SCOLIOSIS

Why Choose the Southwest Scoliosis and Spine Institute

In many cities, surgeons fix broken bones, but do not specialize in the care of adults and children with scoliosis; therefore, many patients must travel to other cities to obtain the benefits from Scoliosis Specialists to improve their lives. Only a handful of surgeons have extensive experience and training to specialize in these difficult life-changing procedures.  Thus, patients come to us from around the world in order to restore a pain-free life. While many patients with spinal curves believe that treatment does not exist, our practice offers medical solutions based on proven techniques and facts.

What is Scoliosis

Scoliosis is a side-to-side three-dimensional curvature of the spine. This curve can look like the shape of a “C” or a double curve, shaped like an “S”. Oftentimes, this condition gets diagnosed in childhood, occurring in both females and males. However, the condition mostly progresses in females, causing issues and pain later in life. This curve can cause deformity and all kinds of symptoms, including pain. The symptoms can exhibit minimal discomfort to really bad pain. Normally, as Scoliosis progresses, the pain gets worse and body changes become more evident.

How is Scoliosis Diagnosed?

First, your Scoliosis Doctor will examine your spine. He or she will observe your spine while standing, bending, and walking. Then if needed your doctor will order and review your X-rays. Should your X-ray films reveal a curve in your spine, your doctor will measure it utilizing the Cobb Angle. This will let the doctor know if the curve in your spine is mild, moderate, or severe. 

Cobb angle

A Cobb angle is measured using X-ray imaging to calculate the degree of how far the curve differs from normal alignment.

Cobb angle scale:

• 10-25 degrees – mild scoliosis
• 25-40 degrees – moderate scoliosis
• 40+ degrees – severe scoliosis

What Causes Scoliosis?

Although scientists and doctors study the causes of scoliosis, most of the time they do not know the answer.  In fact, according to the Scoliosis Research Society (SRS), a specific cause is not found in 8 out of 10 cases. While many cases of spine curvature can be linked to genetics, there is no single cause that everyone can agree upon. Therefore, our current research is so important. In our research groups, we conduct research to enhance current conservative treatments by increasing their effectiveness, better use of implants, post-surgery patient outcomes, and more. All of this research helps our team develop new treatments and improve others.

Research also motivates us to learn to predict outcomes of different types of non-surgical treatments, how different surgery techniques affect patients after surgery, devise new surgical treatments, and helps us to stretch our thought processes as a group as well. “To date, we have a number of findings, but there’s no unified theory of what causes Scoliosis curves,” says Dr. Hostin. “Thus, we don’t possess the tools to determine why one person with a curve will progress to need a complex surgical procedure, while another with a curve that seems the same reaches adulthood and doesn’t need surgery.”

Several observations do exist:

• Heredity – This curved spine condition tends to run in families with different effects in each generation, perhaps even skipping generations.
• Degenerative scoliosis – can occur with age and osteoporosis.
• Spinal cord injury – A spine deformity can appear following a spinal cord injury or trauma. Also, spinal curvature patients who had polio in the 1930s, ’40s, and ’50s may get a spine curvature as a result of paralysis.
• Congenital – A spine curvature can result from the improper formation of vertebrae during fetal development.
• Neuromuscular – Abnormal nerve or muscle function can result in a large “C” shape in the spine.

Some of the conditions below may develop Scoliosis:

• Cerebral Palsy
• Spina Bifida
• Muscular Dystrophy

Doctors wonder if a scoliosis gene exists, Research is being conducted to identify specific genes with a nexus with curvatures of the spine in the hope that doctors could predict which curves are at the highest risk for growth. “Scoliosis might be genetic, and a result of many genes; however, it has variable penetrance, meaning that in each generation genes act differently in how strongly they are expressed, which determines how severe a curve can progress,” explains Dr. Kishan. “This condition tends to run in families, but it tends to show different effects in each generation. For instance, a mother may have a mild curve who has a daughter with a severe curve, or a mother with a severe curve may have grandchildren who then have a spine curvature, but the intervening generation didn’t show any problems.”

Our expert spine specialists have received many academic honors & awards and have published articles in several peer-reviewed journals as well as presented their work at national and international meetings. In addition, they are also members of several noted research societies, including the American Academy of Orthopaedic Surgeons, Pediatric Orthopaedic Society of North America, Scoliosis Research Society, American Orthopaedic Association, and the Growing Spine Study Group.

Common Forms of Scoliosis

• Congenital
• Degenerative
• Adolescent Idiopathic Scoliosis
• Lumbar
• Neuromuscular
• Thoracic
• Levoscoliosis
• Dextroscoliosis
• Pediatric Scoliosis (Scoliosis in Children)
• Early onset Scoliosis

What are the Symptoms of Scoliosis?

