Most people with scoliosis will never require surgery. But who does need surgery, and how do you know?
Often diagnosed in childhood, scoliosis is characterized by an abnormal curve in the spine that can range from as small as 10 degrees to more than 100 degrees. In pediatric patients, this can result in pulmonary problems if the curve is severe.
However, pediatric patients’ complaints are mostly centered around their appearance due to the cosmetic defects associated with the torso. The indications for surgery in the pediatric population are primarily based on curve severity. Many patients will have curves that will never progress to surgery and can be managed through conservative measures. However, curves are not static and tend to progress over time as one ages – sometimes causing pain in adult patients.
Therefore, if someone knows they have scoliosis, it is important to work with a physician who specializes in scoliosis and can help coordinate your care as you age.
What to look for
When looking at a standing person straight-on, their head should be positioned over the center of their pelvis. From the side, their head should be over their hip joints. A disruption in this balance will result in increased energy expenditure to maintain an upright posture, eventually leading to pain and disability – which will worsen over time without treatment.
Scoliosis can sometimes be detected by pediatricians or primary care providers during regular checkups, but definitive detection requires a full body X-ray. Sometimes scoliosis can be found incidentally on CT or MRI; however, this will need to be followed up by a standing x-ray imaging that imparts gravity on the curve in order to reveal its true features. In the pediatric population, pain is not a common symptom of scoliosis. However, in adults, the first signs of the disorder might be pain, numbness, weakness, worsening posture, or gait.
If you are experiencing these symptoms, consult a scoliosis specialist who can guide you to appropriate conservative treatments or determine if surgery is needed.
Try non-surgical treatment options first.
In most cases, scoliosis specialists will recommend conservative approaches. Non-surgical treatments such as physical therapy, acupuncture, and epidural injections can help mitigate pain, symptoms and improve function.
For example, physical therapists can work with you on core-strengthening exercises to strengthen your abdomen and back muscles and exercises to improve your flexibility and gait. While pain specialists can help with targeted injections to pain-producing regions in the spine.
If surgery is necessary
If all conservative treatments have failed at alleviating the pain, surgery should be considered to improve a person’s quality of life.
Over the past two decades, there have been significant improvements in not only our understanding of how to surgically treat scoliosis in adult and pediatric patients but also in the safety of surgical treatments. For instance, the 7D Surgical FLASH Navigation system allows for faster, radiation-free image-guided spinal surgery. This results in less blood loss, decreased risk of neurological injury, decreased operative time, and an overall safer surgery for the patient.
And as medicine advances, so do scoliosis patients’ options. If you have been diagnosed with scoliosis, take comfort in knowing that you likely will never require surgery.
But who does need surgery, and how do you know? Find a team of specialty-trained experts you can trust to ask.
Pawel P. Jankowski is a neurosurgeon, Hoag Memorial Hospital Presbyterian, Newport Beach, CA.
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