Q: What exactly is a rib thoracoplasty and why is it performed?
A: Simply stated, a rib thoracoplasty involves shortening of certain ribs in the thoracic or chest area. It is done to reduce the size and severity of a rib hump which may accompany scoliosis. The procedure is usually performed after the patient has had corrective surgery for scoliosis.

Q: What are the goals of a rib thoracoplasty?
A: For moderately severe deformities, the procedure appears to result in a significantly greater improvement in a patient’s overall appearance, though it will not result in perfect symmetry. The procedure also relieves pain that may be associated with a rib hump, such as when an individual leans up against a chair.

Q: Are there a lot of different surgical techniques being used today for a rib thoracoplasty?
A: As far as I know, most surgeons use fairly similar techniques. However, some surgeons make an incision over the peak of the rib hump, whereas I prefer, as do many others, to use a midline incision-that is, to use the same incision that’s used for a posterior spinal fusion. Patients seem to prefer having a single midline incision.

Q: What determines which ribs are shortened, and how do you decide how much to shorten them?
A: We determine which ribs are shortened based on which ones are prominent and are not expected to be reduced by correction of the curvature. As far as deciding how much to shorten ribs, we decide on a case by case basis; it depends on the nature of a patient’s curve, as well as the severity of the rib hump.

Q: When the ribs grow back after surgery, do they actually form new rib bone and reconnect to the spine, and how long does it take for this to happen?
A: Yes, the ribs do grow back, forming a new rib. This takes approximately two to three months.

Q: Is the new growth as strong as the original rib?
A: The new rib, once it is completely healed, will be as strong as the original rib.

Q: Is there any chance of the rib hump returning?
A: That would only occur if the curvature progresses.

Q: Could a rib grow back crooked or out of place?
A: This is rarely, if ever, encountered.

Q: Is it always necessary to wear a brace following this surgery? Will wearing or not wearing a brace affect the outcome of the surgery?
A: The use of a brace appears to protect the ribs from rubbing against the chest cavity and seems to result in less likelihood of fluid collection and the subsequent need for a chest tube. Not wearing a brace will not affect the long term outcome of the surgery, but in the short term a brace could avoid the complications as mentioned.

Q: During recovery, is there any danger for the unprotected chest wall?
A: Not in the course of normal activities. There might be a theoretical risk of a very forceful blunt trauma causing damage, but this would, of course, be very unusual.

Q: Can a patient damage the rib cage during recovery by stretching or moving incorrectly? Are there any movement restrictions once the healing is complete?
A: A patient wouldn’t damage the rib cage during the course of normal activities. Once healing is complete, there are no movement restrictions. In fact, tennis and golf would be possible within the constraints of spine fusion limitations.

Q: How long is recovery time?
A: For patients who choose to undergo thoracoplasty surgery as a separate procedure, full time in hospital is 5 to 7 days; recovery is 2 to 3 months for this procedure.

Q: Aside from the risks of anesthesia, what are the possible complications from this procedure, and what can be done about them?
A: The main complications would be: fluid or air collection in the lungs, both of which can be treated with a special device called a chest tube. There might be too much resection resulting in a rib concavity, and there could be a temporary decrease of lung capacity.

Q: Can a patient go back to surgery after the corrective spine surgery and have a rib thoracoplasty done?
A: Yes, many patients elect to have the thoracoplasty performed after recovery from their major spinal corrective surgery.

The post Rib Thoracoplasty first appeared on National Scoliosis Foundation.

Q: Dr. Winter, is pain a symptom of scoliosis in the adolescent?
A: Very rarely. In fact, if a typical 12 to 14 year old adolescent with scoliosis visits our clinic and her main complaint is “I hurt,” we would be concerned, because most patients of that age simply don’t hurt. We would wonder (1) Why is this girl different from the usual patient? and (2) Is there something else going on besides scoliosis? Then we would order a variety of tests to find out whether she has a bone infection, a bone tumor, a spinal cord tumor, or some other type of problem.

Q: Let’s say the patient mentioned above undergoes various test, and you find that she has no abnormal condition other than scoliosis. What might be causing her pain?
A: Some adolescents with scoliosis may experience pain which is truly “organic” in other words, they experience a muscular type of pain which occurs because the muscles on the convexity of the curve are working overtime trying to control the curve. When muscles are overworked, they hurt.

