[MERGED] Scoliosis

[quinone]

my doc told me i would've been 2 in. taller if i didn't have scolio!
sayang noh?!

[travis_mc_gee]

I RECENTLY INTERVIEWED THIS BRILLIANT ORTHOPEDIC SURGEON FROM PGH WHO IS CURRENTLY WORKING ON A SURGICAL TECHNIQUE THAT "PROMISES TO REVOLUTIONIZE THE TRADITIONAL TREATMENT OF SCOLIOSIS".

EWAN, I'M A REALLY JADED PERSON, PERO BUMILIB AKO DITO SA DOKTOR NA 'TO. IT'S TRULY ADMIRABLE, BECAUSE DESPITE THE LIMITED FUNDS FROM PGH, THIS DOCTOR IS STEADFAST IN HIS RESEARCH FOR THE BEST AND MOST RISK-FREE METHOD FOR THE TREATMENT OF SCOLIOSIS.

HE IS STEADILY GAINING QUITE A NUMBER OF SUCCESSFUL OPERATIONS, USING HIS NEW TECHNIQUE. OF COURSE, AS WITH EVERY OTHER SURGERY AROUND, IT STILL INVOLVES SOME KIND OF RISK, BUT CONSIDERABLY LESS THAN THAT IF ONE GOES THROUGH THE TRADITIONAL SPINE SURGERY TECHNIQUE FOR SCOLIOSIS.

I HAVE ZERO MEDICAL KNOWLEDGE, AS I WRITE FOR A LIVING, BUT FROM WHAT I LEARNED DURING SAID INTERVIEW, x_roads, YOU SOUND LIKE AN EXCELLENT CANDIDATE FOR THIS NEW PROCEDURE. YOU MIGHT WANT TO GET IN TOUCH WITH HIM. JUST CALL PGH AND ASK TO BE CONNECTED TO THE ORTHOPEDIC SECTION, AND LOOK FOR DR. BUNDOC. I HOPE YOU GET BETTER SOON.

[mac_bolan00]

my wife has a 3-degree curvature in the upper back. it hurts after a day of doing heavy housework. when she got pregnat, the ob-gyne expressed concern. a scoliosis in the upper part of the back will get pretty strained as the pregnancy progresses. this went against what we thought at first. conversely, a scoliosis in the lower back is relatively safe during pregnancy.

[Ira]

What's with the all caps?

I think it's not Dr. Bundoc, It's Dr. Rafael Bondoc.

[sakura22]

hi doc..(doc ira..eyedoctor doglover etc..)

whenever i have an xray..the results would always say mild to moderate dextrorotatory scoliosis... i know that its located on my right side...but what does mild to moderate mean? ilang degrees na kaya yun? and can i still improve this?

kasi i never went to a doctor pa...

thanks!

[Ira]

Your x-rays probably weren't specifically for scoliosis angle measurement. You probably only had lumbosacral xrays with anteroposterior (and maybe lateral) views. You'll have to undergo serial lumbosacral xrays with different views to know how much angulation "mild to moderate" is.

[eboy73]

I am 30 years old with a 33 degree curve. I saw an ortho and was told that at my age it shouldn't progress anymore. He also said that won't operate on anyone my age with a curve less than 50 degress. The pain is unbearable at times, should I find somone else willing to perform the operation? How much will it cost in the Philippines?

[Ira]

When was your scoliosis angle last measured thru xray, and at what age were you first diagnosed with this? What was the initial angle? Have you undergone bracing/physical therapy? How frequent is the pain and when does it appear? What is your height and weight? What is your occupation?

[sweet_7326]

doc ira, can you recommend a doctor for me sa makati or manila area?

and also, i'd like to know approximately how much i will spend for therapy to correct the scoliosis.

thanks.

[Ira]

You can try Dr. Edward Wang (He has clinics in Cardinal Santos, Manila Doctors, PGH, and St. Luke's) or Dr. Dave Cabatan (Makati Medical Center or Phil. Orthopedic Institute at the back of MMC). Just call whichever hospital you want to follow up in and ask for the clinic schedule of whoever you may want to consult.

