Today we’re going to discuss scoliosis and I think we should divide scoliosis up. Today, we’re only going to discuss people who have no other diseases, they don’t have cerebral palsy, they don’t have arthrogryposis, they don’t have spina bifida. They just were diagnosed with scoliosis and who are these people?
Usually they’re women and young girls, some of the age, ages of 10 and 14, usually before they get their period and they’re diagnosed with scoliosis. It can happen in boys as well but often it’s more severe in girls. Scoliosis just means you have a curve in your back, that’s all that means. We don’t know the reason, we don’t understand the reason and I’ll be doing later discussions for people who have other reasons for it, that will be a specific conversation.
For today, let’s just discuss what happens if you went to your doctor and they said you have a curve in your back.
The first thing you have to know is you got a curve in your back to the side, like an “S” and that’s called scoliosis or a “C” like scoliosis or you could be bent forward like hunchbacked and that’s called “kyphosis” and those are 2 different things. Again, I’m going to be limiting this talk to just scoliosis.
Scoliosis is measured in degrees in angles like we learned in geometry. You could have 0 degrees which means you have a straight spine. You could have a 10 degree curve which means you have a very small curve. 20 degree curve, you have a moderate curve. 30 degree curve, more moderate and then once you get above 40 degrees, you have a severe curve. I always hear people say “percent”. There’s no percent curve, it’s just the number of degrees of angulation. We just measure the angles of the curve of your back done on x-ray and we can also do in your exam when we examine you.
So how do we evaluate you? The first thing we do is we examine you; we take a history. Does your mother have it? Did your grandmother have it? Does your aunt have it? It usually runs in families. Does your sister have it? Does your brother have it?
Then we ask does it hurt you? It can hurt a little bit but it shouldn’t hurt a lot. It shouldn’t wake you up at night, you shouldn’t have any skin changes over your back, and you shouldn’t feel any numbness or tingling. If you do, then often times you’ll fit into a different category and we’ll get MRIs and something like that. Usually we can get x-ray and today x-ray can be done with very minimal radiation unlike in the past and then we’re getting into newer and newer ways of doing this with very, very small amounts of radiation. We’d look at your scoliosis and we’d see the number of degrees that you have and then we’d determine a treatment plan.
If it’s very low then we say we’ll just observe you, maybe see you in 4 to 6 months. If it’s getting higher, then if you’re very young and you have a lot of growth left then you use that bad word called “bracing” ‘cause no kid wants to wear a brace. Sometimes the bracing can just be done at night, sometimes the bracing has to be done during the day and we try to figure out how you can handle that. And if you can’t handle it, we can say well perhaps you want an internal brace and we talk about stapling and that’s something I won’t really discuss today but there are ways of using internal bracing and even surgery to do that, the results are certainly not certain but it’s a way of not having to wear a brace for many years.
As you’re aware, you can only wear your brace at night, perhaps and we can discuss that too if I saw you and you said you needed a brace. We try to take the whole child into perspective. We speak to the parents, can your child tolerate wearing a brace? We don’t want to ruin someone’s body image by wearing a brace. Does the brace work? We think so. Does it work all the time? Well hopefully it will delay or stop progression of the curve.
When do you talk about surgery? Usually over 50 degrees; the scoliosis is over 50 degrees. We try to prevent it from being over 40 degrees when you reach maturity. ‘Cause usually scoliosis gets worse when you’re young, when you’re growing, the growth spurts increase scoliosis.
That’s basically what scoliosis is. The surgery today, completely different than it used to be. But even when I was training, we had people in casts and braces and things like that, that we don’t use anymore. Now, you’re out of bed right away, back in school in a few weeks and really, you can do all the sports as soon as you’re able to. Really, it’s really changed.
Are risks behind scoliosis surgery? There are certainly risks but I think we’ve minimized them and it’s really become pretty tried and true how we take care of this. That doesn’t mean you should have surgery, it means we should try to avoid it if we can and sometimes we can’t avoid it.
We can discuss and as I make these and you can see from other tapes specifically about surgery for scoliosis, specifically about what happens if your child’s very young, 3 years old, 4 years old, new born with scoliosis. Different treatment, different discussion. I think for the teenager, for the young pre-teen 12 year old, that’s basically scoliosis. The treatment is nothing from 0 to 30 degrees then talk about bracing for the young child, perhaps surgery if this really progresses and I think that, that basically is scoliosis in a nutshell.
David S. Feldman, MD is Chief of Pediatric Orthopedic Surgery and a professor of orthopedic surgery & pediatrics at NYU Langone Medical Center / NYU Hospital for Joint Diseases, specializing in the care of children with complex scoliosis, arthrogryposis, hip dysplasia, Legg-Calve-Perthes disease, and lower limb deformities.
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