A curved spine can exist as a hidden disorder with no obvious signs of curvature, or it can cause great discomfort, pain, and disability. Some patients have undetected curvature of the spine for years until the curve starts to increase in size, causing pain and difficulty. “We think of scoliosis as being a childhood disease.  However, in fact, most commonly, curvatures of the spine are diagnosed in the juvenile and adolescent stages. These are children aged 8, 9, 10, 11, and 12 years of age,” observes Dr. Hostin. “However, adult-onset or degenerative scoliosis, which we think develops as a result of disc degeneration, probably comprises an entirely separate entity from what we commonly think of as adolescent scoliosis.” Some symptoms include:

• A  shoulder blade that appears higher than the other
• A pelvis that appears tilted
• Any imbalance in the rib cage or other deformities along the back

More Advanced Scoliosis Cases:

• Back pain
• Neck pain
• Rib pain
• Difficulty breathing
• Headaches
• Limited movement

Scoliosis Pain

While most people with scoliosis do not get pain from the deformity it causes, some people may feel varying degrees of pain. The pain that sometimes comes with scoliosis is different from person to person with the main factors involved being age and the severity of the condition.

Scoliosis will cause pain in the elderly with adult-onset scoliosis due to the pressure on spinal discs and facet joints and the age-associated spinal degeneration that occurs. Also, the spinal curvature may cause contact with nerves, irritating them and inflaming joints. This can also cause mild or severe pain depending on the nerves and joints affected.

Scoliosis usually results in low back pain that requires urgent attention. Other painful symptoms include muscle tightening, painful sensations shooting down the legs, and uncomfortable postural changes. The aforementioned conditions can cause pain with movements over time.

Scoliosis Treatment

When doctors identify and diagnose the curvature of the spine, they can determine what type of treatment should follow, there are many different treatment options for different types of scoliosis.  The following are important indicators for determining the treatment:

• Spinal maturity – Does the patient’s spine show signs of growth?  Does the curve show change?
• Degree and extent of curvature – How does the curve affect the patient’s lifestyle?
• Location of the curve – according to some experts, thoracic curves are more likely to progress than curves in other regions of the spine.
• Possibility of curve progression – patients who possess large curves prior to their growth spurts become more likely for the curve to progress as they grow older.

After these variables are assessed, the doctor may suggest the following treatment:

Observation

In many children, a mild spinal curve does not require treatment. However, we may wish to monitor the child every four to six months. In adults with spine curvatures, X-rays are scheduled to track any progression or change.  

Bracing

After the evaluation, your doctor may want you to wear a brace. We brace patients who have not reached skeletal maturity. If the child continues to grow and his or her curve measures between 25 degrees and 40 degrees, the doctor may recommend a brace to prevent the curve from growing.  As there are many different types of braces exist, your doctor will help you decide the best one for your child.

Surgery

In adults and children, the three primary goals of surgery target stopping the curve from progressing,  stopping spinal deformity, and stopping the pain. Per our policy, we suggest surgery only when needed and all other treatments have been tried. Our surgeons use spinal fusion, one of the most common procedures, to correct scoliosis.

Some adults who were treated as children may need revision surgery.  For instance, if treatment occurred 20 to 30 years ago — before major advances in spinal surgery were implemented. Oftentimes the adult patient will get new symptoms, mainly severe back pain, trouble walking, or broken hardware. Another reason for revision surgery occurs when the lordosis does not function correctly, like flatback syndrome. In general, the doctor may recommend surgery when the science reveals that surgery will improve the quality of life.  

Scoliosis Statistics:

Prevalence:

• 2-3% of the population: This translates to roughly 6-9 million people in the United States alone.
• Equal prevalence between genders: However, females are 8 times more likely to require treatment due to curve progression.

Age of Onset:

• Primary age: 10-15 years old: This is known as adolescent idiopathic scoliosis (AIS), the most common type.
• Can develop earlier or later: Scoliosis can also occur in infancy, childhood, and adulthood.

Treatment:

• Only a small percentage (30%) require bracing: Monitoring is often sufficient for mild curves.
• Even fewer (10%) require surgery: This is reserved for severe curves that impact health or aesthetics.
• Yearly visits to doctors: Over 600,000 occur for scoliosis concerns.
• 30,000 children fitted with braces: This helps manage curve progression during growth.
• 38,000 patients undergo spinal fusion: This surgery aims to permanently correct the spinal curvature.

Additional Statistics:

• Pain: 63% of children with scoliosis report pain, compared to 31% without.
• Pain severity: 23% of scoliosis patients rate their pain as “horrible,” exceeding those without.
• Emergency room visits: Over 90,000 annually, highlighting potential complications.
• Adult considerations: 40% of adults with scoliosis experience curve progression, though usually mild.

We Can Help

From the first time you walk into our Southwest Scoliosis and Spine Institute offices in either Dallas, Plano, or Frisco, Texas, you will feel at ease. You will talk to one of our expert doctors.  Our doctors will listen and understand your problem and perform a detailed exam. The doctor will review your X-rays and other tests with you, in detail, and provide a diagnosis. After you become well-informed, you and your doctor will plan the right treatment. Finally, if your scoliosis doctor feels that surgery will not provide the desired result, he’ll tell you that too, and offer a non-surgical remedy as to the first course of treatment.

We invite you to schedule an appointment at one of our Scoliosis Centers and usually, we can get you in within a 24-hour period from Monday to Friday.

_____________________________________

Footnotes:
Scoliosis Research Society: Scoliosis Information and Support