[eboy73]

Originally posted by Ira
When was your scoliosis angle last measured thru xray, and at what age were you first diagnosed with this? What was the initial angle? Have you undergone bracing/physical therapy? How frequent is the pain and when does it appear? What is your height and weight? What is your occupation?

It was last measured a year and a half ago. I wore a brace when I was younger. I also had an xray 5 and 7 years ago and the angle hasn't changed. It hurts almost everyday. I also want it corrected for aestehic reasons. I work out everday other day; other than that I live a sedentary, corporate life.

[Ira]

Go ahead and get a second opinion if you want, although 33 degrees generally isn't considered a severe enough angle to risk surgery. However, the indications for doing surgery in adults is not as clear-cut as those in teens (with teens, it's strictly 50 deg or those with developing cardiopul. problems, 40 deg for the more aggressive surgeons). In the adults, indications include an increasing discomfort or pain in a curve that appears to have increased. Be warned though that surgery may or may not always reduce the deformity and the discomfort or pain. The surgery isn't going to be cheap-- my guess is the ortho's PF alone would already be in the very high 5-digits or low 6 digits. You will have to factor in operating room, anesthesia, room costs, and physical therapy costs for that too.

[x_roads]

elo Doc Ira!! ang tagal ko na ring hindi nakapagpost ** a.. well,nyways, may question lang ako.hindi ko pa rin kasi ma-gets kung pano napapagaling ng pagsswimming ang scoliosis.pwede pakiexplain po? thanks.
well,sa laki ng degree ng scolio ko,nasabi ko na ** na ooperahan na ko,kaso ayaw ni mama. pero,nung last week, nung pumunta kami sa ortho ko(w/c was my 2nd doctor),***** na kailangan na daw talaga operahan kasi lumaki pa ng konti *** curve ng scoliosis ko.kakatakot talaga pero wala akong magagawa. pero,mejo pumayag na rin mama ko. nirecommend ng doktor na dun ako sa PGH magpa-opera. kinakabahan talaga ko.sana walang mangyaring masama..hehe pls pray 4 me!! thanks.
pero sa laki ng degree ng scolio ko,ndi naman siya palaging sumasakit kasi palagi akong nag-eexercise..hehe wala lang..

[Ira]

Swimming actually will not improve the curvature of your spine--what you're trying to do is developing the muscles supporting your spine. When you work out the muscles surrounding your bones, your bones will be more stable, and you won't feel as much pain.

Good luck with your surgery. I hope you and your family will finally decide to push through with it, because it seems that your curvature is progressing. Postponing it will not make the procedure easier.

[amazingdoctor]

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[x_roads]

Hi doc Ira!! pwede uli magtanong? bakit mas common ang scoliosis sa girls kesa sa boys? saka pwede ka bang magkaroon ng cyst o tumor sa likod pag may scoliosis ka? tnx!!

[ruger97]

there are classifications of scoliosis based on age onset:

- adolescent (common, young girls) 10-16 (or approx. to the end of skeletal growth
- juvenile (girls) 4-9
- infantile (boys) birth to age 3

as you can see, even in the age range, girls have more susceptibility to scolio... studies still have difficulty isolating the cause of scolio in women, some have even suggested finding a "faulty gene" that brings about scolio...

here's a recent article from www.apta.org for adult scolio...

Treating Adult Scoliosis
Chronic and severe back pain is the primary complaint among adults with this condition.

By Edgar G. Dawson, MD

Scoliosis—typically considered a childhood disorder—isn't just for kids. Nearly 4 percent to 8 percent of adults experience the condition, according to the Scoliosis Research Society. A curvature of the spine, scoliosis usually occurs in the mid-back (thoracic spine) or lower back (lumbar spine). The spine is often twisted.

