The spine is made up of a stacked alternating vertebral bodies and disks. The spine is usually straight on anterior posterior x-ray. Scoliosis is an abnormal curvature of the spine. The spine may look like a C or S on X-ray. Scoliosis may arise from birth abnormalities where the spine was formed wrong, such as missing half of a vertebrae or from changes resulting from arthritis. The cause of scoliosis in young people is unknown and is called idopathic even though certain genetic traits have been defined.
Children are commonly screened at school for scoliosis, especially at the time of the growth spurt when the development and progression is most common. Patients suspected of having scoliosis undergo a history and physical and relevant laboratory investigations. This may include x-rays, serial x-rays, CT and MRI. Patients found to have a spinal curvature of greater than 10 degrees are diagnosed as scoliosis.
Scoliosis alters the mechanics of the back and puts significant strain on the vertebral bodies, disks, muscles and even the nerves leading to chronic pain and suffering.
Treatment is complex and requires individualization. Smaller curvatures are watched while larger curvatures greater then 20 to 30 degrees may require bracing. Surgery is usually reserved for very large curvatures greater then 45 to 50 degrees which have high likelihood to progress even more. Other indications for surgery include pain, weakness, difficult mobilizing and breathing. Surgery usually involves spinal fusion surgery, this may be done through the front (anterior), side (lateral) or back (posterior) combined with spinal instrumentation (screws and rods).
Overall prognosis of scoliosis depends on the likelihood to progress. Patients with larger curvatures, thoracic curves, double curves and immature spines (such as adolescents) have higher chance or progressing.
ABOUT DR CARL SPIVAK.
Dr Spivak is a neurosurgeon who specialized in minimally invasive endoscopic spine surgery. He is a well known teacher and speaker in laser spine surgery. For more information on scoliosis, other spinal disorders or laser spine surgery please call 908-452-5612 or click schedule-an-appointment.