General Medical · Health

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

Dr. Cunningham’s Perspective:

Adults and children with scoliosis differ in that their spinal curves have dramatically different potentials to worsen. Scoliosis—or, more broadly, spinal deformity (to include kyphosis, kyphoscoliosis, and others)—tends to worsen during periods of rapid growth, such as during adolescence. During these times, patients’ curves are at risk for progression (up to 15 to 20 degrees in a year) and they should be monitored very closely. In adulthood, patients’ curves progress not because of growth, but more because of muscle imbalance, degeneration, and, to some extent, gravity; and they progress much more slowly than during childhood—perhaps a degree per year or so. These differences in the natural history of curve progression have an impact on how they are managed from a surgical perspective. In children, we are concerned with how big the curve is and how big it will eventually get, while in adults, the size of the curve is not as important as the associated symptoms experienced (back pain, leg sciatica, walking limitation [e.g.,  stenosis]). As was discussed in the prior post, efforts are made to limit curve progression in children by using braces, and non-surgical techniques are used as the “first line” management options for adults to treat symptoms—options such as physical therapy for low back pain and posture complaints, oral and injected medicines for other inflammation-based problems. Surgery is considered when the non-operative treatments have been attempted and have been ineffective.

In a very simplified view, spine surgeons do two things: we make bones grow together (spine fusion), and we make more room for the nerves within the spine (decompression). Some patients need fusion only (progressive scoliosis in an adolescent who has no pain symptoms), some need decompression only (an adult with a thoracic scoliosis and sciatica pain from an unrelated disc herniation in the lumbar spine), and some patients need both (an adult or child with unstable spine deformity in the lumbar area who complains of low back pain and sciatica). Children with scoliosis rarely require decompression, and much more commonly have surgery through an incision on their back, where the fusion surgery is done. Adults with scoliosis have a more difficult time with surgical fusions, and will frequently require fusion procedures from the front of the spine to have a successful outcome. The fusions in the front of the spine are at times done from the back (transforaminal or posterior lumbar interbody fusion), using minimally invasive techniques from a lateral approach (lateral lumbar interbody fusion), or from the classical anterior approach (anterior lumbar interbody fusion).

Specifics for these different surgeries are beyond the scope of this post, but suffice it to say that adult spinal fusions require more surgery to be successful than those done on children. Regardless, excellent results can be expected for both populations in appropriately treated patients.

Recovery following surgery is also different between the two groups: Children tend to heal faster and get released to full activity, typically at six months post-procedure when they are pain free, while adults are commonly advised to restrict vigorous activity for up to a year.

The difference in return to activity has to do with the kinetics of bone healing in the respective age groups and the physician’s desire to allow the spine to heal and become stable before allowing patients to “stress-test” their new backs.

 

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  • 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

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  • 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.

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