Adult scoliosis can be caused by a progression of the disease from childhood, which occurs if it isn't treated early or goes undetected. Another cause is the asymmetric degeneration of spinal elements from osteoporosis (porous bone), disc degeneration, compression fracture or a combination of these factors.

Left untreated, adult scoliosis can eventually lead to severe, persistent pain, deformity progression and, in rare cases, reduced cardio.pulmonary (heart and lung) function. But there's good news for adults with scoliosis. A 50-year study showed that untreated adults with long-term idiopathic scoliosis were still productive and functional decades later, with little physical impairment other than back pain.1

Physical Effects
Among the physical effects of scoliosis are rib prominence on one side and leg length discrepancy, which can adversely affect walking or running. In addition, adults with scoliosis may have difficulty sitting or standing, experience stiffness and spinal rigidity and develop a humpback. An asymmetric pelvis can lead to trunk imbalance, making it appear as though the patient is listing to one side.

For adults with scoliosis, back pain is and always has been the primary complaint. Although most of us will experience occasional back pain during our lives, the back pain caused by scoliosis is chronic and much more severe. Pain is more common and intense in the lumbar or lower spine. When the pain is centered in the thoracic area, simple rest often alleviates it.

Before treatment can be prescribed, clinicians must determine the location and duration of the pain. The following types of pain occur from scoliosis:

Muscle fatigue pain, which originates on the outer side of the curve and worsens as the day goes on;
Pedicular pain, which occurs on the concave side due to pedicular kinking at the apex of the curve;
Junctional zone pain, which patients feel between two curves;
Facet disease, which causes pain upon rising from bed and standing upright.
A thorough physical and neurological examination by a physician trained in adult scoliosis is essential and will help pinpoint the sources of pain, allowing for proper treatment.

Several factors cause severe and chronic pain in adults with scoliosis. As the degree of curvature increases, the body's posture worsens. Muscles in the back, neck, shoulders, hips and legs are constantly stretched or constricted out of alignment, leading to pain and fatigue. The imbalance of the curves also can cause arthritis of the spine, called spondylosis, in the spine vertebrae.

Nearly all adults with scoliosis will develop spondylosis over time, with the risk increasing with age. With spondylosis, bone spurs develop on the facet joints of the spine, as the joints become inflamed and enlarged. In more advanced cases, the vertebral joints may fuse together on their own, locking the spine into the curved position. Bone cartilage also thins, making movement more difficult, and nerve damage can occur as the misaligned vertebrae begin to press on nerves that exit the spinal canal, leading to numbness and tingling down the legs.

Beyond age 50, adults with scoliosis also will begin to experience the effects of osteoporosis and compression fractures, particularly among women—who comprise 90 percent of those with scoliosis, according to the Scoliosis Research Society. Many of my adult surgical patients had adolescent scoliosis that went treated; they're now reaching an age in which the pain can no longer be controlled with conservative treatment methods.

Treatment Options
Fortunately, most patients with adult scoliosis don't require surgery. The nonoperative mainstay for treatment and pain management focuses on correcting pre-existing conditions that can cause or aggravate the pain. Treatment may include weight loss, which reduces the vertical load on the spine while standing or sitting; exercise and re-conditioning, such as low-impact aerobics and Pilates, which improve overall muscle tone; and muscle strengthening to maintain strength of the back muscles. (Older adults tend to lose strength due to reduced activity.) Jogging is contraindicated because of its pounding effect on the spine.

Other treatment methods involve applying moist heat to painful areas and nonsteroidal anti-inflammatory medication, as well as osteoporosis treatment to prevent small compression fractures of the spine and reduce pain.

Osteoporosis treatment includes exercise, calcium and Vitamin D supplements and prescribed medications, such as Fosamax. As another treatment, some patients have turned to chiropractic care. Although it's popular, there is no evidence that chiropractic treatment improves scoliosis.

