What is Scoliosis? A person’s spine rotates and curves sometimes making an ‘S’ or ‘C’, which is called ‘Scoliosis‘. A person’s ribs are attached to your spine. When the spine rotates, it raises the ribs and creates a ‘Rib Hump’. https://images.app.goo.gl/2ytyHTeW961Xc9Qu7
The ‘Rib Hump’ is most noticeable when a person bend forwards. A sufferer/patient may also note differences in his/her chest and breast size, shoulder or waist. This actually may appear uneven.
As a person grows, the curve may become longer. Like when the curve reach 45 to 50 degrees at the middle of your back, it will continues to worsen throughout the life. This increase in curve can affect a persons breathing too it it increases beyond 70 degrees.
Usually the disease called “Scoliosis” is Idiopathic in most cases. Idiopathic means ‘we don’t know the actual cause of the disease’.
Carrying something heavy or bad posture does not cause Scoliosis. It also does not cause backpain in most of the people who are suffering from Scoliosis.
How to detect Scoliosis at home?:
When screening for scoliosis, several things can be considered. Scoliosis signs can include;
1- Head is appearing off centered between the hips
2- Cloths worn by the sufferer hangs unevenly
3- Rib cage and the trunk appear to shift to one side
4- One shoulder looks higher than the other
5- Waist appears to be asymmetrical
6- One hip appears lower than the other
7- One shoulder blade is becoming more prominent than the other
Tests to diagnose Scoliosis:
First test which you doctor will perform is called ‘ADAM’s FORWARD BEND TEST’. As your spinal curve develops and twists, asymmetry of waist or rib cage is created. The device which is used to measure the amount of rotation is called SCOLIOMETER.
Trunk rotation is determined with the reflection of the severity of scoliosis and forward bend of the waist.
Scoliosis may be present if rotation of greater than 5 to 7 degrees may be present.
There are many treatments for Scoliosis. Treatment may include watching your curve and also getting an X-ray regularly. Your doctor/physician may consider the size and type of your curve and how much growing you have left to do, medical condition if have any.
The Goal is to prevent curve from getting bigger or progressing. Sometimes wearing a BRACE can be affective between 20 – 40 degrees in growing children, but wearing it does not make the curve smaller.
Alternative treatments for Scoliosis:
Other alternative treatments besides wearing a Brace and Surgery include;
. physical therapy
. chiropractic care
But currently there is no specific evidence that improve the curve or prevent progression of curve.
For larger curves your Doctor might recommend Surgery.
Non-operative management for scoliosis:
Scoliosis can be treated non-operatively and operatively depending on the size and severity of patient’s curve. Every individual’s curve is unique, that’s why there is not a ‘one size fits for all’ solution.
Non-operative treatment options are mainly focused on amount of growth remaining and size of curve.
BRACING; as a non-operative treatment option:
What is BRACING? Bracing is conducted by a ‘Bracing Specialist’ and ‘orthotist’, who design an external support system (or a Brace) after evaluation, as an attempt to stop abnormal curves in spine.
How does Bracing works:
A typical ‘Scoliosis Brace‘ is made up of contoured plastic that fits snuggly around the hips and the torso. There are a variety of Brace styles. Some designed to be worn full time and others to be worn only at night.
The biomechanical principles of Bracing:
The biomechanical principles of bracing are founded on evidence that ‘directed pressure reduces the curve’ and moves the spine into better alignment when the Brace is worn.
“Whether Scoliosis Bracing is affective”? Occasionally it is not but bracing done with proper plan is effective. Research has shown a 72% success rate in stopping the curve progression.
A success rate of 48% has been shown by the patients who constantly wore Brace as compare to the patients who did not wear it.
The above same research also said that the optimal amount of time required to halt progression of curve is 18 hours a day. This shows that people who consistently wear a brace are less likely to develop the curve that may require surgery.
So till now the most effective non-operative treatment option for Scoliosis is Bracing.
Are there other treatment options that prevent Scoliosis:
The other treatment options that prevent Scoliosis from worsening is of great debate. Some proponents claim many other treatments and techniques can help to prevent Scoliosis progression including;
. Bio feedback
. Traditional physical therapy
. Electrical stimulation
. Chiropractic stimulation
. Scroth physical therapy
. Shoe orthotics
and other less traditional treatments.
