Many of us have heard about scoliosis, but did you know there are many treatment options, and most people don’t require surgery? NEBH spine surgeon Pablo Diaz-Collado, MD, explains what scoliosis is, and the various treatment options available.
What is Scoliosis
Scoliosis refers to an abnormal curvature and rotation of the spine, and can begin at birth (congenital) or develop later in life for different reasons. The most common type of scoliosis in the young (from infants to adolescence) is idiopathic, while in adults is degenerative. The specific cause of idiopathic scoliosis is unknown. However, it has a higher prevalence in adolescent females. Degenerative scoliosis in adults is due to the wear and tear and arthritis of the discs as they collapse on each other over time and thus cause the spine to rotate and bend. While the causes for scoliosis are different, they can be related. For example, idiopathic scoliosis curves that do not require surgery when young can degenerate over time throughout adulthood. Scoliosis curve(s) can change and become more pronounced over time or may remain relatively unchanged.
Scoliosis can be graded from mild to severe. Mild curves are common and may not cause any symptoms or be noticeable to the eyes, however can show up on x-ray. Severe scoliosis is noticeable without imaging, affects posture, and may be painful. Pain can localize to the back and sometimes radiate down the legs with associated numbness and tingling.
If the scoliosis curves are mild and general posture is well balanced, surgery to treat the scoliotic curves may not be needed.
If the scoliosis is more moderate and painful, then we first recommend a course of dedicated physical therapy consisting of low-impact exercises to strengthen the core and para-spinal muscles of the spine. Anti-inflammatory medications and corticosteroid injections can help improve the pain. In moderate scoliosis cases, if the pain and disability is not improved with physical therapy, anti-inflammatory medications and corticosteroid injections, then we may recommend a surgery.
Patients always ask about the use of braces. In adults, bracing scoliosis curves has not been found to make a significant difference in outcomes. Thus, for adults we do not recommend the use of a brace as it does not prevent the progression of the scoliosis nor does it improve pain. The use of braces in pediatric patients is very different. In particular, adolescent idiopathic scoliosis patients often times are treated with a brace to help stop the progression of the curve especially around their growth spurt. Once the patient reaches maturity, the brace is usually discontinued.
If the curve is severe and progressive, surgery often times is needed to help stop the progression of the curves. Surgery to treat scoliosis typically involves a long fusion of the spine. Special techniques such as osteotomies (cuts in the bone) are needed to help correct the spine. For this reason, if you are considering surgery, Dr. Diaz-Collado recommends finding a surgeon who specializes in spinal deformity procedures as this is something not many spine surgeons are trained to do. There are few spine surgeons and institutions, who do this type of surgery on a routine basis. At New England Baptist Hospital, we are fortunate to have surgeons like Dr. Pablo Diaz-Collado and Dr. Frank Rand, who specialize in scoliosis and count with the most advanced techniques for treating complex spine problems and scoliosis.