Q: What about adult patients with scoliosis who complain of pain; is their pain due to scoliosis, or to something else?
A: This is one of the toughest questions doctors face when confronted with the scoliotic adult who complains of pain; how to distinguish between conventional low back pain and pain due to scoliosis. First, it should be noted that all adults-whether they have scoliosis or not-can have low back pain. It’s just part of being a human being who stands upright and is growing older. As we age, all of us eventually experience disc degeneration-i.e., the fibrous, spongy discs between our vertebrae wear out. Moreover, various joints of the body tend to wear out with age-a condition known as degenerative or “wear and tear” arthritis (also know as osteoarthritis). When these conditions occur, bone rubs against bone, which causes pain-but the pain may be due to disc degeneration or wear and tear arthritis, problems that everyone faces with age.

Q: If an adult with scoliosis is experiencing pain that is not due to disc degeneration or arthritis, what might be causing the discomfort?
A: The answer to your question has to do with mechanics. You need to understand that the discs in your back are being loaded with weight by gravity every day. If the vertebrae of the spine are perfectly straight, then the loading will occur symmetrically. However, if the spine is curved, the loading will be asymmetric and highly concentrated in the concavity of the curve. When discs and joints are loaded asymmetrically, they wear out asymmetrically, and at a much faster rate than they would normally. In these cases, we would say that the patient has scoliotic pain: the back pain, usually found in the thoracolumbar (mid-back) or lumbar area (lower back), is due to the spinal curvature which is causing asymmetric loading of discs and joints. Scoliotic pain usually does not occur in persons in their twenties or thirties but rather in those in their forties and beyond.

Q: Is there any connection between the magnitude of a curvature and the amount of pain one might feel?
A: Let me answer the question this way, I’ve seen adult patients at our clinic who have 30 degree curves and they’re miserable; yet just down the hall I’ll visit a patient who is 67 years old with a 95 degree curve and she’ll say it doesn’t hurt at all. Generally speaking, thoracic (upper back) curves don’t hurt even if they’re 90-100 degrees; in this case, breathing capacity may be diminished, but the lungs wouldn’t hurt. Lumbar Curves over 45 degrees tend to hurt over time, yet I’ve seen 95 degree lumbar curves that didn’t hurt at all.

Q: In terms of diagnosing a patient, how do doctors determine whether a patient has conventional low back pain or scoliotic pain?
A: We would begin with a physical examination and then look at routine x-rays. We might also use special diagnostic techniques such as a myelogram (an x-ray of the spinal cord); high-tech scanning devices such as Magnetic Resonance Imaging (MRI), which uses a computer to produce three-dimensional images; and/or discography which is the injection of a dye into the disc which can assess both the patient’s pain response to the injection as well as the radio graphic pictures of the discs.

Q: If the doctor determines that the patient has disc degeneration or arthritis, what can be done to treat the pain?
A: The first step for the doctor is to block scoliosis from the mind-i.e., treat the patient as though she came in with a straight spine and low back pain. The next step is patient education; learn all you can about body mechanics so that you know how to lift, sit and sleep properly; find out from your doctor which type of exercise will help you (some patients with arthritis of a spinal joint or joints, for example, may benefit more from isometric toning than from aerobic motion exercise). Third, learn not to panic when you have a little back pain. I’m a great believer in doing simple things when you can: perhaps a non-steroidal anti-inflammatory drug (NSAID) such as aspirin or ibuprofen will help. Quite often, wearing a corset, using a heating pad, lying on the floor with your feet propped on a chair, or resting in a fetal position for 10 minutes, can give you relief. As for the use of chiropractic treatment of pain, if it works for a patient, it’s fine. I’m not particularly enthusiastic about biofeedback or acupuncture for treatment of pain.

Q: What about treatment for true scoliotic pain?
A: Once the doctor has determined without a doubt that the pain is caused by the scoliotic curve, surgical techniques can be designed to solve the problem. It is crucial that the diagnosis be accurate. If the pain is strictly in the curvature, then by treating the curve surgically you treat the pain and patients do very well. On the other hand, if the doctor thinks the pain is due to the curve but in reality it’s due to disc degeneration outside the curve, you can treat the curve from now until doom’s day and the pain won’t go away.

Q: We’ve heard that there are some situations which may give rise to pain after surgery. Examples include flat back syndrome and a broken rod. Would you comment on these?
A: Flat back syndrome is a condition that occurred more frequently ten years ago, when doctors weren’t cognizant of the fact that you just can’t use a Harrington distraction rod on the lumbar spine and get good results. Today, we know that a long fused segment in the lumbar area places a great deal of stress on the remaining joints and wears them out. The condition can be corrected surgically with reconstruction techniques, but we prefer to prevent it from occurring in the first place. We still do low fusions, but we do not use Harrington distraction rods in the lumbar area. When a rod breaks, it usually happens because the patient has a pseudarthosis part of the fusion doesn’t heal properly. In this situation (which can be corrected surgically with good results), it’s the pseudarthosis of the fusion that causes pain, not the broken rod.