Bracing is rarely used to help control pain because most older adults won't tolerate wearing one. In my experience, more than 90 percent of adults will abandon a brace in a very short time due to the discomfort and inconvenience. Bracing also will not correct or cure scoliosis. Rather, it's designed for immature skeletons in adolescents and has no role in treating adult scoliosis.

Surgery is not normally recommended for adults with moderate spinal curvatures (in the 30 degree to 50 degree range) as long as their curves are stable and not causing disability. Adults with spinal curvatures greater than 50 degrees have the greatest risk of worsening deformity, while those with curves of less than 30 degrees have the least risk. An X-ray can help physicians predict whether curves can be expected to worsen over time. Typically, if the disease is progressing, curves will increase at a rate of 1 degree to 3 degrees annually. Surgery is generally considered for adults if any of the following conditions exist:

Thoracic curve is greater than 50 degrees with persistent pain;
Progressive thoracolumber (mid and low back) curve;
Lumbar (low back) curve with persistent pain;
Decreased cardiopulmonary function due to thoracic curve.
Pain control and increasing disability are the primary reasons most adults decide to have surgery, although appearance and deformity are also factors. Because our spines become much more rigid as we age, adults can typically expect no more than a 50 percent to 60 percent correction in the curve of the spine. Therefore, adults must understand that spinal surgery won't create a perfectly straight spine. Rather, it will help them achieve balance and relieve pain.

Surgery may include removing an intervertebral disc (e.g., discectomy), combined with spinal instrumentation and fusion. Spinal instrumentation involves rods, bars, wires, screws and other types of medical hardware to stabilize the spine, enhance the fusion and provide a more permanent solution. When considering spinal surgery, we should not let age be a deterrent. Forty percent of spinal surgery to correct adult scoliosis is now being performed on patients older than 50, according to data from the Scoliosis Research Society.

In my practice, the average age of my patients is 65, and I have successfully operated on patients 80 and older. Typically, patients older than 80 choose surgery because they can no longer walk, and it's the only option to regain mobility. The average recovery period for older adults undergoing spinal surgery is five days in the hospital, depending on their prior physical condition. However, it may take up to a year to get back to a high level of function, depending on how strong the patient was before surgery.

Given today's advanced medical techniques, spinal surgery has a higher level of success and lower complication rates than ever before. But spinal fusion is an irreversible procedure and should not be considered lightly. Because this surgery is so specialized, patients should choose a surgeon who is trained and experienced in treating adult scoliosis. Whether the recommended treatment course is conservative or surgical, I recommend that patients incorporate physical therapy whenever possible to help build muscle strength, increase their range of motion and maintain flexibility.

Reference
1. Weinstein, S.L., Dolan, L.A., Spratt, K.F., et al. (2003). Health and function of patients with untreated idiopathic scoliosis; A 50-year natural history study. Journal of the American Medical Association, 289(5), 559-567.

Dr. Dawson is a board-certified orthopedic surgeon specializing in the treatment of complex spinal disorders, including scoliosis, at The Spine Institute at Saint John's Health Center in Santa Monica, Calif. A fellow of the American Academy of Orthopedic Surgeons, Dr. Dawson is a member and past president of the Scoliosis Research Society and the American Orthopedic Association. For more information, contact www.espineinstitute.com

[ruger97]

there are classifications of scoliosis based on age onset:

- adolescent (common, young girls) 10-16 (or approx. to the end of skeletal growth
- juvenile (girls) 4-9
- infantile (boys) birth to age 3

as you can see, even in the age range, girls have more susceptibility to scolio... studies still have difficulty isolating the cause of scolio in women, some have even suggested finding a "faulty gene" that brings about scolio...

here's a recent article from www.apta.org for adult scolio...

Treating Adult Scoliosis
Chronic and severe back pain is the primary complaint among adults with this condition.

By Edgar G. Dawson, MD

Scoliosis—typically considered a childhood disorder—isn't just for kids. Nearly 4 percent to 8 percent of adults experience the condition, according to the Scoliosis Research Society. A curvature of the spine, scoliosis usually occurs in the mid-back (thoracic spine) or lower back (lumbar spine). The spine is often twisted.

