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What is Scoliosis?

Scoliosis is a condition in which there is a sideways curve to the spine. People with scoliosis may recognize the following symptoms:

• One arm hangs longer than the other due to a tilt in the body.
• One shoulder blade is higher and protrudes further than the other.
• A "rib hump" occurs as a hump on the back sticks up when the spine is bent forward.

As scoliosis develops, back pain can develop. The deformity can exert pressure on the nerves and the spinal cord, leading to weakness, numbness, and pain in the lower extremities. There are cases when pressure on the spinal cord causes loss of coordination in the leg muscles, impairing one's ability to walk. Breathing problems, fatigue, and heart failure can result if the scoliosis deforms the chest.

Causes of Scoliosis

In most cases, adult scoliosis is idiopathic -- that is, the cause is not known. In other cases, scoliosis occurs as the result of aging and degeneration.

Causes of scoliosis may fall into the following categories:

• An idiopathic curve means that there is no known reason why the spine is curved
• Myopathic Deformity occurs when the muscles work improperly. The irregular curve may result from a muscular or neuromuscular disease, such as cerebral palsy, polio, or muscular dystrophy.
• Paralytic Curve occurs from paralysis due to injury to the spinal cord. If the muscles around the spine cease to work, the spine is thrown out of balance, producing a curvature in the spine.
• A congenital curve often occurs from birth. In some cases, congenital scoliosis may not be recognized to require treatment in childhood. The scoliosis can worsen due to wear and tear around the injured area of the spine.

Nonsurgical Treatment of Scoliosis

Nonsurgical treatments are tried first. As there are risks involved, spinal surgery is most often a last resort. Conservative treatments include bracing, medication, physical therapy, and exercise.

Bracing may offer some relief, although it will not allow the spine to straighten in adults. Bracing is used for pain relief rather than prevention. For some people, scoliosis causes a difference in the length of one's legs. In this case, special shoe inserts (orthotics) can reduce back pain.

Mild pain medications may be prescribed to block the pain. Narcotics, however, should generally be avoided due to risk of addiction.

Physical therapy may bring relief to adults with scoliosis. Through working with a physical therapist and under an appropriate rehabilitation program, the person may improve in mobility and strength. Daily activities can be done with greater ease. Generally speaking, the goals of the physical therapy program are to maximize spinal stabilization; improve spine posture; and further understand ways to manage the symptoms of scoliosis.

While physical therapy and exercise can improve posture and reduce pain, it cannot change the curves of scoliosis.

Surgical Treatment of Scoliosis

If conservative treatment does not alleviate the pain, surgery may be considered. As surgery does carry risks, patients should only consider it if their nonsurgical treatments failed to stop difficulty breathing, experience continuing pain, or have significant disfigurement or a worsening curve. Normally, for those patients whose curve is less than 40 degrees, surgery will not be recommended.

Surgery may be suggested for these situations:

• Pain. About 85 percent of adult scoliosis surgeries are done to relieve severe pain.
• Worsening of Curve. If the curvature worsens to the point where it gets beyond 45 degrees, surgery may be needed. Curves above 60 degrees normally require surgery as this may result in the twisting of the torso, leading to lung and heart conditions.

What the Surgery Involves

There are several procedures from which a surgeon can choose to solve the problems brought on by scoliosis. Most surgeries include these objectives:

• stop the deformity from worsening
• remove any pressure from the nerves and spinal cord
• protect the nerves and spinal cord from further damage
• straighten the spine as far as possible

The surgeon may perform an operation on the back of the spine, the front, or both. The surgeon will first straighten the spine and then fuse the vertebrae together into one solid bone.

Surgeons employ two methods to achieve these objectives. The first is lumbar fusion with pedicle screws and rods. The second method inserts customized cylinders between the vertebrae to be fused. This is lumbar fusion with intervertebral cages. Both methods use specialized metal screws, plates, and rods to straighten the spine and hold the vertebrae in place while the fusion solidifies. The screws (which are inserted into the vertebrae) work with the rods and plates to form an internal brace that holds the vertebrae in alignment while the fusion forms.