At Rubin Orthopedics we treat a large number of patients for scoliosis. Methods of treatment depend on the severity: for minor curves observation with regular office visits, for moderate curves we may use a brace, and for severe curves Dr. Rubin performs surgery.
An x-ray showing the curvature of the spine
What is Scoliosis?
Scoliosis is an abnormal curve in the spine. Often people notice scoliosis because clothes don’t seem to hang right or one shoulder sits higher than the other. The easiest way to see scoliosis is by looking at your child’s back. The spine should be straight, with just a bit of dip at the low back (lordosis) and mild protrusion through the upper back (kyphosis). For some people, the normal curves are exaggerated, or a side-to-side curve emerges. Often the sideways curves result in some twisting of the spine bones as they stack one upon the other. The vast majority of scoliosis patients we see do not need surgery.
Why does it happen?
Many things cause scoliosis. Sometimes scoliosis runs in families. Often it develops during early puberty as the body grows rapidly. Frequently, the speed of growth brings out a small curve that previously went unnoticed. Rarely, a child may be born with incomplete formation of the spine, or legs of different lengths. For others, scoliosis is the result of injury to the back. For these patients, asymmetric healing of a fractured backbone, or narrowing of the space between bones may leave the spine bent or twisted.
These different causes of scoliosis are described below:
- Functional scoliosis occurs when a normal spine develops an abnormal curve. Frequently it is the result of differing leg lengths, imbalanced muscles or muscular weakness leading to poor posture.
- Neuromuscular scoliosis results from improper growth of the spine. The bones of the spine are shaped to be stacked perfectly to bear weight and create freedom of movement. However, if bones fail to form, or separate from each other, normal movement is impeded and imperfect stacking results. Occasionally, a partial or extra vertebrate may form, causing a sharp bend in the normal curve of the spine. While this is less common, it occurs at birth and is frequently noticed early. Quick treatment is the key to preventing the extreme curves that can result from this syndrome.
- Degenerative scoliosis generally occurs in adults. It results from increased wear-and-tear on the spine. As the spine ages, arthritis develops and weakens the supporting structures of the spine. Slowly, the body fails to reshape the spine in response to the repeated demands of life. For these patients, injury, hard labor or bad genetic luck make their spines less likely to recover from life’s daily stresses. Overtime, the unbalanced changes to the spine reshape the normal curves.
- Pathological scoliosis results from a disease in the bones of the spine. Infection, dysplasia or immune reactions cause growths or holes in portions of the spine. Frequently, these are painful conditions requiring medicines and swift surgery for repair. However, sometimes more mild cases slowly develop, causing shifts in the normal alignment of the spine.
Who may have scoliosis?
Scoliosis occurs in 2-3% of the population. An estimated 6 million Americans have some form of diagnosable spinal curve. In general, girls are twice as likely as boys to experience scoliosis. Although scoliosis may run in some families, an extreme curve in one generation does not mean the same degree of scoliosis will occur in the next generation. Sometimes scoliosis doesn’t run in a family but a young teenager may begin to grow asymmetrically. This is known as idiopathic scoliosis.
How do we treat it?
Dr. Rubin uses several approaches to treat scoliosis. These include careful monitoring and exercise programs, bracing, casting and even surgery. The surgical procedure often entails, Dr.Rubin straightening the curve and placing rods and screws to secure the poistion. Of course the severity of the curves dictates the degree of intervention. And it is always important to begin treatment early in the process. For many patients, scoliosis is first noticed in the pre-teen years. For these patients and families, we’ve found the best way to address their medical and personal concerns is bi-monthly scoliosis clinics. In addition, the full efforts of the staff and allied professionals are available. For more information please see our Scoliosis Clinic.
The less invasive therapies are familiar to anyone who frequents the gym. Physical therapy and home exercise programs may be used to help balance the muscles that shape the spine. Generally, this is an attempt to slow the process or compensate for weakness in the bones and ligaments of the spine.
Many cases will require bracing or casting. Casting is used on small, rapidly growing children because traditional braces aren’t practical given the speed of change of their bodies.
Dr. Rubin (foreground) and Mike Trofimenko PA-C (background) casting a 10 month old baby for scoliosis in the operating room. The patient has infantile scoliosis with a rib-vertebral angle difference measuring 37 degrees. The cast will need to be changed every 8 to 12 weeks.
Generally, older children or teens will use bracing. Modern braces are custom-formed synthetic shells that fit under normal clothing. Most braces can be easily covered and don’t restrict the child from normal play and activities. A professional Orthotist shapes each brace for the patient’s body and needs. There are a large number of scoliosis patients who are treated at Rubin Orthopedics, click here for more information about our Scoliosis Clinic. However, for adults with extreme curves or the rare child with a congenital or pathological process surgery is still the best option. Frequently, surgery requires the installation of a pair of rods on either side of the spine.
What is the surgery like?
The most common method of spinal surgery is a fusion. Depending on the shape of the patient’s curves, the surgery will be performed either from the front of back of the patient. The most common method is a posterior approach, as shown. This provides a minimal disruption of normal tissues and allows for faster healing.
This patient’s curve is obvious without measurement. An incision along the center of the back allowed Dr. Rubin to reach the spine with less risk to important organs.
In either method, rods inserted along the spine stabilize the curve, while bone cement is used to help fuse the vertebrate together. The rods are attached to various levels of the spine with a series of hooks, screws and pins. The variety of attachments allows Dr. Rubin to control for various curves and rotational defects of the spine. This combination of instruments realigns the spine and prevents further worsening of the curves.
After surgery, patients recover quickly and eventually participate in most recreational activities. While a spinal fusion does limit the movement of the spine in the areas that have been joined, patients compensate with motion at the uninvolved vertebrate. One of the few limitations of spinal fusion is the inability to serve in the armed forces.
These are the before and after x-rays of a 15 year old girl who had a double curve scoliosis.
What do patients say?
“Ann had her surgery almost two years ago. And it’s going great. She’s had no back pain for a long time. Her movement and activities are all back to normal. And she’s planning to try out for the 8th grade basket ball team.”
– Arlyn E., about her 13 year-old daughter.
“I’d been a little crooked my whole life. But I was able to hold a normal job, have kids, live life. Then, something happened in the last few years. I never noticed my back change. But I was slowly falling over to the side. After a while, it was hard to pick up clothes from the floor. I didn’t want to complain, but part of me didn’t want to live like that anymore.”
“My son noticed without me telling him. And he made me see a doctor. I saw a lot of doctors, but no one wanted to help. At my age, 64, many people ask why fix your back now. Well, I had bad hip pain. And I couldn’t walk fast enough to keep up with normal life. But Dr. Rubin understood my complicated case. He listened to me and what I wanted.”
“I already get around great and my hip doesn’t hurt anymore. I’m really happy with Dr. Rubin. I trust him to take great care of me.”
– Elaine T.-talking about her complex degenerative spinal condition.