Logo

Scoliosis

Scoliosis

Scoliosis is a medical condition characterized by an abnormal lateral curvature of the spine. The condition can manifest in different forms and degrees, ranging from mild curves that require minimal intervention to severe deformities necessitating complex treatments. Scoliosis can be categorized based on its cause, age of onset, and the location of the curve in the spine. Treatment options vary depending on the severity of the curvature, the age of the patient, and the specific type of scoliosis.

Types of Scoliosis

1. Idiopathic Scoliosis:

  • The most common form, especially in adolescents. It is of unknown origin and accounts for about 80% of scoliosis cases.
  • Adolescent Idiopathic Scoliosis (AIS)  is the most common subtype, typically diagnosed in children between 10 and 18 years old.


2. Congenital Scoliosis:

Results from spinal abnormalities present at birth. These abnormalities arise from improperly formed vertebrae.


3. Neuromuscular Scoliosis:

Occurs in individuals with conditions such as cerebral palsy or muscular dystrophy. The  curvature is due to muscle imbalances and weakness around the spine.


4. Degenerative Scoliosis:

Often occurs in adults due to the degeneration of the spinal discs and joints, leading to a curvature of the spine.

Diagnosis

Scoliosis is usually diagnosed through a combination of physical examination and imaging tests. During a physical exam, a healthcare provider may ask the patient to bend forward to check for asymmetries in the back. Imaging techniques like X-rays, MRI, or CT scans are used to measure the degree of curvature and assess the spine's structure. The Cobb angle is the standard method used to quantify the degree of scoliosis, with an angle of 10 degrees or more confirming the diagnosis.

Treatment Options

1. Observation

For mild scoliosis (Cobb angle less than 20 degrees), especially in growing children, observation is often the first course of action. The patient is monitored regularly to ensure the curve does not progress. If the curve remains stable, no further treatment may be needed.


2. Bracing

Bracing is the primary treatment for moderate scoliosis (Cobb angle between 20 and 40 degrees) in children and adolescents who are still growing. The goal of bracing is to prevent the curve from worsening as the child grows. It is most effective in idiopathic scoliosis and requires the patient to wear the brace for a significant portion of the day, often up to 18-23 hours. Types of braces include:

  • Thoracolumbosacral Orthosis (TLSO): A common type of brace that covers the torso.
  • Milwaukee Brace: Extends from the neck to the pelvis and is used in higher thoracic curves.
  • Charleston Bending Brace: Worn at night, it is designed to correct curves by bending the spine in the opposite direction.
  • Bracing is typically discontinued once skeletal maturity is reached, around 18 years of age.


3. Physical Therapy

While physical therapy alone is not considered a treatment for scoliosis, it plays a supportive role in managing symptoms and improving spinal alignment. Specific exercises known as the Schroth Method or SEAS (Scientific Exercises Approach to Scoliosis) aim to strengthen the muscles supporting the spine, improve posture, and increase flexibility. Physical therapy is often used in conjunction with bracing or surgery.


4. Surgical Treatment

Surgery is generally recommended for severe scoliosis (Cobb angle greater than 40-50 degrees) or when conservative treatments fail to prevent curve progression. The goal of surgery is to correct the curve, stabilize the spine, and prevent further worsening. Several surgical techniques are available, depending on the patient’s age, the severity of the curve, and the specific characteristics of the scoliosis.


Spinal Fusion:

  • The most common surgical procedure for scoliosis. It involves fusing two or more vertebrae together to prevent them from moving independently. Metal rods, screws, and bone grafts are used to hold the spine in the correct position during healing.
  • Fusion can be performed posteriorly (from the back) or anteriorly (from the front).


Vertebral Body Tethering (VBT):
A less invasive, growth-friendly option often used in children with significant growth remaining. It involves placing a flexible cord along the side of the spine, allowing for some movement and continued growth while correcting the curve.


Expandable Rods:

  • Used in very young children with progressive scoliosis.These rods can be lengthened periodically as the child grows, reducing the need for multiple surgeries.


Osteotomies:

  • In cases of severe deformities, portions of the vertebrae may be removed (osteotomies) to achieve better correction during spinal fusion.
  • Surgical treatment generally results in a significant reduction of the spinal curve and improves the patient's quality of life. However, like all surgeries, it carries risks such as infection, nerve damage, and the potential for spinal stiffness.


5. Postoperative Care and Rehabilitation

Post-surgery, patients usually stay in the hospital for several days to a week, depending on the complexity of the procedure. Physical therapy is a critical part of the recovery process, helping patients regain mobility, strength, and flexibility. Recovery can take several months, during which the patient will gradually return to normal activities. Long-term follow-up is necessary to monitor the spine's stability and ensure that the surgical correction is maintained.

  • Emerging Treatments and Research
  • Recent advances in the understanding of scoliosis have led to new treatment approaches and ongoing research aimed at improving outcomes:
  • Genetic Testing: Research is underway to identify genetic markers associated with scoliosis, which could lead to early diagnosis and personalized treatment plans.
  • Robotics and Navigation in Surgery: Robotic-assisted surgery and intraoperative navigation systems are being explored to enhance precision and safety during scoliosis surgery.
  • Biological Treatments: Studies are investigating the use of biological agents, such as bone morphogenetic proteins (BMPs), to enhance spinal fusion and healing.

Conclusion

Scoliosis is a complex condition that requires a multidisciplinary approach for effective management. The treatment strategy is individualized based on the severity of the curve, the age and overall health of the patient, and the specific type of scoliosis. While mild cases may only require observation, moderate and severe cases often need a combination of bracing, physical therapy, or surgical intervention. Advances in surgical techniques and a deeper understanding of the condition continue to improve the outcomes for individuals with scoliosis, enabling them to lead active and fulfilling lives. Regular follow-up and a comprehensive rehabilitation program are essential components of successful scoliosis management.