“At Southwest Scoliosis Institute, we see adult patients who are in pain or are embarrassed by the curves. This is where our expertise and experience with complex adult scoliosis make the difference in improving these lives.”
Richard Hostin, MD
Adult Scoliosis can be more problematic. Southwest Scoliosis Institute evaluates adult patients, often women, who fall into one of two categories:
Type I: Progressive Scoliosis – Women often have spinal curves but with no pain. “Often, I see young women with very large curves who have no pain. I tell them that statistically the probability of the disease progressing is 80 or 90 percent, and that untreated they may well have problems in later life. With these women, we discuss their treatment options on a case-by-case basis.” Richard Hostin, MD
Type II: Adult Scoliosis – Scoliosis that begins in adulthood in response to degenerative disease of the spinal column. This type of scoliosis can progress at a much more rapid pace than in Type I Progressive Scoliosis.
Adult Scoliosis Diagnosis
Scoliosis is usually diagnosed by a combination of physical examination and specialized X-rays. During the physical examination, Dr. Hostin looks for the degree of rotation in the curvature of the spine, as well as secondary changes in other parts of the body. These may include:
- Uneven shoulders
- Rib hump or asymmetry
- Low back hump or asymmetry
- Change in the shape of the waist
- Uneven pelvic bones or hips
Frequently, these changes are not visible in a person while standing but become noticeable when the person bends forward. X-rays are important to pinpoint the shape and location of the curves, as well as for measuring the degree of the curvature so it can be classified. Southwest Scoliosis Institute uses an advanced X-ray imaging system that allows us to quickly take full-body images of patients in standing or seated positions while delivering the lowest possible dose of radiation.
Adult Scoliosis Treatment
Dr. Hostin specializes in complex surgeries to treat adult scoliosis. Scoliosis Treatment decisions are based on a combination of factors: the degree of curvature, curvature location, risk of progression, spinal imbalance, underlying disease progression, and degree of pain the patient is experiencing. In recent years, the medical profession has made great advances in the diagnosis and treatment of scoliosis. The surgeons and medical staff of Southwest Scoliosis Institute are on the leading edge, offering the most advanced treatment options available. To date, we have seen over 29,000 new patients and successfully performed more than 5,900 surgeries.
You deserve to get the care you need from only the best trained orthopedic physicians. At Southwest Scoliosis Institute, we understand our patients are dealing with more than the physical challenges of scoliosis. They are also coping with emotional challenges as well. One of the most powerful ways we’ve found to help patients considering scoliosis surgery is to hear about other people’s experiences. “We measure our success by our patients’ expectations of success,” says Dr. Hostin. “We commonly receive letters and pictures from our patients telling us how we have been a significant part in their recoveries and how much the quality of their lives has improved.”
Adult Scoliosis Treatment Options
Whenever possible, nonsurgical adult scoliosis treatments are chosen first. Spinal surgery will generally be a last resort due to the risks involved. Conservative treatments commonly include medication, bracing, and physical therapy and exercise. If osteoporosis is present, the treatment of osteoporosis may also slow the progression of scoliosis. This can be accomplished in several ways. The current recommendations include increasing calcium and vitamin D intake and weight-bearing exercises.
Mild pain medications may be prescribed to use as needed. Usually, strong pain medications, such as narcotics, are not recommended due to the risk of addiction.
Adult Scoliosis Brace
A spinal brace may provide some pain relief. In adults, it will not cause the spine to straighten. Once you have reached skeletal maturity, bracing is used for pain relief rather than prevention. If there is a difference in the length of your legs (or if scoliosis causes you to walk somewhat crooked), special shoe inserts, called orthotics, or a simple shoe lift may reduce your back pain.
Physical Therapy and Exercise
Adults with scoliosis may work with a physical therapist. A well-rounded rehabilitation program assists in calming pain and inflammation, improving mobility and strength, and helping them do daily activities with greater ease and ability. Exercise has not proven helpful for changing the curves of scoliosis. However, it can be helpful by addressing pain, posture, and spinal stabilization. Therapy sessions may be scheduled each week for four to six weeks.
