Wednesday, 26 June 2013

Intro to scoliosis

For my June article in the New Hamburg Independent, I wrote about the often misunderstood condition known as scoliosis.  As per usual with these articles, it is more of an introduction into the topic.  If you have additional questions, do not hesitate to contact me!

The truth about treating scoliosis

Scoliosis is a medical condition where the spine curves from side to side rather than sticking to its normal, centralized position.   It impacts about 1.5-3% of our population, so is a relatively common condition.  Despite how common the condition is, there still seems to be an abundance of confusion and miss information on what causes it, and more importantly, how to manage it.

So what exactly does make a spine to curve from side to side?  There are three major reasons; (1) it’s congenital (you were born with it), (2) it is secondary to other diseases or conditions (such as cerebral palsy or trauma), or (3) idiopathic (in other words, we do not know).  Surprisingly, the majority of cases are idiopathic.  More often than not, the curves develop for no apparent reason.

 It is important to note that all three of these examples are different from the tilt we sometimes get in response to an acute back injury.  In these instances, muscles can be asymmetrically tight, nerves may be pinched, or the soft discs that separate our vertebrae may be damaged.  These types of injuries may result in discomfort when trying to stand upright, and therefore we tend to lean to the side that feels the best.  This is not a sign of a true scoliosis, and as soon as the cause for that back pain is fixed, the lateral bending in the spine will disappear.  

The best way to diagnose scoliosis is with a detailed physical exam, history and radiographs to measure the extent of the curvature.  The type and extent of the curvature will have a strong impact on how the condition is treated.

When deciding how to treat the condition, it is important to note if the patient is skeletally mature.  This is important because if the spine has stopped growing, the risk of the curve progressing is very low.  However, if the spine still has potential to grow, then there is also a much higher likelihood of the curve getting worse.

Other important risk factors include if the patient is female and if the curve is located in the mid-back.  These are two additional factors that are associated with a higher risk of curve progression.

In terms of treatment, there are three major approaches; (1) physical therapy, (2) bracing and (3) surgery.

The goal of any scoliosis physical therapy plan is to correct the biomechanical issues that arise from the curve.  There is conflicting evidence in the literature of if an exercise plan can reverse a curve, or even slow its progression.  However, what exercise can do is maintain function along with range of motion, and have an extremely positive impact on quality of life.  These exercise protocols should be prescribed by a properly trained manual therapist, and can be complimented with soft tissue work and other treatment modalities.  Physical therapy is the absolute most important approach in mild to moderate cases of scoliosis.

Bracing, by contrast, is typically used only in more advanced instances of scoliosis in patients who are not yet skeletally mature.  There are a few different types, but the basic mechanism of each is to apply external support to slow the progression of the curve.  These external braces are not associated with a high degree of success typically as a result of how hard they are to use.  They must be worn 22-23 hours per day, and are so tight that they restrict breathing and the ability to move normally.  It should be no surprise that compliance with these braces is often low.

Finally, the last resort treatment for those suffering from scoliosis is surgery.  Again, this option is typically reserved for those who are not yet skeletally mature and/or have advanced forms of scoliosis.  There are a few surgical options, but the most common is to attach steel rods to the spine, and fuse the vertebrae together.   This provides mechanical support to prevent the curve from progressing, but should only be used in high-risk and more advanced cases.

Finally, it is important to keep in mind that in a vast majority of cases, scoliosis does not have any long term health implications.  One recent large-scale study showed that after a 50 year follow up, scoliosis patients had the same cardiac health, mental health, lung function and neurological function as those without scoliosis.  

With whatever type and degree of scoliosis that you have, it is never a mistake to seek opinions from multiple health care practitioners.  While scoliosis typically is not a serious condition, it should not be ignored.  If you or somebody you know suffers from it, it is important to have a properly trained medical progression examine it sooner rather than later.