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Scoliosis

All you should know about Scoliosis

Our Neurosciences service treats patients with a variety of ailments such congenital birth defects, angle deformities, angle correction, fusion (anterior and posterior) and without fusion surgery. We are inspired and committed to cutting-edge patient care and the treatment of patients with spinal neurological illnesses to the satisfaction.

Scoliosis is a medical condition in which a person’s spine is curved from side to side. Although it is a complex three-dimensional deformity, on an X-ray, viewed from the rear, the spine of an individual with scoliosis may look more like an “S” or a “C”, rather than a straight line.

Scoliosis is typically classified as either congenital (caused by vertebral anomalies present at birth), idiopathic (cause unknown, subclassified as infantile, juvenile, adolescent, or adult, according to when onset occurred), or secondary to a primary condition. Secondary scoliosis may be the result a neuromuscular condition (spina bifida, cerebral palsy, spinal muscular atrophy, or physical trauma), or syndromes such as Chiari malformation.

Signs and Symptoms

Patients having reached skeletal maturity are less likely to have a worsening case. Some severe cases of scoliosis can lead to diminishing lung capacity, putting pressure on the heart, and restricting physical activities.

The signs of scoliosis can include:

  • Uneven musculature on one side of the spine
  • A rib prominence and/or a prominent shoulder blade, caused by rotation of the ribcage in thoracic scoliosis
  • Uneven hips, arms or leg lengths
  • Slow nerve action (in some cases)

Diagnosis

Scoliosis is defined as a spinal curvature of more than 10 degrees to the right or left as the examiner faces the patient (in the coronal plane). Deformity may also exist to the front or back (in the saggital plane). Patients who initially present with scoliosis are examined to determine whether the deformity has an underlying cause. During a physical examination, the following are assessed to exclude the possibility of underlying condition more serious than simple scoliosis. The patient’s gait is assessed, and there is an exam for signs of other abnormalities (e.g., spina bifida evidenced by a dimple, hairy patch, lipoma, or hemangioma.

During the examination, the patient is asked to remove his or her shirt and bend forward. This is known as the Adams forward bend test and is often performed on school students. If a prominence is noted, then scoliosis is a possibility and the patient should be sent for an X-ray to confirm the diagnosis.

Bracing

Bracing is normally done when the patient has bone growth remaining and is, in general, implemented to hold the curve and prevent it from progressing to the point where surgery is recommended. Braces are sometimes prescribed for adults to relieve pain related to scoliosis. Bracing involves fitting the patient with a device that covers the torso; in some cases, it extends to the neck. The most commonly used brace is a TLSO, such as a Boston brace, a corset-like appliance that fits from armpits to hips and is custom-made from fiberglass or plastic. It is sometimes worn 22–23 hours a day, depending on the doctor’s prescription, and applies pressure on the curves in the spine. The effectiveness of the brace depends not only on brace design and orthotist skill but on patient compliance and amount of wear per day. The typical use of braces is for idiopathic curves that are not grave enough to warrant surgery, but they may also be used to prevent the progression of more severe curves in young children, to buy the child time to grow before performing surgery, which would prevent further growth in the part of the spine affected.

 

Casting

In progressive infantile and sometimes juvenile scoliosis, a plaster jacket applied early may be used instead of a brace. It has been proven possible to permanently correct cases of infantile idiopathic scoliosis by applying a series of plaster casts (EDF: elongation, derotation, flexion) on a specialized frame under corrective traction, which helps to “mould” the infant’s soft bones and work with their growth spurts. This method was pioneered by UK scoliosis specialist Min Mehta. EDF casting is now the only clinically known nonsurgical method of complete correction in progressive infantile scoliosis. Complete correction may be obtained for curves less than 50° if the treatment ends before the second year of life.

Surgery

Surgery is usually recommended by for curves with a high likelihood of progression (i.e., greater than 45 to 50° of magnitude), curves that would be cosmetically unacceptable as an adult, curves in patients with spina bifida and cerebral palsy that interfere with sitting and care, and curves that affect physiological functions such as breathing.

Surgery for scoliosis is performed by a surgeon specializing in Spine Surgery in India. For various reasons, it is usually impossible to completely straighten a scoliotic spine, but in most cases, significant corrections are achieved.

 

What are the Treatment Options for Scoliosis?

