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Typically scoliosis is found during a routine pediatric evaluation or in a school screening. Sometimes it is picked up by family or friends at the pool. When found, it generally is referred to an orthopaedic or spine surgeon. General physical evaluation, looking at the individual's spinal alignment both in the frontal and side planes will help ascertain the severity of the curve. Also evaluated are the alignment of shoulders, scapulae, hips and pelvis. The forward flexion test familiar to most people from school screenings is invaluable to also ascertain the significance of the spinal rotation.
The mainstay in evaluating scoliosis is the standing 36 inch X-ray in the front and side view. A standing X-ray is critical because gravity will show the scoliosis at its worst rather than a supine or lying down film which may lessen the severity of the curve. Also, full length views are important to determine spinal balance, or where the head appears in space in relationship to the pelvis. The goal of treatment whether it is conservative or surgical is to maximize the alignment of the head over the pelvis.
Generally, low degrees curves are watched and re-evaluated every 6 to 12 months depending on the potential for growth and progression of scoliosis. If growth and progression are both ongoing, bracing may be recommended with a TLSO or thoracolumbar sacral orthosis, a hard plastic clamshell type brace which may help limit progression of the curve. Sometimes these braces are worn 24 hours a day or just at night depending on the condition and surgeon preference. If bracing does not slow or stop curve progression and curve magnitude is approaching the 40 to 50 degree range surgery may be recommended. There is no absolute number of degrees that require surgery but it is more a function of growth potential, skeletal maturity, and rate of progression.
In the mature spine a progression of 2 or 3 degrees a year may not sound like a large progression but if you have a 40 degree curve with a 2 degree per year progression, in 15 years you have a 70 degree curve which is a significant problem. Therefore, sometimes follow up X-rays may be needed into adult life to make sure there is no progression of the scoliosis. Once this is determined, the patient is generally released from follow up with instructions to return if loss of height or change in shape occur or new onset pain begins that may indicate a change in the scoliosis.
Generally scoliosis is not a problem for individuals throughout their lives and patients are encouraged to remain active and maintain a weight close to ideal body weight to avoid extra stress on the spine. Women generally have no trouble bearing children but sometimes do have back pain with the additional stress of carrying 30 to 40 pounds of extra weight during pregnancy. Continued back pain after child birth should be evaluated for potential progression of the scoliosis.
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Scoliosis Pre-Op 64 degree curve |
Scoliosis Post-Op 11 degree curve |
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