Adult scoliosis can be caused by a progression of the disease from childhood, which occurs if it isn't treated early or goes undetected. Another cause is the asymmetric degeneration of spinal elements from osteoporosis (porous bone), disc degeneration, compression fracture or a combination of these factors.

Left untreated, adult scoliosis can eventually lead to severe, persistent pain, deformity progression and, in rare cases, reduced cardio.pulmonary (heart and lung) function. But there's good news for adults with scoliosis. A 50-year study showed that untreated adults with long-term idiopathic scoliosis were still productive and functional decades later, with little physical impairment other than back pain.1

Physical Effects
Among the physical effects of scoliosis are rib prominence on one side and leg length discrepancy, which can adversely affect walking or running. In addition, adults with scoliosis may have difficulty sitting or standing, experience stiffness and spinal rigidity and develop a humpback. An asymmetric pelvis can lead to trunk imbalance, making it appear as though the patient is listing to one side.

For adults with scoliosis, back pain is and always has been the primary complaint. Although most of us will experience occasional back pain during our lives, the back pain caused by scoliosis is chronic and much more severe. Pain is more common and intense in the lumbar or lower spine. When the pain is centered in the thoracic area, simple rest often alleviates it.

Before treatment can be prescribed, clinicians must determine the location and duration of the pain. The following types of pain occur from scoliosis:

Muscle fatigue pain, which originates on the outer side of the curve and worsens as the day goes on;
Pedicular pain, which occurs on the concave side due to pedicular kinking at the apex of the curve;
Junctional zone pain, which patients feel between two curves;
Facet disease, which causes pain upon rising from bed and standing upright.
A thorough physical and neurological examination by a physician trained in adult scoliosis is essential and will help pinpoint the sources of pain, allowing for proper treatment.

Several factors cause severe and chronic pain in adults with scoliosis. As the degree of curvature increases, the body's posture worsens. Muscles in the back, neck, shoulders, hips and legs are constantly stretched or constricted out of alignment, leading to pain and fatigue. The imbalance of the curves also can cause arthritis of the spine, called spondylosis, in the spine vertebrae.

Nearly all adults with scoliosis will develop spondylosis over time, with the risk increasing with age. With spondylosis, bone spurs develop on the facet joints of the spine, as the joints become inflamed and enlarged. In more advanced cases, the vertebral joints may fuse together on their own, locking the spine into the curved position. Bone cartilage also thins, making movement more difficult, and nerve damage can occur as the misaligned vertebrae begin to press on nerves that exit the spinal canal, leading to numbness and tingling down the legs.

Beyond age 50, adults with scoliosis also will begin to experience the effects of osteoporosis and compression fractures, particularly among women—who comprise 90 percent of those with scoliosis, according to the Scoliosis Research Society. Many of my adult surgical patients had adolescent scoliosis that went treated; they're now reaching an age in which the pain can no longer be controlled with conservative treatment methods.

Treatment Options
Fortunately, most patients with adult scoliosis don't require surgery. The nonoperative mainstay for treatment and pain management focuses on correcting pre-existing conditions that can cause or aggravate the pain. Treatment may include weight loss, which reduces the vertical load on the spine while standing or sitting; exercise and re-conditioning, such as low-impact aerobics and Pilates, which improve overall muscle tone; and muscle strengthening to maintain strength of the back muscles. (Older adults tend to lose strength due to reduced activity.) Jogging is contraindicated because of its pounding effect on the spine.

Other treatment methods involve applying moist heat to painful areas and nonsteroidal anti-inflammatory medication, as well as osteoporosis treatment to prevent small compression fractures of the spine and reduce pain.

Osteoporosis treatment includes exercise, calcium and Vitamin D supplements and prescribed medications, such as Fosamax. As another treatment, some patients have turned to chiropractic care. Although it's popular, there is no evidence that chiropractic treatment improves scoliosis.

