Scoliosis Diagnosis & Treatments
How is Scoliosis Diagnosed?
Accurate and thorough diagnosis is key to selecting the best treatment options. The following is part of a comprehensive diagnostic workup:
- Medical history – Assessment of symptoms, previous treatments and care.
- Physical examination – A careful examination by a spine specialist for limitations of movement, problems with balance, and pain. The examination should also cover loss of reflexes in your extremities, muscle weakness, loss of sensation or signs of spinal cord damage.
- Diagnostic tests – Generally, plain x-ray films are taken which allows the physician to rule out other problems such as infections. CT scans and MRIs are often used to give them a three-dimensional view of the lumbar spine and can help detect the extent of scoliosis
What are the Treatment Options for Scoliosis?
Treatment for scoliosis ranges from conservative observation to bracing and surgical intervention. Based on two factors treatment depends on the skeletal maturity of the patient (how much more growth can be expected) and the degree of spinal curvature. Although the cause of idiopathic
scoliosis is unknown the way the curves behave is well understood.
- Small degree of curvature in a patient nearing skeletal maturity will most likely not need treatment
- A young patient with a bigger curve is likely to have continued growth in their curvature and will need treatment in the future
No physical therapy or exercising has shown to reduce or prevent scoliosis curvature. However, exercising to strengthen the patients back muscles and improve flexibility is strongly encouraged.
Least Invasive Surgery For Scoliosis
If pain persists and patient is intolerant to the pain after non-surgical treatment and there is evidence by CT Scan, MRI or X-ray or neurological deficit, then surgical intervention may be recommended.
In some patients the curvature of the spine, a nerve can become pinched or cause narrowing of the foramen where the nerve exits the spine. Endosopic spine surgery can directly decompress the exiting nerve without fusion.
- Endoscopic Discectomy (transforaminal): With an incision less than a ¼ inch. The surgeon can avoid all lamina bone resection and enter the spinal canal without disturbing or cutting muscle. The surgeon directly observes the pinched nerve in a water (arthroscopy) environment with a surgical working channel endoscope coupled with an HD camera. Recovery is superior to microdiscectomy with most patients returning to work within a week. Conscious sedation is used with the patient awake, comfortable and aware during the procedure.
What are the Surgical Treatment Options for Scoliosis?
A physician usually monitors the degree of curvature in the spine with the Cobb Method an accurate way to measure and track the progress of curvature of the spine.
- Curves less than 10 degrees are not considered scoliosis but called spinal asymmetry. These types of curves are unlikely to progress and do not need any treatment. In children, the physician should continue to monitor and check periodically.
- Curves between 20 and 30 degrees in a growing child should be observed on 4 to 6 month intervals by an orthopedic surgeon who is trained in scoliosis.
When a patient is still growing, treatment will be needed if the spinal curvature progresses more than 5 degrees during a typical observation period or the spinal curvature has reached 30 degrees of more.
Back bracing does not correct spinal curves already present. Spinal deformity surgery specifically spinal fusion can correct the curvature up to 50%. The surgery also prevents and further progression of the curve in the spine. Modern instrumentation including hooks and screws are applied to the spine to anchor long rods that are used to help straighten the spine. The hooks, screws and rods hold the spine in place while a fusion brings the vertebral bodies together permanently. This fusion provides spinal stability.
Following scoliosis surgery, patients typically stay in the hospital for 4-6 days and are able to get up and walk around after 2-3 days. At home, you will need to continue to rest. You will be instructed on how to gradually increase your activity. You may still need to take the pain medications for a while. However, pain and discomfort should begin to reduce within a couple of weeks after surgery. Patients can return to school or work within 2-4 weeks after surgery. Activity and physical work must be limited in order for the bone fusion and healing to occur. Bending, lifting and twisting are all discouraged for the first 3 months after surgery.