These curves of 82° and 75° will need surgery to restore normal posture Your doctor will order an x-ray image of your child’s spine to make a firm diagnosis of scoliosis. The x-ray will also show your doctor how severe the curve is.

In planning your child’s treatment, your doctor will take into account how severe your child’s curve is and where it occurs in the spine. Your child’s age is also an important factor – if your child’s spine is still growing, it will affect treatment choices. Your doctor will determine how likely it is that the curve will get worse, and then suggest treatment options to meet your child’s specific needs.

In general, curves measuring 25 to 50 degrees are considered large enough to require treatment. Curves greater than 50 degrees will likely need surgery to restore normal posture.

What will make the Spine go Back to Being Straight Again?

A scoliosis curve will not get straight on its own. Bracing will help it from getting worse. Surgery — a spinal fusion — is the only thing that will straighten out the spine, but it will not make it completely straight.

 

What happens if my Child has just a Slight Curve?

Children who have mild curves (less than 20 degrees) or who are already full grown, will be monitored to make sure the curve is not getting worse. Your doctor will check your child’s spine every 6 months and schedule follow-up x-rays about once a year.

 

Will having so many X-rays cause Future Health Problems?

X-rays are necessary to follow the progression of the curve. There can be small negative effects with frequent x-rays, but these effects are minimized by using protective shields over certain body parts to protect the child from unnecessary exposure.

 

What happens if No Treatment is done? Will the Curve get Worse?

Two factors can strongly predict whether a scoliosis curve will get worse: young age and a larger curve at the time of diagnosis. Children younger than 10 years with curves greater than about 35 degrees tend to get worse without treatment.

Once someone is done growing, it is very rare for a curve to progress rapidly. We know from studies that once someone is fully grown, scoliosis less than 30 degrees tends not to get worse, while those curves greater than 50 degrees can get worse over time, by about 1 to 1 1/2 degrees per year.

 

Common Questions About Bracing

Two factors can strongly predict whether a scoliosis curve will get worse: young age and a larger curve at the time of diagnosis. Children younger than 10 years with curves greater than about 35 degrees tend to get worse without treatment.

Once someone is done growing, it is very rare for a curve to progress rapidly. We know from studies that once someone is fully grown, scoliosis less than 30 degrees tends not to get worse, while those curves greater than 50 degrees can get worse over time, by about 1 to 1 1/2 degrees per year.

 

Do I have to Wear a Brace if I have scoliosis?

A typical underarm brace.

Your doctor will order an x-ray image of your child’s spine to make a firm diagnosis of scoliosis. The x-ray will also show your doctor how severe the curve is.

Most people with scoliosis do not have to wear a brace. About one out of every six adolescent patients show signs that their curves may increase quite a lot during their growth spurts. The larger a curve gets, the more likely surgery may be needed to correct it. Therefore, if you have signs of curve progression, your doctor may recommend you wear a specially designed back brace to try to keep the curve from getting much larger as your spine grows.

 

What degree do you decide to do a brace?

Brace treatment is generally used to prevent scoliosis from getting worse when you have:

  • Curve that is moderate in size (25 to 40 degrees)
  • A curve that is progressive (has increased by more than 5 degrees)
  • A lot of growing yet to do (Risser 0 to 2)

Your doctor may consider other factors in recommending a brace, such as if you have additional medical conditions, or have family members with scoliosis.

 

Does Bracing Work ?

Several research studies show that bracing for scoliosis can keep your spinal curve from growing large enough to require surgery. Your curve will most likely get smaller as it is being held in the brace. When your spine is fully grown and you stop wearing the brace, your scoliosis curve will eventually go back to its original size. In some cases, the curve stays smaller after bracing treatment.

There are some cases, however, where the curve continues to grow even though a brace is worn.

So bracing can work, but doctors need more research to show when and how bracing can be even more effective.

 

What kind of a brace will I need and why?

Your doctor will work with an orthotist (a professional who makes assistive devices like braces) to recommend the best type of brace for you.

The kind of brace you need depends upon several factors, such as:

  • Where your curve is located on your spine
  • How flexible your curve is
  • The number of curves you have
  • The position and rotation of some of the vertebrae in your spine
  • Any other medical conditions you may have

Your doctor and orthotist will also take into account your activities and lifestyle when suggesting braces. You and your parents can then decide which brace you prefer among the choices given.

