Scoliosis - A Patient Primer.
Edited By: Theodore A. Wagner, M.D.
Last updated Wednesday, February 09, 2005
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Management and treatment
Treatment
The goal of scoliosis treatment is to stabilize the curve (stop it
from getting bigger) and to keep the patient balanced (keep the head
over the pelvis so that the patient can stand straight). In adults, the
goals also include relief or limitation of back pain, as well as
preservation of neurologic function, both of the spinal cord and of the
individual nerve roots. In very large curves (which often occur in the
neuromuscular patient), preservation of lung function can be a goal.
For the patient with neuromuscular scoliosis, preservation of walking
ability and/or balance while sitting are also goals.
In children and adolescents, mild scoliosis is often followed
expectantly- that is, no surgery or braces, just routine follow-up with
Xrays. For curves of a certain size, braces are often recommended in
this population, although this recommendation depends on a great number
of factors, including the type of scoliosis and the age and skeletal
maturity of the patient.
For the child with a progressive scoliosis, surgery is usually
recommended to preserve neurologic function. Neuromuscular patients
with scoliosis are often treated with spinal fusion because their
curves tend to be very stiff and progressive in nature, leading to
great difficulty with balance, which can cause problems for caretakers.
For the adolescent scoliosis that does not stabilize with bracing,
surgery in the form of spinal fusion is often recommended, depending on
the age of the patient, the size of the curve, and the skeletal
maturity of the patient. Adult patients are somewhat more complex, in
that they often have nerve compression in the lumbar spine in addition
to a curve, which calls for a decompression (removal of the compression
on the nerves) followed by a fusion to attempt to straighten and
stabilize the spine. The goal of surgery is usually not to straighten
the curve completely, as this cannot usually be done without injuring
the spinal cord. Rather, the goal is to balance the spine and prevent
the curve from getting worse.
Self-management
The most important thing the patient can do is to stay as active as
possible, maintain a healthy weight, and minimize the risk of
osteoporosis. These recommendations apply regardless of the type of
scoliosis. However, it is widely accepted that congenital scoliosis
will need to be treated surgically. For the remainder of patients,
maintaining strong trunk musculature and keeping the limb musculature
long and limber go a long way towards minimizing the symptoms of
scoliosis. There is no data to show that muscle strengthening and
stretching will alter the natural history of scoliosis, although there
is some evidence that elderly patients with osteoporosis will tend to
have more rapidly progressive curves than those without osteoporosis.Health care team
Usually an orthopedic surgeon specializing in spinal surgery and/or
pediatrics is the physician of choice for scoliosis patients.
Physiatrists (rehabilitation doctors) and physical therapists can
follow scoliosis patients and manage them non-operatively. Surgery is
performed by an orthopedic surgeon specializing in spine surgery.Pain and fatigue
The majority of children and adolescents with scoliosis do not
experience pain and fatigue. Staying as active as possible and taking
acetaminophen and non-steroidal anti-inflammatories (NSAID’s) such as
ibuprofen are usually all that are required.
For adults with scoliosis the mainstay of treatment is therapy for a
strong core musculature and keeping the lower extremity musculature
strong and limber. Acetaminophen and NSAID’s are recommended as needed.
Narcotic medications are strongly discouraged as the pain and
discomfort from adult scoliosis is chronic in nature and patients can
become narcotic dependent.
Braces can be used in adult scoliosis for flare-ups, but usually
long term brace use deconditions core musculature, which only makes
patients more symptomatic.
Diet
Poor diet itself is not a cause of scoliosis, but maintaining a healthy
diet can diminish the symptoms of scoliosis. Osteoporosis can cause
progression of scoliosis, so Viatmin D and sunshine are recommended
prior to menopause, as is weight-bearing activities to maximize bone
mass. Obesity can cause patients to have increased back pain and
discomfort, as the discs in the back function as shock absorbers which
can get overloaded with too much weight. Maintaining a normal body
weight certainly will minimize the pain and discomfort caused by
scoliosis.Exercise and therapy
Staying active and maintaining a healthy weight are of paramount
importance in managing the pain and discomfort of scoliosis.
Strengthening of the core musculature (abdominals, paraspinals) can
alleviate scoliosis pain. Stretching of the lower extremity musculature
can be quite beneficial as well, as hamstrings can become tight as the
lumbar swayback is lost. In addition, sometimes the nerve roots
supplying the lower extremity muscles can be compressed, resulting in
lower extremity spasms. Paraspinal spasms can also be problematic for
scoliosis patients; stretching of these can be helpful as well. For
patients with kyphosis (excessive thoracic hump) in addition to
scoliosis, pectoral (chest musculature) stretching can be helpful.Medications
Acetaminophen and NSAID’s are recommended as needed. Narcotic
medications are strongly discouraged as the pain and discomfort from
adult scoliosis is chronic in nature and patients can become narcotic
dependent.Surgery
Surgery can help treat scoliosis, in large curves that have not
responded to non-operative treatment and continued to progress. Surgery
involves fusion of the portions of the spine that are curved. Fusion
refers to taking away the joints that are between the bones and packing
them with bone so that they heal together and become one long bony
column. The goal of surgery is usually not to straighten the curve
completely, as this cannot usually be done without injuring the spinal
cord. Rather, the goal is to balance the spine and prevent the curve
from getting worse.Joint aspiration
Injections can be used to treat the symptoms of spinal stenosis- areas
where arthritis and ligament is pressing on nerve roots. The goal with
these injections is to alleviate leg pain and sciatic type symptoms.
Some physicians use trigger point injections of local anesthetic with
anti-inflammatory medication in the office to manage muscle pain and
spasm. There are no injections used to manage scoliosis per se.Surgery for scoliosis at the University of Washington, Department of Orthopaedics and Sports Medicine, Seattle, Washington
If you are interested in making an appointment to discuss this procedure in Seattle, you can request an appointment using our online referrals website. To request a referral online, please click here. You can also call 206-598-4288 to make an appointment. Our clinical center is located in Seattle Washington, USADisclaimer
This resource has been provided by the University of Washington Department of Orthopaedics and Sports Medicine as general information only. This information may not apply to a specific patient. Additional information may be found at http://www.orthop.washington.edu or by contacting the UW Department of Orthopaedics and Sports Medicine.
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