Scoliosis is one of the most common spine disorders, affecting more than 7 million Americans. Defined as a sideways curvature of the spine measuring 10 degrees or greater on an x-ray, scoliosis can range from mild, barely noticeable cases to complex medical conditions that cause severe pain or even lead to heart and lung complications. While scoliosis can be caught early through childhood screening exams, it may also develop or be diagnosed later in life.
At El Camino Hospital, we are fortunate enough to have some of the top spine surgeons in the nation. They treat a variety of spine disorders, including scoliosis. If you suspect you, or your child may have scoliosis or another spine disorder, don’t wait, because the problem could become more serious. Seek out a board-certified spine specialist, who can assess the condition quickly, often through a simple examination and x-ray. There are numerous options for scoliosis treatment, and the spine specialists at El Camino Hospital will work with you to find just the right solution, whether it’s back surgery, bracing or simply monitoring the condition over time
What is scoliosis?
When you look at a person with a normal spine from the back, the back bone appears straight or “I” shaped. Scoliosis is a spine disorder in which the spine has a sideways curvature and a rotation of the back bones (vertebrae). Viewed from behind, the spine of a person with scoliosis may curve into either an “S” or a “C”shape. Spinal curvature from scoliosis may occur on the right or left side of the spine, or on both sides in different sections. Both the thoracic (middle) and lumbar (lower) spine may be affected by scoliosis. Some minor curves or postural curves of the spine do not require back surgery, or even any treatment at all. A normal spine can appear to be curve because of a difference in leg length.
What causes scoliosis?
In more than 80 percent of cases, the cause of scoliosis in young patients is “idiopathic”, or unknown. Other cases can be the result of congenital malformation of the vertebrae, paralysis, tumors, spinal cord abnormalities, infection or other conditions. In some adult cases, scoliosis may develop along with degeneration of the spinal disks.
What are the signs and symptoms of scoliosis?
The signs of scoliosis generally have to do with asymmetry in the positioning and height of the shoulders, head, hips, arms, such as:
- A difference in shoulder or shoulder blade height or position
- A difference in hip height or position
- A difference in the way the arms hang beside the body when a person is standing straight
- A difference in height of the sides of the back when bending forward
- The head is not centered with the rest of the body
Often children are screened in schools for scoliosis; a test involving bending at the waist is one of the more common ways this spine disorder is first detected. Although scoliosis is not typically painful in children, it often causes pain in adulthood, prompting people to seek medical attention. Because the symptoms of scoliosis may be a result of a serious injury or infection, or result from other spine disorders or deformities, it is important to see an orthopedic spine surgeon for a diagnosis.
How is scoliosis diagnosed?
Early detection and accurate diagnosis of scoliosis are key to successful treatment. At El Camino Hospital, our spine surgeons evaluate each patient as carefully and thoroughly as possible. In addition to taking a patient’s medical history and performing a physical examination, the doctor will take x-rays, the primary diagnostic tool for scoliosis. The physician measures the degree of spinal curvature on the x-ray in order to establish a diagnosis. Magnetic resonance imaging (MRI) or computed tomography (CT/CAT scan) may be necessary to assist with the diagnosis.
How is scoliosis treated?
Specific treatment of scoliosis is determined based on the severity of the condition and the patient’s age, overall health, medical history, tolerance for specific treatments, and expectations for the course of the condition.
Treatment may include:
- Observation and repeated examinations
In most cases, physicians take a “wait and see” approach, observing the spine over time to determine if it is continuing to curve. A new genetic test from a saliva sample has become available for adolescent patients (age 9 to 13) with mild curves (10 to 25 degrees). This test can actually predict curve progression, allowing the physician to individualize the monitoring program and treatment based on the projected severity of scoliosis as the child grows to adulthood.
Bracing is generally used when the curve measures between 25 and 40 degrees on an x-ray, and when more skeletal growth is anticipated (as is the case with children). The type of brace and the amount of time spent in the brace depends on the severity of the spine disorder.
Surgery may be recommended when the curve measures more than 45 degrees on an x-ray. In children, surgery is used to either correct a curve or prevent it from getting worse. In adults, most surgeries are performed to relieve pain. Back surgery may also be used in adults to prevent a curve from worsening, which can lead to heart and lung problems over time. There is no scientific evidence to show that other methods for treating scoliosis, such as manipulation, electrical stimulation or corrective exercise, have any success in preventing the progression of the disease.
Having surgery at El Camino Hospital
The spine surgeons at El Camino Hospital look at each case of scoliosis carefully to determine which type of back surgery is most appropriate. With scoliosis surgery, there are a variety of procedures, using different instrumentation and surgical approaches. Not all orthopedic surgeons are experts in spine surgery, and it is critical to seek out spine surgeons with extensive skill and experience, like the team at El Camino Hospital. Our spine surgeons have performed hundreds of successful operations for scoliosis on both adolescent and adult patients. If you are contemplating spine surgery for yourself or your child, don’t be shy about asking our surgeons about their experience. They are happy to discuss their experience with you.
The surgical experience
Prior to surgery, our on-site spine coordinator, a registered nurse, talks to the patient about what to expect on the day of surgery and provides an overview of the procedure. We’ve been doing back surgeries for decades, and have had the same spine coordinator for more than 20 years, so we have fine-tuned the entire pre-operative process to where it actually serves as a model for hospitals nationwide.
There are several different approaches to scoliosis surgery but the most common approach is the posterior (back) approach, in which the surgeon fuses two or more vertebrae together. Metal screws and rods are positioned along the spine to stabilize it and correct the curve. This procedure has excellent results, as the combination of bone fusion and metal instrumentation prevents further curve progression. In some cases the curve is best treated through an anterior (front) approach. More severe or complex problems may require combining both an anterior and posterior approach. Because no two spines are exactly alike, our spine surgeons customize surgical technique and use of instrumentation to fit each individual case.
Recovery from surgery
El Camino Hospital has a three-decade history of superior results from scoliosis surgery. We have restored quality of life for adults suffering from scoliosis-related pain and enabled them to return normal function. In children, we’ve been able to stop the progression of spinal curvature, with a rapid return to school and normal activities. In most cases, our patients are up and walking the day after surgery, and are home within three to seven days. If physical therapy is needed after surgery, it is arranged through El Camino Hospital’s highly skilled Rehabilitation Services team. Our physical therapists have extensive experience working with orthopedic patients of all ages and work with our spine coordinator and surgical team to customize each patient’s rehabilitation plan.
For more information
If you suspect you, or your child, may have scoliosis or another spinal condition, please do not hesitate to contact one of our spine specialists. We are happy to answer any questions you may have and will help you determine the best treatment option for you.