General Medical · Health

Medical Management of Scoliosis: Part 2 of Our Series on “Curvature of the Spine”

As a physiatrist who treats various musculoskeletal and spinal conditions, my primary goal is to help my patients maintain their function (exercise, work, chores, etc.). To accomplish this goal, I try to educate my patients on the type of spinal curvature they have as well as postures and even activities that they need to avoid (e.g., always wearing a shoulder bag on one side or leaning to the same side while sitting or standing).  I also try to teach them about the benefits of a comprehensive fitness plan that includes endurance, flexibility, strength, and postural and balance training. To create this plan I rely heavily on the expertise of physical therapists, who will teach my patients ways to achieve better muscle balance and postural alignment by stretching tight muscles and strengthening weak muscles. Exercise, physical therapy, and some emerging techniques (e.g. the Schroth method) will be the focus of the final post on scoliosis.

I frequently provide care as part of a medical team, and for some patients with scoliosis I need the expertise of metabolic bone specialists, like Dr. Alana Serota, of New York City’s Hospital for Special Surgery, and orthopedic spine surgeons, like Dr. Matthew Cunningham, of the same hospital. In the remainder of this post they will share their clinical expertise and knowledge, as well as highlight the most important medical management tips for those with scoliosis.

In addition to the right fitness plan, women with scoliosis also need a plan to maintain normal, healthy, and strong bones (aka normal bone density). This helps to ward off osteoporosis, spinal fractures, and secondary postural problems such as thoracic kyphosis (aka rounded back posture). These issues are at times complex and require the care of a metabolic bone expert.

Dr. Serota’s Perspective:

As a consequence of the mechanical challenges to the spine from scoliosis, it is extremely important that bone health be optimized. Vitamin D deficiency, osteoporosis, and other metabolic bone diseases are extremely common comorbidities in patients with scoliosis, and their incidences increase with age. Specialists in metabolic bone disease include, but are not limited to, primary care doctors, rheumatologists, and endocrinologists. They can assist in the identification and treatment of these underlying conditions, which are often silent or asymptomatic, just like the onset of hypertension and diabetes. Like these medical conditions, osteoporosis can pose real and serious health dangers.

Osteoporosis is defined as decreased bone density and/or diminished bone quality that predisposes patients to fractures. Those with osteoporosis present with low energy fractures with little or no antecedent injury; they are also more likely to have severe fractures with high-energy injuries. Vertebral compression fractures are the most common type, and two-thirds of these are clinically silent, meaning that they are asymptomatic and they do not come to medical attention. Vertebral compression fractures are both more common and more significant in those with an abnormal spine. Take, for example, a patient with scoliosis, who will commonly have kyphosis as well; the compression fracture turns a block-shape vertebra into a wedge shape that further rounds the spine (aka worsening kyphosis). This secondary complication can negatively impact appearance, upright posture, mobility, balance, and even lung function.

Kyphosis

Identifying osteoporosis and other metabolic bone diseases, correcting underlying causative or contributing factors, and attenuating increased fracture risk with appropriate lifestyle, nutritional, and pharmaceutical interventions will optimize the objectives of non-surgical and surgical treatment of scoliosis. These are systemic “software” problems that impact on the progression and treatment of the “hardware” issues.

Finally, I find it important to teach my patients about the warning signs of worsening scoliosis and secondary spinal problems. These include spinal pain, radiating pain, weakness and/or numbness in the arms or legs, impaired bowel and/or bladder function. Under these circumstances it may be necessary for a physician re-visit, repeat imaging tests such as spinal X-rays and/or MRI’s, and even spine surgery referral. In my opinion, the spine surgeon that you refer to or choose to see needs to be have specialized training and expertise with spinal deformities such as scoliosis. One such surgeon is Dr. Matthew Cunningham, and in the remainder of this post he presents a surgeon’s perspective on adult scoliosis.

Join the conversation

This site uses Akismet to reduce spam. Learn how your comment data is processed.

  • Valerie Sonnenthal March 9, 2015 at 8:21 am

    Let’s not forget MELT Method for managing and minimizing chronic pain, this work has done wonders for people with scoliosis. See meltmethod.com

    Reply
  • Valerie Sonnenthal March 9, 2015 at 8:19 am

    Schroth Method, created in 1930’s Germany, and only now being introduced in US hospitals is not the answer. As long as the medical profession continues to see the body as requiring outside bandaids versus methods such as Emilie Conrad’s Continuum work and Liz Koch’s Core Awareness work which works with the fluid system inside our bodies, there will only be minor change. Gyrotonic Application for Scoliosis created by Paul Horvath and Uwe Herbstreit will always be more beneficial for the body than Schroth which imposes a physical change without sporting muscle change.

    Reply