This past week, I got a chance to see a 53 yo gentleman from Mississippi who works as a river boat engineer.
He has a 94 degree thoracic curve, and has developed severe pain in his low back over the past 10+ years which has gotten significantly worse during the past year.
This is a good example of the long-term consequences of scoliosis. Many scoliosis patients do well with smaller curves with no significant treatment. However, there is a subset of scoliosis patients who have slow curve progression, which eventually becomes very symptomatic. Correction of thoracic scoliosis curves at a younger age may help prevent this lower lumbar degenerative collapse which can cause spondylolisthesis, spondylosis (severe facet arthritis) and disc degeneration. It can also cause spinal stenosis as the arthritis builds up, and the ligaments thicken in response to the collapse. This can cause sciatica, and spinal claudication, with trouble standing and walking.
A couple weeks ago, I fixed a 16 yo young man, who is a big-time golfer from southern Florida, who had a 68 degree preoperative curve. He and his parents actually put off having the scoliosis fixed because of concerns about being unable to return to sports, including golf. When Alex and his parents learned that people can now return to athletics including golf after scoliosis surgery, he was then willing to get it fixed.
By correcting Alex’s curve now, at age 16, rather than waiting to age 53, there are several advantages:
- Less medical risk.
- Better curve correction. Younger curves are usually more flexible.
- More years to enjoy the improved posture and self-image and appearance.
- Possibly help prevent the lower lumbar disc collapse and progression, by getting the spine into better alignment over the lumbar and lumbosacral discs.
- Quicker recovery time
- Stronger bone and faster/better spinal fusion rates.
Yet despite these advantages, I know many young, middle and older age adults are fearful or reluctant to have their scoliosis fixed, even if there is documented curve progression, and/or progressive back symptoms. Some are even fearful or reluctant to get their scoliosis checked, or are unaware of the potential for progression of scoliosis or kyphosis during adulthood.
While it is always better to try to get spinal deformity fixed when you are younger, older patients can still do very well after scoliosis fusion. I have actually helped patients up to age 96 who had significant spinal deformity. The 96 yo woman I treated several years ago actually went back to work in the furniture industry, and actually walked with my wife all over huge furniture warehouses, successfully selling her a LOT of furniture and rugs, including our dining room set we enjoy frequently!
However, it is important to have your scoliosis and kyphosis followed not just during adolescence, but throughout adult life. Curves should be accurately measured every 1-5 years, depending on age and years of observed stable curve measurements.
If there is documented curve progression, or if symptoms from scoliosis or kyphosis are progressive, surgery should be considered. However, it is always important to be evaluated by surgeons who have significant experience caring for people with scoliosis. Many of my patients, including ones I have recently seen like Alex from south Florida (654 miles), this gentleman from Big Creek Mississippi (745 mi) , and Mary from Princeton NJ (468 miles) have found it helpful to seek out more than one opinion, potentially traveling to different scoliosis centers around the country to find the right treatment and right doctor and team for you. I’ve actually seen patients over the past 3 and a half years or so from as far away as northern California (2,700 miles) and Stockholm Sweden (4,353 miles) and Honolulu, Hawaii (4,786 miles). I think the Internet, and the ability for people to do more research on their own has really empowered people with spinal deformity, and their families to do a lot of research and communication, and then even get on an airplane to get things checked out, and possibly fixed. Fortunately, scoliosis and kyphosis usually gives people plenty of time to research their options, unlike other more urgent medical conditions. In a way I guess it really does make sense to travel sometimes, since we all travel often hundreds or thousands of miles for good vacations with family. However, there may be a scoliosis expert that you will like closer to home, so you may want to check the http://www.SRS.org website for a scoliosis surgeon in your region.
Lloyd A. Hey, MD MS
https://www.heyclinic.com
Hey Clinic for Scoliosis and Spine Surgery
Raleigh, NC USA
