When viewed from the side, the spine has several normal curves that help distribute weight evenly and center the weight of the head and body over the pelvis. However, when viewed from the front or from behind, the normal spine is straight. Scoliosis is an abnormal sideways curvature of the spine that causes the spine to look more like an “S” or “C” than a straight line when viewed from the front or from behind. Scoliosis can cause the bones of the spine to rotate upon one another so that one shoulder, scapula (shoulder blade), or hip appears higher than the other.
Patients who did not have scoliosis during childhood or adolescence can develop secondary scoliosis due to other spinal conditions that affect the vertebrae. Such conditions can include degeneration, osteoporosis (loss of bone mass), or osteomalacia (softening of the bones). Scoliosis can occasionally appear years after spinal surgery for other conditions.
Scoliosis symptoms do not typically include pain, even when structural abnormality is visible. If pain is present, it typically begins as low back pain. A combination of the degeneration of the spine and scoliosis deformity may also cause pressure on nerves. This can lead to weakness, numbness, tingling and pain in the lower extremities. In rare and severe cases, pressure may develop on the spinal cord, leading to weakness, spasticity, gait difficulties, and bowel and bladder problems.
Scoliosis Treatment Options
Scoliosis Treatment Without Surgery
Usually degenerative scoliosis treatment options are on the conservative side. Treatment commonly includes medication and physical therapy and exercise. 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. Exercise and physical therapy typically does not fix the abnormal spinal curves of scoliosis. However, a well-rounded physical therapy program can ease pain and inflammation and improve mobility, strength, and posture, thus allowing patients to carry on with their activities of daily living. Therapy sessions may be scheduled each week for four to six weeks.
Bracing is not used as routinely as it is in cases of childhood or juvenile scoliosis. The use of a spinal brace may provide some pain relief, but in adults the brace will not cause the spine to straighten due to skeletal maturity. Special shoe inserts, called orthotics, or a simple shoe lift may reduce back pain in patients affected by crooked gait or differences in leg length.
Scoliosis surgery may be recommended in some cases of degenerative scoliosis, especially for patients having worsening nerve problems, uncontrollable pain, or spinal stenosis. Surgery is often reserved for pain that is chronic and severely debilitating. The options for surgery include laminectomy and spinal fusion.
Lumbar laminectomy, also called decompressive laminectomy of the lumbar spine, involves removal of a small section of the bone on the back of the spine (lamina). This takes pressure off the nerve roots. Bone spurs or fragments from a degenerated disc that are pressing on the nerve are also removed, thus taking pressure off the nerve roots.
Laminectomy is commonly combined with a spinal fusion to straighten and stabilize the spine and stop the progression of the curve. Fusion for scoliosis may involve a posterior approach only or may require both an anterior and posterior approach, depending on the severity of the scoliosis and the amount of curvature correction needed. Once the bones are fused, they become one long column. Because these fused spinal vertebrae are no longer made up of separate bones and joints, there will be no movement or flexibility in that area, thus halting the progression of the scoliotic curve.
Schedule Your Scoliosis Consultation
The Houston neurosurgeons at the Texas Spine & Neurosurgery Center are the only neurosurgeons in the area trained to perform complex surgery for scoliosis, including fusions. Dr. Park has also done fellowship training in spine surgery at the Cleveland Clinic and New England Baptist Hospital in Boston. Schedule a scoliosis consultation today by calling (281) 313-0031.