Bracing is rarely used to help control pain because most older adults won't tolerate wearing one. In my experience, more than 90 percent of adults will abandon a brace in a very short time due to the discomfort and inconvenience. Bracing also will not correct or cure scoliosis. Rather, it's designed for immature skeletons in adolescents and has no role in treating adult scoliosis.

Surgery is not normally recommended for adults with moderate spinal curvatures (in the 30 degree to 50 degree range) as long as their curves are stable and not causing disability. Adults with spinal curvatures greater than 50 degrees have the greatest risk of worsening deformity, while those with curves of less than 30 degrees have the least risk. An X-ray can help physicians predict whether curves can be expected to worsen over time. Typically, if the disease is progressing, curves will increase at a rate of 1 degree to 3 degrees annually. Surgery is generally considered for adults if any of the following conditions exist:

Thoracic curve is greater than 50 degrees with persistent pain;
Progressive thoracolumber (mid and low back) curve;
Lumbar (low back) curve with persistent pain;
Decreased cardiopulmonary function due to thoracic curve.
Pain control and increasing disability are the primary reasons most adults decide to have surgery, although appearance and deformity are also factors. Because our spines become much more rigid as we age, adults can typically expect no more than a 50 percent to 60 percent correction in the curve of the spine. Therefore, adults must understand that spinal surgery won't create a perfectly straight spine. Rather, it will help them achieve balance and relieve pain.

Surgery may include removing an intervertebral disc (e.g., discectomy), combined with spinal instrumentation and fusion. Spinal instrumentation involves rods, bars, wires, screws and other types of medical hardware to stabilize the spine, enhance the fusion and provide a more permanent solution. When considering spinal surgery, we should not let age be a deterrent. Forty percent of spinal surgery to correct adult scoliosis is now being performed on patients older than 50, according to data from the Scoliosis Research Society.

In my practice, the average age of my patients is 65, and I have successfully operated on patients 80 and older. Typically, patients older than 80 choose surgery because they can no longer walk, and it's the only option to regain mobility. The average recovery period for older adults undergoing spinal surgery is five days in the hospital, depending on their prior physical condition. However, it may take up to a year to get back to a high level of function, depending on how strong the patient was before surgery.

Given today's advanced medical techniques, spinal surgery has a higher level of success and lower complication rates than ever before. But spinal fusion is an irreversible procedure and should not be considered lightly. Because this surgery is so specialized, patients should choose a surgeon who is trained and experienced in treating adult scoliosis. Whether the recommended treatment course is conservative or surgical, I recommend that patients incorporate physical therapy whenever possible to help build muscle strength, increase their range of motion and maintain flexibility.

Reference
1. Weinstein, S.L., Dolan, L.A., Spratt, K.F., et al. (2003). Health and function of patients with untreated idiopathic scoliosis; A 50-year natural history study. Journal of the American Medical Association, 289(5), 559-567.

Dr. Dawson is a board-certified orthopedic surgeon specializing in the treatment of complex spinal disorders, including scoliosis, at The Spine Institute at Saint John's Health Center in Santa Monica, Calif. A fellow of the American Academy of Orthopedic Surgeons, Dr. Dawson is a member and past president of the Scoliosis Research Society and the American Orthopedic Association. For more information, contact www.espineinstitute.com

[x_roads]

bakit ba mas common ang scoliosis sa girls kesa sa boys? sana may sumagot. *pray* tenks!!

[Ira]

Haay. Don't you just love PEx's speed right now?

The cause of the is unknown, much less why it occurs more often in females than in males, but there are certainly hereditary factors present here. By hereditary factors, it doesn't necessarily mean that you won't acquire scoliosis just because your parents or grandparents didn't manifest any signs of having the condition. There may have been a silent gene that you inherited from your elders. There are also some theories which say that it is caused by nutritional and hormonal factors. However, as mentioned, since the cause is still unknown, these are just speculative.