7 things you should know about scoliosis

From The Orange County Register

By Alison Glander/Staff Writer

In the pediatric orthopedic community, summer is considered scoliosis season.

It’s the most common period for children to undergo procedures to straighten abnormal curvatures of the spine, leaving enough time for the lengthy recovery process before the new school year gets underway.

What is scoliosis?

Scoliosis is the most common deformity of the spine, affecting one in 40 people, or about 7 million in the U.S. It’s even tested for in California schools.

The condition is an abnormal curvature over 10 degrees – mostly to the side – or rotation of the spine. Most cases – up to 85 percent – have no known cause. An estimated 30,000 children are fitted for a brace annually and more than 100,000 children and adults undergo surgery for scoliosis in the U.S.

What are the signs and symptoms?

Indications of scoliosis generally appear between ages 10 and 15, when the body is still growing, according to the National Scoliosis Foundation. A lateral spinal curve develops over time, so signs may be hard to spot. Experts say they include uneven shoulders, an asymmetrical ribcage, prominence of one shoulder blade or hip, and leaning to one side.

“Symptoms depend on the magnitude of the curvature,” said Dr. Francois Lalonde, a pediatric orthopedic specialist at CHOC Hospital in Orange. “If you have mild scoliosis then there may not be too many issues. Many patients don’t have much back pain. … Severe scoliosis can develop respiratory and abdominal issues.”

How is it tested?

The California Department of Education requires by law that every girl in seventh grade and boy in eighth grade be tested for scoliosis. But parents can opt out if they choose.

According to the Scoliosis Research Society, in 2009, the year for which the most recent figures are available, fewer than half of states required screening for scoliosis in schools.

Testing for scoliosis usually involves the child bending forward at the waist, arms hanging down in front. A trained examiner looks for unevenness in the back or ribs and uses an instrument similar to a level to estimate abnormal curvature. An X-ray may also be taken.

“It’s noninvasive and an easy screen. It’s cost-effective if you catch it early on and can have an effect on the outcome,” said Lalonde.

What are the treatment options?

Experts say treatment is influenced by factors such as gender, severity, location of the curve and bone maturity.

“If you’re young and have this condition, there’s a chance it could progress with growth,” Lalonde said.

A curve severe enough to require treatment is 8 percent more common in females. Having family members with scoliosis increases a person’s risk by 20 percent, according to the Scoliosis Research Society.

Lalonde said general guidelines for treatment include:

Observation: For curves of less than 25 degrees (or curves of less than 45 degrees in patients who are finished growing), regular follow-ups are recommended to monitor the curve.

Bracing: For curves between 25 and 45 degrees in children, a brace may be worn to prevent further progression of the curve while the spine is still growing. Braces do not correct curves but can prevent them from getting worse.

Surgery: For curves greater than 45 degrees, spinal fusion is recommended for correction and to prevent progression.

“Treatment is tailored to the patients’ curve magnitude and beliefs. It’s a really patient-centered approach these days. The families and patients are active in decision-making,” Lalonde said.

Alternative treatment such as physical therapy, chiropractic medicine and yoga have not been scientifically proven to improve abnormal curvature, according to the Scoliosis Research Society. However, these methods may improve overall health as well as relieve symptoms.

What are surgery and recovery like?

In spinal fusion, vertebrae are connected with bone grafts. Metal implants such as hooks and screws, commonly made of titanium, are attached to the spine and connected to one or two rods that hold the spine straight while the graft and vertebrae fuse. This reduces the spinal curvature and stops progression, according to the American Academy of Orthopaedic Surgeons.

We try to maintain mobile segments above and below the fusions,” Lalonde said. “The more segments that are left, the more mobility they’ll have after.”

The operation usually lasts four to eight hours and the patient remains in a hospital for up to a week. Children can return to school after four to six weeks, according to the American Academy of Orthopaedic Surgeons, and can participate in sports within six months to a year.

“It’s a major surgical event and a stressful time,” Lalonde said. “The first month or two is difficult for patients and families. The surgery challenges coping mechanisms as well as support systems in terms of friends, family, etc. But there’s also some optimism that the surgery will restore height, prevent future progression and help the child have an improved body image.”

Complications can include infection, bleeding, blood clots and nerve damage, but there is no risk of complications in future pregnancies or deliveries, according to the American Academy of Orthopaedic Surgeons.

“People can expect to live a good life after surgery and minimize having back issues in the future,” Lalonde said.

What if scoliosis isn’t treated?

Lung and heart problems: In severe scoliosis, with curves greater than 70 degrees, the ribcage can push against the heart and lungs, causing chest pain and breathing issues, according to the Mayo Clinic. The heart may have difficulty pumping blood.

Back problems: Adults with scoliosis are more likely to experience back pain.

Appearance: In severe cases, a spinal curve will be visible. A patient may have unevenness in the shoulders, ribs or hips, and can develop a humped back.

Will insurance cover it?

The cost of spinal surgery depends on many factors including the hospital stay, materials used, surgeon’s fees and anesthesia, according to the American Academy of Orthopaedic Surgeons. In general, scoliosis surgery is an expensive operation, often in the hundreds of thousands of dollars.

Most insurance covers the operation.