At present none of the above mentioned methods have evidence to prove their claims. So eventually it is the responsibility of the patient, parent and the physician/doctor to choose the best course of action in treatment method.
The treatment approach should be based on many factors including amount of growth remaining, the degree of curvature, the patient’s willingness to follow the Bracing Program and the most importantly open communication between the patient, parent, physician/doctor, and orthotist is necessary to achieve success.
Types of Scoliosis on the basis of size and degree of the curve:
Primarily non-operative treatments options are focused on size of curve and amount of growth remaining.
- Curves between 10 – 25 degrees are considered MILD. At this recommended to observe the patient if the patient is still growing. Observing the patient includes visit to his/her doctor regularly, where he monitor the patient’s curve by taking periodic x-rays of his/her spine. No treatment is necessary if the patient is no longer growing.
- Curves between 25 – 40 degrees are considered MODERATE. This is the stage when patients are advised to wear a Brace. For patients who are no longer growing, observation over the period of 3-5 years is the recommended option for treatment.
- Curves greater than 75 degrees are considered SEVERE. This is the stage where Surgery is recommended to the patient whether he/she is still growing or not.
What is Scoliosis Surgery:
When despite wearing a Brace, your curve is still progressing, the next step would be to ask the Scoliosis Expert opinion, which is the need of the hour if your spine is continuing to progress into the Surgical Range. The reason to opt for surgery is to prevent further progression of Scoliosis to correct the spine to the point where it can be done safely.
When the surgery is recommended:
This decision partially depends on stage of growth, the severity of the curve and the location of the curve, the curve pattern and surgeon’s preference. As its already been discussed that as the scoliosis curve gets to 50 degrees, it will continue to worsen through out the life if left untreated. So a doctor/physician start to consider surgical options when the curve reaches 50 degrees.
a- Spinal Fusion surgery for Scoliosis:
Spinal fusion surgery can be considered as a preventive surgery. Many patients especially children suffering from Scoliosis experience little to no pain or symptoms of the condition. Surgery is considered to be a good approach to consider here as these curves will continue to worsen, and sometimes becomes more symptomatic throughout life.
What is Scoliosis Surgery?
“Scoliosis surgery is a procedure to prevent further progression in correcting curvature of spine”.
To do Surgery to prevent scoliosis progression, Implants which includes rods, wires, screws and hooks are used which are either made of titanium, stainless steel or cobalt chrome. These are made to touch to the vertebrae at the section of the spine that is curved.
To make my readers understand better about this procedure, let’s consider an approach called ‘Posterior Spinal Fusion” with instrumentation. In this procedure an incision is made in the spine. The surgeon will remove the Facet Joints. This will help the surgeons to see where its better to place the screw, which can make the spine more flexible.
In the next step, screws and hooks are going to touch to the vertebrae at the curved section and the rods are touched to the hooks and the screws. These screws and hooks plays the role of anchor points to secure the rods.
When the correction desired is achieved, the bone graft is used to fuse the spine to its corrected position. With time the bone graft fuses with the existing bone, where it forms a solid column of bone in that area. The fusion of bones with the help of implants (mentioned above) may take 6-12 months generally.
What are the side effects of Spinal Surgery:
The section of the spine which has been permanently fused will loose motion any further and will not grow. For a patient this affect will be un noticeable. The patient may likely feel taller when leaving the hospital, as he/she was before surgery. This minor difference in height is because of straightening of curve which has been straightened now following surgery.
How long will implant stays in your body:
Implants will stay in the patient’s body forever. In actual the job of implants ends after the bone fusion process, as after fusion of bones its the fusion which maintains the correction. Another surgery is required to remove the implants (i-e rods, hooks, screws), which is a major surgery and mostly it is not necessary.
b- Anterior Vertebral Body Tethering (VBT):
“Anterior vertebral body tethering” is a new correction technique which is fusionless i-e it does not require fusion process of bones. VBT may be an option for certain immature patients with worsening scoliosis.
VBT procedure uses a tether which is like a strong cord that is made to touch to the spine to correct the curve, as the patient grows. In VBT procedure, more mobility is maintained after surgery, as there is no fusion involved in this process. This procedure sets the scoliosis straight.
POINT TO CONSIDER here is; no two spines are alike. Your treating doctor/physician should be the most important source of guidance to your Scoliosis treatment.