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More than Posture: Diagnosing and Treating Scoliosis

July 12, 2017 1:00 PM with Dr. David Roberts

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While uneven shoulders, hips or waists may just appear to be growing pains, they’re actually signs of something bigger; scoliosis. This condition, which usually appears in childhood or adolescence, can be associated with spinal abnormalities and neurological disorders, and if it goes untreated, it can cause chronic pain, pressure on the organs and increased curvature of the spine. Thankfully, advancements have allowed specialists like Dr. David Roberts, NorthShore Pediatric Orthopaedic Surgeon, to use innovative methods to successfully treat this condition. If you have questions about scoliosis, join him for an online chat; he’ll be discussing symptoms and diagnosis, as well as the latest advancements in treatment. 

Dr. David Roberts (NorthShore) - 12:59 PM:
Welcome to the chat!

Kathryn (Moderator) - 1:00 PM:
Our scoliosis chat is now open. You can submit questions at any time during our chat.

  Elizabeth (Idols, IN) - 1:01 PM:
I'm 56 years old. One side of my back appears larger then the other side. Are there any exercises that will possibly help straighten out my curved spine?
Dr. David Roberts (NorthShore)
Unfortunately, exercises do not correct or straighten out the spine. It is important to be wary of "miracle cures" - only surgery will straight out the curvature for scoliosis in adults. However, most adults with scoliosis do not need this unless the curve is progressive, severe, and associated with significant pain and disability. However, keeping your back strong and flexible will help with your posture and can make it look better. In addition, exercises from a physical therapist can also relieve pain, and improve strength and flexibility for adults with scoliosis. We have a specialized program at NorthShore with therapists trained in the Schroth method, who do see adults as well as adolescents, and may be a good option to pursue.

  Amanda (Evanston, IL) - 1:06 PM:
Do you recommend bracing for young children (age 7-8) for a 22 degree curvature? Are there other therapies that you recommend for young children with mild curvature?
Dr. David Roberts (NorthShore)
Possibly. Typically bracing is for curves >25 degrees. 22 degrees is below this, but close. For mild curves (<25 degrees), the most important thing is close observation over time, and to start treatment if the curve gets any worse. However, 2 people can look at the same x-ray, and vary by a few degrees as to how the angle is measured (e.g. measurement error is about +/-3-4 degrees). It is important to see a specialist in pediatric scoliosis, who will probably be most consistent with measurements over time. There are physical therapy programs for scoliosis (e.g. Schroth method), but at this age it depends on the maturity level of the child if this is a good option. Some children are too young to properly do the exercises, and it may be better to wait until the child is older. However, it could be considered, and we have therapists certified in this at NorthShore trained in this.

  Christina (Hawthorn Woods, IL) - 1:18 PM:
My 19 month old daughter was recently diagnosed with scoliosis. She is having an MRI to rule out other causes, but it sounds like the doctor is going to recommend monitoring, and then a brace once she turns 2. I've heard Mehta casting is sometimes used on patients her age - what would being a candidate for Mehta involve?
Dr. David Roberts (NorthShore)
Mehta casting is the preferred treatment for progressive infantile scoliosis, which occurs in children under age 3. These curves can lead to significant health problems, since they start so early in life. Usually the initial x-rays can predict if the curve is going to be progressive or not. Progressive curves are best treated with Mehta casting, which can be curative for if started early (< age 2). Bracing only prevents progression, and may not be best for a progressive curve. Mehta casting involves applying a body cast under anesthesia while the child is asleep, using a special table and casting technique. The cast is re-applied every 3-4 months under anesthesia until the curve resolves. The success rate is high >90% if started early (age <2). Referral to a specialist training in Mehta casting is recommended at the initial diagnosis to see if this is an option for your child. It may be worth another opinion. I would be happy to see you!

  Carole (Kildeer, IL) - 1:31 PM:
I wore a brace during my teenage years - now at 59, I exercise a lot, but have chronic back pain, mostly on the right side. What are your thoughts on the use of botox injection to treat chronic pain? Any other thoughts on alternative treatments chronic pain (like yoga)?
Dr. David Roberts (NorthShore)
It is not uncommon for adults with scoliosis to have on/off bouts of back pain. Most of this is muscular and related to strength/flexibility. Fortunately, it usually responds to conservative treatment with physical therapy or other strengthening/exercise program. I do not have a lot of experience with Botox for this use. I would probably start with physical therapy for core/abdomen strengthening, and back/hip stretching. Yoga or Pilates strengthen some of the same muscles, and are another option that can be tried on your own. I recommend this to most of my patients as part of good back health in adulthood.

  Nikki (Glenview, IL) - 1:34 PM:
I am a 28 yo female & a surgical nurse. Was diagnosed with scoliosis at a yearly physical with my pediatrician in 8th grade. I got a TLSO brace and eventually went down to wearing the brace at night. Later I was told I didn't have to wear it anymore, but I now live with back pain. What are some things I could do to address this longterm?
Dr. David Roberts (NorthShore)
I would see an adult spine or scoliosis specialist, to reassess the curvature, and see what is best. Pain is not uncommon in adults with significant scoliosis. Fortunately, it usually responds to simple measures such as a physical therapy or exercise program focusing on core strengthening and flexibility.

  Gavina (Winthrop Harbor, IL) - 1:35 PM:
At what degree of curvature lumbar area on a 16 year old, would you consider surgery versus using a back brace to correct scoliosis ?
Dr. David Roberts (NorthShore)
Surgery is recommended for severe curves >50 degrees, or in some cases >45 degrees in children with significant growth remaining. Curves in this range have a high likelihood to get worse into adulthood, and hence why surgery is recommended. Bracing is best for curves 25-40 degrees, in children with growth remaining (pre-menarche or <6 months after onset of menses in girls). Bracing is not as effective for curves >40 degrees -- the curve may still progress even with the brace, but it can be tried in some cases. Some curves fall into a "gray zone" (40-50 degrees) where the curve is beyond typical criteria for bracing, but not yet severe enough to do surgery. For these, bracing can still be done (provided you are ok with lower chance of success), or the curve can be closely observed. Some curves stay in this safe range and may not need surgery. If there is progression, then surgery can be recommended as soon as it is indicated to ensure best results.

  Lynda (Highland Park, IL) - 1:49 PM:
How are seniors (over age 65) affected by spinal-fusion surgery they've received as adolescents? Are there any symptoms/long term things to look out for?
Dr. David Roberts (NorthShore)
This is an excellent question. Spinal instrumentation was developed in the 1960s, and modern techniques gained wider use in the 1980s (hooks) and 1990s (pedicle screws). Because of the stiffness of the fusion, there is a concern that this could put additional stress on the unaffected parts of the back, and lead to increased the risk of degenerative disc disease later in life. However, most patients do well life long, without any major issues. If a flare-up of a back pain occurs, it is treated similarly to those without spinal fusion (e.g. physical therapy, exercises), and this is all that is needed for most patients with prior adolescent fusions into adulthood. We have early long-term research with 20-30 years out that confirms this. Keys to keeping your back healthy are regular exercise, especially core strengthening (yoga, pilates), maintaining a healthy weight, and avoiding smoking. These are all important for back health, and especially so with a prior fusion.

Kathryn (Moderator) - 2:02 PM:

This will be the end of our chat. Thank you for your questions; we will be working on follow up content to address what we did not get to today.

For more information on scoliosis, treatments mentioned today including the Scroth Method, or to schedule an appointment with a specialist like Dr. Roberts, contact the NorthShore Orthopaedic Institute or call 855.929.0100.


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