Scoliosis is a term used to describe a curvature of the spine. This two part series on scoliosis will discuss scoliosis, diagnosis, and treatment at the request of several readers. Scoliosis screening is very important for early intervention and prevention of long term and irreversible problems.
Idiopathic adolescent scoliosis is a structural scoliosis. It has strong genetic tendencies and is the most common type of scoliosis. There is abnormal sidebending of the spine in an otherwise healthy child. The cause remains unknown! General characteristics are as numerous. The scoliosis often manifests after puberty, 80% are 11-14 year old females with rapid curve progression during the growth spurt. Also, it is more common among taller than average girls with an earlier growth spurt, longer growth period and advanced skeletal age. It is associated with an increased level of growth hormone and may have associated postural, equilibrium, and vestibular dysfunctions.
The progression of the curve is determined by several factors a more rapid curve progression is noted in females with a rapid rise in progression at the onset of the adolescent growth spurt. It is less common after menarche and after a sign of skeletal maturity (Risser Sign). Double curves progress more frequently than single curves and curve magnitude increases in larger curves.
To develop a comprehensive treatment approach, a thorough musculoskeletal evaluation must be performed. This may include assessments from a variety of medical professionals and various imaging studies. Observation with repeat x-rays to determine progression is the first phase in addressing adolescent idiopathic scoliosis. The rest of the treatment course may progress as follows:
I. Non-operative Treatment Progression
A. Electrical stimulation (LES)
1. to the muscle on the convex side of the curve
2. less effective than bracing
1. May prevent 74 – 81% of the curve from worsening
2. Most effective in curves between 25–35 degrees
3. General guidelines:
a. if < 20 degrees and skeletally mature, bracing is not recommended
b. if < 30 degrees, but progresses > 5 degrees over 12 months, bracing is required
c. if > 30 degrees brace immediately
4. Effectiveness is time dependent(worn 23 hours per day)
5. Worn until skeletal maturity
II. Operative Treatment Progression
A. Operative Treatment is indicated if
1. curve > 50 degrees and skeletally mature
2. curve > 30 degrees with marked rotation
3. double major curves of > 30 degrees
B. Options for surgical intervention
1. Segmental Instrumentation
2. Instrumentation with fusion with either casting or bracing until fusion solid (4 to 8 months)
Adult scoliosis is another type of structural scoliosis. The adult curves may progress more slowly. There are two types. One, is associated with an original onset before skeletal maturity. The second type arises early in adult life due to:
1. Osteoporosis (decreased bone density) which causes compression fractures that have a major role in scoliosis progression in post menopausal women. Therefore, in pre-menopause perform 20 minutes of general low-impact aerobics 4x/week and in post- menopause consider adding hormonal therapy and calcium.
2. Osteomalacia: decreased bone formation, decreased bone mass, and Vitamin D deficiency
3. Iatrogenic: multiple level decompressions secondary to spinal stenosis or degenerative changes
When adult scoliosis progresses, the individual may notice:
1. Change in the way clothes fit
2. Increased rib hump
3. Loss of height
4. Loss of waist line
Non-operative management of adult scoliosis can decrease pain, increase function, but can not stop progression. These treatments include:
If there is significant curve progression, neurologic problems, increased disability, pain that significantly impacts daily activities, surgery may be recommended. Cosmesis is another reason for surgical intervention in adult scoliosis. The procedure of choice is usually instrumentation with fusion.
In summary, your physical therapist can assist in treating scoliosis by providing a thorough screening evaluation, designing an appropriate therapeutic exercise regimen, and offering pain management. If needed, the therapist can also develop the post-operative reconditioning program. The cost of bracing and surgery are comparable, but when screening is combined with bracing, the total cost decreases. In the end, the key to treating scoliosis is early detection and intervention.
Visit your doctor regularly and listen to your body.
Keep moving, eat healthy foods, and exercise regularly
Contributor: Janet Caputo, PT, DPT, OCS is clinical director at Mackarey & Mackarey Physical Therapy Consultants, LLC. in downtown Scranton where she specializes in orthopedic and neurological rehab.
NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum" in the Scranton Times-Tribune.
This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: firstname.lastname@example.org
Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at The Commonwealth Medical College.