The brace only works if you wear it as requested, so it is important that you help choose the one you will use.

 

What does the brace look like?

Whether you need a plastic or soft brace, your orthotist will custom-make your brace to comfortably fit your body.The soft braces use elastic straps, Velcro, and various smaller plastic or metal pieces to put the brace into the shape that is best for your type of curve, and help keep it in place as you move around.

 

How long will I need to wear the brace? Can I wear it at night only?

You need to wear a brace until your spine stops growing. This timing varies quite a bit from person to person. Your doctor will check your brace and the status of your growth every 4 to 6 months.

The amount of time each day that you have to wear the brace depends upon several things, including your growth and the type of brace you wear. The most common daytime braces are worn 16 to 23 hours each day.

Some braces are worn only while you sleep, but they do not work for all curve types. Your doctor will advise you about which brace and wearing time is best for you.

 

What will it be like to wear a brace?

It may take some practice to get used to putting on your brace, but soon you will become an expert at it. Clothes in loose-fitting styles will easily cover your brace.

As long as your doctor approves, you will be able to remove your brace to play sports or do other recreational activities.

 

What happens if I don’t wear the brace?

Wearing a brace is one important way you can try to prevent your scoliosis from getting worse.

A brace will only work if you wear it. Like many things in life, you have a choice, but your choice also has consequences. If your doctor recommends a brace and you choose not to wear it, then you run the risk of your curve getting larger.

Depending on how big your curve gets, you may need surgery to correct it. Or you may choose to do nothing about the curve and run the risk of it continuing to increase. This may cause various medical and quality of life issues later in your life.

 

Are there other options for brace treatment?

Most experts who provide nonsurgical care for scoliosis understand the importance of bracing when there is a high potential for continued progression of a curve.

Various treatments are offered — mostly through the internet — that claim to be able to stop or reverse scoliosis without the use of a brace, even in those situations where you show strong signs for curve progression during growth. At this time, there is NO scientific evidence to support these claims.

 

Common Questions about Alternative Treatments for Scoliosis

Many patients and their parents ask about the effectiveness of treatment options other than bracing and surgery.

Will physical therapy help my scoliosis?

It has not been proven that physical therapy can help people with scoliosis.

Different physical therapy methods have been designed to offset the effects of scoliosis, and improve the shape and look of your body. There is some scientific evidence to show that physical therapy may help you to look straighter and improve your breathing. However, there is little evidence to show that physical therapy is more effective than doing nothing in stopping the curve from getting worse during growth.

If you have spinal problems in addition to your scoliosis, your doctor may prescribe physical therapy to address your specific needs.

 

Will chiropractic treatment help?

Chiropractic is a controversial method of treatment that seems most effective in treating acute, short-term pain. Chronic conditions do not seem effectively managed by long-term chiropractic care.

Patients who have scoliosis and choose chiropractic treatment should be referred to a spinal orthopaedist or neurosurgeon if their curves keep increasing. Insurance may or may not cover chiropractic treatment.

 

Will acupuncture help treat and manage my back problems?

Acupuncture uses fine needles that are intended to stimulate points in the body and supposedly create an energy flow to treat many illnesses. There is no scientific evidence that proves this theory or that its use helps in treating back problems or back pain. Insurance usually does not cover such treatment.

 

Will yoga help treat and manage my back problems?

There are many systems of yoga. Basically, most yoga systems are intended to improve muscles through stretching, holding positions, and breathing exercises. Some yoga systems also include meditation. How much it will help with back problems is not proven, but those with back pain may be helped. Your general health also may improve. Insurance may or may not cover treatment.

How can massage help my back problems?

Massage may help those with back pain. Your spinal orthopaedist or neurosurgeon may refer you to one.

There are many techniques of massage. Be sure to find out if your massage therapist is licensed by the state in which you live, and where he or she has been trained. Insurance generally does not pay for massage treatments.

 

Will Pilates make my scoliosis or back problems better?

Pilates are vigorous exercises that focus on strengthening abdominal and back muscles. There also is emphasis on posture and breathing. Exercises should gradually increase in level of difficulty, and should not increase back pain. Pilates are not intended for those with severe back pain. Patients should ask about the training of any instructor.

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