Care at Every Age

Scoliosis, or the side-to-side curvature of the spine, can progress at any age, though it is at highest risk of progression during the adolescent growth spurt. Many medical providers will screen for scoliosis using a scoliometer measurement on a forward-bend test. If the scoliometer reading is greater than 5 degrees, an x-ray is recommended to confirm the diagnosis. Any curvature of the spine measuring greater than 10 degrees on an x-ray is considered scoliosis.

It is important to closely monitor for progression of a curve with repeat low-dose x-rays every 3-6 months during growth. When identified early, there are several conservative treatments that can be utilized to help prevent progression of a curve, or in some cases, even help correct it.

Schroth therapy is a method of physical therapy specific for scoliosis that can be started once a curve reaches ~15 degrees. Teenagers with curves above 25 degrees who still have growth remaining may be eligible for a Rigo scoliosis brace. Schroth and the Rigo brace can be used separately, or together, as a conservative method of treating scoliosis.

SCOLIOSIS

If scoliosis reaches 50+ degrees, surgery is typically recommended in order to prevent future suffering. Curves in the 40-50 degree range are in what we call the “gray area,” meaning that we can do the conservative therapies, but surgery is also a potential option, if desired. While it is overwhelming for parents to think of a surgery for their child at such a young age, children/teenagers tend to have better bone quality, less surgical risk, and the fusion surrounding the hardware forms faster. This allows them to quickly return to an active lifestyle with a balanced spine.

KYPHOSIS

Kyphosis is another disorder that is first noted at a young age. This is more common in males than females and is usually monitored with regular x-rays to check for progression. In some cases, the kyphosis can actually improve as the teenager grows. Treatment options for kyphosis include conservative therapies including PT, and/or surgery depending on the severity of the curve and symptoms.

SPONDYLOLISTHESIS

Some young athletes will develop a pars fracture as a result of injury or overuse. This can lead to a condition known as “spondylolisthesis,” or slippage of one vertebra over another. Treatment options for this vary from conservative to injections or surgery as a last resort, depending on the teenager’s symptoms and whether or not the slippage is progressive.

During your visit at the Hey Clinic, we will thoroughly discuss all appropriate treatment options based on your diagnosis, and help you choose the one that is best suited for you and your family. Every patient is precious and every spine is unique. Therefore, we provide care tailored to each individual, putting YOU at the center of the decision-making process to ensure that you are comfortable and confident with the chosen treatment plan.

Though scoliosis is at highest risk of progression during the adolescent years, the curve can continue to progress at any time in adulthood. Having accurate follow-up measurements throughout your life is critical for helping you guide future treatment decisions and maximize your quality of life in the long run. Our EOS X-Ray machine allows us to get excellent quality images, while also dramatically decreasing radiation exposure down to 4% of regular digital x-rays, which decreases cancer risk. For those who have finished growing, we recommend follow-ups once a year through age 25 and after each pregnancy. After age 25, follow-up is usually every 1-3 years depending on risk of progression, or earlier if the deformity becomes symptomatic.

While scoliosis is generally diagnosed in childhood, existing curves can progress as an adult, or new curves can develop. For females, this is especially true after menopause. Hormonal changes, decreased bone quality and/or loss of disc space can lead to changes in the curvature of the spine. Therefore, it is important to continue monitoring scoliosis and kyphosis throughout the lifespan.

As we age, there are many degenerative changes that occur in the spine. The facet joints become arthritic and intervertebral discs begin to wear out, causing the bones to rub against each other which can be very painful. For people with scoliosis, the curve can start to “buckle” over time due to uneven loads put on the discs as a result of the curve. In response to degeneration, the spine will grow bone spurs in an effort to strengthen the spine and prevent movement. The human body is amazing in that it has these methods of healing itself, however this process can be slow and sometimes frustrating. There are many conservative therapies to help manage back pain while the body finishes this process.

As we get older, it is frustrating to feel that our bodies are slowing us down. Our bodies begin to “settle” and may start to degenerate and lose bone quality. Oftentimes, the spine becomes the focus of our weariness and discomfort. Have you ever gotten back pain relief by leaning over the shopping cart? If so, the shopping cart is acting as a support, taking some of the load off of your spine. Leaning forward also relieves pressure on the nerves in the spine, thereby reducing symptoms of stenosis. Frequently, strengthening the core abdominal muscles or adding a supportive low back brace can provide ongoing relief.

Scoliosis and kyphosis can continue to progress in older adults as a result of degeneration and decreased bone quality. It is particularly important for older women to get a enough calcium and vitamin D in their diet (or through supplements) and to get regular DEXA scans to monitor for osteopenia and osteoporosis. While it is not common for men over the age of 40 to lose bone density as rapidly as women, there may be a slight risk for some men.