curvature of the spine, include no known cause (idiopathic scoliosis, which is the most common), malformation since birth (congenital scoliosis), and conditions like cerebral palsy, spinal cord trauma, and muscular dystrophy (neuromuscular scoliosis).
Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.