CONDITIONS EXPLAINEDScoliosis

CONDITIONS EXPLAINEDScoliosis

Scoliosis is a deceptively complex condition of the spine in which deformities occur in the curvature of the vertebral column. The visually apparent nature of scoliosis means frequent diagnoses in youth, and indeed is the most common spinal deformity in children. Though the degree varies between patients, the spine in scoliosis curves to either side forming an S shape. Presentation can range from a barely noticeable defect to life threatening breathing disruptions. Fortunately, most cases are fairly easy to treat with little more than consultation with a spine specialist and some orthopedic rehabilitation.

Physical changes are the most prominent feature of scoliosis, and asymmetries are usually clearly visible upon inspection. More serious symptoms may involve pain, radiculopathy, and loss of bowel and bladder control in the extreme cases. Prompt medical evaluation and treatment is essential to prevent unnecessarily permanent deformity.

Scoliosis is divided into several categories based on etiology and age of diagnosis. Most cases of scoliosis are diagnosed between the ages of 10 and 15. Idiopathic is a classification denoting an unknown cause, while scoliosis of known cause is named in relation to its etiology. Forms of scoliosis include:

  • Infantile Idiopathic Scoliosis – Diagnosed between 0 and 3 years of age
  • Juvenile Idiopathic Scoliosis – Diagnosed between 0 and 10 years of age
  • Adolescent Idiopathic Scoliosis – Diagnosed between 11 and 18 years of age
  • Congenital Scoliosis – Diagnosed from birth as a result of embryological anomalies
  • Neuromuscular Scoliosis – May arise from brain, spinal cord, or muscular disorders, such as cerebral palsy or Arnold-Chiari malformations
  • Syndromic Scoliosis – Occurs in conjunction with characteristic syndromes, such as Marfan’s
  • Degenerative Scoliosis – Occurs when discs degenerate asymmetrically, shifting the supported vertebra to the side
  • Thoracogenic Scoliosis – This form of scoliosis is secondary to medical procedures early in life such as radiation or surgery
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Detection & Diagnosis

Screening for scoliosis is commonly performed for identifying the abnormality early. Physical examination aided by a scoliometer is typically adequate to identify the condition in most clinically relevant cases. For some patients, additional imaging studies may be ordered to visualize the spine and associated structures. These may include:

X-Ray
This form of imaging is quick and effective for identifying skeletal abnormalities
MRI
Magnetic Resonance Imaging is occasionally performed in cases suspected of neurological involvement

OUTCOMESRelated
Treatments & Procedures

An immense number of therapies exist for the treatment of scoliosis, and the specific course of a patient varies greatly with the degree to which the condition presents. Mild to moderate cases typically can be resolved without invasive surgical procedures, but more severe cases may require it. Some of these non-surgical treatments include:

  • Bracing, one of the oldest and most effective non-surgical treatments for scoliosis
  • The Schroth Method, of which breathing is key. The goal of this practice is to slow the progression of scoliosis by keeping it in a more neutral position
  • Physical Therapy, massage, and specialized stretches
  • Core strengthening exercises
  • Passive therapies such as manual therapy, electrostimulation, myofascial release, ultrasound, heat, and ice
  • Pain Management with NSAIDs, steroids, or nerve ablation

In patients for which conservative treatments are ineffective, several surgical options also exist.

  • Spinal Fusion
  • Vertebral Body Tethering
  • ApiFix

Spinal Fusion is a procedure in which a portion of the spine is stabilized using a natural or synthetic bone graft. It is an invasive procedure with a long history in scoliosis treatment, and the most commonly performed.

Vertebral Body Tethering is a relatively new and minimally invasive procedure approved for use in pediatric patients in August of 2019. The process involves the implantation of several screws and anchors into vertebrae through small incisions and attached to a flexible cord tightened to correct the abnormal curvature.

ApiFix was similarly approved recently in September of 2019, and is also known as posterior dynamic distraction. This minimally invasive procedure features the implantation of three screws and a device sitting vertically along the vertebral column. The screws may then be ratcheted post-surgically to correct for the misalignment.

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Anterior Lumbar Interbody Fusion

Anterior Lumbar Interbody Fusion (ALIF) is a procedure performed from the anterior to fuse vertebrae into a single structure. This technique is usually favored when..

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Artificial Disc Replacement

Artificial disc replacement is a procedure with the goal of removing a painful intervertebral disc and replacing it with a prosthetic one. Spinal fusion is much more commonly performed..

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Decompression (Laminectomy)

Decompression Lumbar Laminectomy is the most common surgical procedure performed for the correction of stenosis in the back. The surgeon will remove or trim the bony lamina and a thick ligament..

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