The goals of physical therapy are to help
- learn ways to manage the symptoms of scoliosis
- improve spine posture
- maximize spinal stabilization
Surgery may be needed in the following situations:
- Pain The most common reason for scoliosis surgery is pain relief for chronic discomfort that keeps getting worse. About 85 percent of adult scoliosis surgeries are done to relieve severe pain. Surgery will probably not be recommended if the pain is manageable through conservative treatments.
- Progression of Curve Surgery may be suggested if the curvature continues to worsen and the curve gets beyond 40 to 45 degrees to prevent problems that come with severe scoliosis. Surgery will usually be recommended for curves above 60 degrees, as the twisting of the torso can lead to serious lung and heart conditions.
- Cosmetics Surgery is generally not recommended merely for the sake of appearance. But sometimes the scoliosis causes physical deformity that is unbearable to the patient. Surgery may be the only option for correcting the condition. Most cases of cosmetic scoliosis surgery are in young adults that have very noticeable curves.
Adult Scoliosis Surgery
For scoliosis patients who experience an increase in curvature and are in pain, we may recommend surgery. Adult Scoliosis surgeries are serious and complex with multi-step procedures, and sometimes more than one surgery is needed— one performed from the front and one from the back. Typically, this can be done in one operation but in some cases two are necessary. In the event a patient needs surgery, our physicians sit down and explain the risks and benefits of the procedure, the possibilities, and expected outcomes. At Southwest Scoliosis Institute, we are with you every step of the way.
When an adult scoliosis patient requires surgery, your orthopedic surgeon can choose from a number of different procedures. Each case of scoliosis is somewhat different and may require a very specialized approach for optimal results. Surgery is suggested to solve the problems brought on by scoliosis — not just to straighten the spine. The goals of most surgical procedures for adult scoliosis include:
- reducing the deformity (straighten the spine as much as possible)
- stopping the progression of the deformity
- removing any pressure from the nerves and spinal cord
- protecting the nerves and spinal cord from further damage
To achieve these goals, the spine surgeon may suggest an operation on the back of the spine, the front of the spine, or both. The goal is to first straighten the spine and then to fuse the vertebrae together into one solid bone. Two different types of surgical methods can be used to accomplish this. One is called lumbar fusion with pedicle screws and rods. The second method is to insert special cylinders between the vertebrae to be fused, a procedure called lumbar fusion with intervertebral cages.
Both procedures usually require some type of metal screws, plates, or rods, in order to help straighten the spine and hold the vertebrae in place while the fusion heals and becomes solid. The screws are placed into the vertebra. The rods or plates then attach to the screws to connect everything together. Tightened together, they form an internal brace to hold the vertebrae in alignment while the fusion heals.
Possible Complications of Adult Scoliosis Surgery
Like all surgical procedures, operations on the back may have complications. Because the surgeon is operating around the spinal cord, back operations are always considered extremely delicate and potentially dangerous. Take time to review the risks associated with spine surgery with your doctor. Make sure you are comfortable with both the risks and the benefits of the planned procedure.
One possible complication specific to the surgical treatment of adult scoliosis is a flat-back deformity. The lumbar (lower) spine naturally has a slight inward curve called lordosis. When the vertebrae in the lumbar spine are fused together, this lordosis curve may be lost, leaving the patient with a “flat-back” deformity. The loss of curve may not appear right after surgery. If the surgery is done in a young person, the loss of lordosis may not even appear until sometime between the ages of 30 and 50.
“After a routine scoliosis surgery, patients are admitted to the intensive care unit where there is focused nursing care,” says Dr. Hostin. “It really is very comforting for both the patient and their family to know that there’s one nurse who is completely attentive to their needs.”
If you experience pain from scoliosis, there is help. Call the Southwest Scoliosis Institute at 214-556-0555.