Conditions & Treatments
Scoliosis is a lateral curvature of the spine, typically forming an “S” or “C” shape. It is primarily a congenital disorder, but it also can be caused by other medical conditions including cerebral palsy or muscular dystrophy. Scoliosis can also develop later in life as our bones and discs degenerate. Many medical providers will screen for scoliosis using a scoliometer measurement on a forward-bend test. If the scoliometer reading is greater than 5 degrees, an x-ray is recommended to confirm the diagnosis. Any curvature of the spine measuring greater than 10 degrees on an x-ray is considered scoliosis.
There are several types of scoliosis:
• Idiopathic Scoliosis – This is the most common type of scoliosis. “Idiopathic” means that there is not a known cause.
• Congenital Scoliosis – In this type of scoliosis, the vertebrae are not formed correctly and may be misshapen or fused. This starts even before birth.
• Neuromuscular Scoliosis – Several medical conditions, including cerebral palsy and muscular dystrophy can lead to scoliosis due to muscle imbalance.
• Early Onset Scoliosis – Any scoliosis that is present before 10 years of age. The Scoliosis Research Society has an excellent article regarding early onset scoliosis. You can review it here.
• Degenerative Scoliosis – This is more commonly seen in the lumbar spine of older adults and is a result of wear and tear on the joints and discs in the spine.
Bracing is an option for adolescent scoliosis patients who are skeletally immature and have an initial measurement of 30-39 degrees, or in those patients who have a documented progression of a curve between 25-30 degrees. Custom molded braces can be ordered through specialty medical suppliers with a prescription. Research has shown that for this age group, even if worn properly at the recommended 18-23 hours a day, bracing has been proven effective only 50% of the time. A brace does NOT correct a curve; it is designed to halt the progression. The decision to wear a back brace is one to be considered by the patient and their support system. We see many second opinions for bracing and like to consider all aspects of wellness in a person, including the psychosocial along with the most up to date research while considering a brace.For patients experiencing degeneration, those in need of spinal support, a lumbar support orthotic brace (LSO) or a thoracolumbar support brace (TLSO) may be prescribed.
Surgery is considered for patients whose curve is greater than 40 degrees, or in certain cases when pain is not alleviated with other treatments. As every curve is different, every surgical procedure is unique to the patient and his or her body. Dr. Hey is continually working on customized techniques to provide optimal correction for each body type.
Physical therapy can help to strengthen isolated muscle groups to support the spine at various levels. This may help to alleviate symptoms associated with a curve. A physical therapist can teach patients exercises to help strengthen the abdominal core, a muscle group that significantly impacts the level of back pain. There are also options for aquatic physical therapy to help those with mobility constraints.
While massage, chiropractic care, Pilates, yoga, stretching and other therapies may provide symptomatic relief, these have been proven inefficient in correcting a scoliosis curve. The Scoliosis Research Society (www.srs.org) has published a paper on alternative treatments, which may be found below.