Q: What can you tell us about patients who have scoliosis and osteoporosis, the condition that is accompanied by brittle and/or porous bones and is associated with loss of calcium from bones?
A: Osteoporosis in and of itself does not hurt, but if you get a compression fracture because of it, it will hurt a lot. Such fractures can occur in individuals who have scoliosis; when they do, they appear either at the concave or convex side of the curvature. It’s important to note, however, that osteoporosis does not cause scoliosis; it causes kyphosis, the skeletal abnormality we associate with a rounded or humped back.

Q: Is there anything that can be done to prevent osteoporosis?
A: Here are a few guidelines: (1) From the age of 18, all women (particularly postmenopausal women) should be taking 1500 milligrams of calcium per day plus the amount of vitamin D that you’d find in a multi-vitamin. (2) In the first five years after menopause, all women should be taking the hormones estrogen and progesterone-unless they have a history of breast cancer or uterine cancer. After five years, women can stop the hormone treatment and return to taking the vitamin D and calcium combination. (3) Exercise in moderation to keep in shape.

The post Pain first appeared on National Scoliosis Foundation.

The Purpose of Spinal Instrumentation

The purpose of the spinal instrumentation is twofold: First, it enables the surgeon to reduce, adjust etc. the curvature to some degree. To keep the curve from progressing, the surgeon performs a spinal fusion and may utilize bone graft from the hip, bone bank, collagraft bone substitutes, etc. Eventually, the grafted bone fuses into a solid bone mass, and the vertebrae are permanently immobilized. However, this takes time-up to a year or more for adults. During this period, the instrumentation fulfills its second purpose: the metal rods make the spine stiff and hold it still so that the fusion can set. Once the fusion is solid, the instrumentation has done its job and could be removed, although it is usually left in place. The instrumentation will eventually fatigue and fail if a solid fusion is not achieved

What follows is an explanation of some of the more popular systems in use today:

Harrington Rod

Harrington-Scoliosis surgery was revolutionized in the early 1960’s with the introduction of the Harrington Rod, designed by Dr. Paul Harrington, It was the first device designed to straighten and immobilize the spine from inside the body. It was so successful that it remained the “gold standard” for scoliosis surgery for over 20 years.

The Harrington system achieves correction of the curve by stretching or distracting the spine. The straight rod, containing a ratcheting mechanism, is positioned along the inside or concavity of the curve. It is attached to the spine with two hooks: one set into the vertebra at the top of the curve, the other into the vertebra at the bottom of the curve. Then, employing the ratcheting mechanism, the surgeon stretches the spine to straighten the curve. Since the rod is attached in only two places, it is necessary for the patient to wear a brace after surgery to achieve more secure immobilization of the spine. Even so, the vertebrae between the hooks sometimes fails to fuse solidly. The most important drawback to the Harrington, however, is that it allows little restoration of the normal contours of the spine when viewed from the side. This includes the normal outward curve at the top of the spine (kyphosis) and the normal inward curve at the bottom (lordosis), which are typically distorted by scoliosis.

Luque-To achieves a more stable, stronger fixation, Dr. Eduardo Luque of Mexico City devised the Luque implant in the early 1970’s. Two flexible L-shaped rods are placed on either side of the spine. The rods are contoured or bent to conform to the curve, and wires are threaded through the spinal canal at each vertebral level. The wires are then twisted around the rods on either side of the spine. The rods apply pressure on the spine to correct the curve. Because there are multiple points of fixation with the Luque technique, the patient generally does not have to wear a brace after surgery as with the Harrington Rod. However, since the wires pass through the spinal canal, this system poses a greater risk of neurological damage than other systems. Luque rods or variations on the Luque technique are still often the preferred instrumentation for neuromuscular curves.

Multiple Hook and Contourable Rod Systems

In 1984, a new concept in spinal instrumentation developed by Drs. Yves Cotrel and Jean Dubousset in France, was introduced in this country. TheCotrel-Dubousset (CD) instrumentation involves the use of two flexible rods and multiple hooks as do both the TSRH developed by the Orthopaedic staff at The Texas Scottish Rite Hospital, and the Isola technique, designed by Dr. Marc Asher and Dr. Charles Heinig and engineers Walter Strippgen and Dr. William Carson. All of these multiple hook and contourable rod systems deal with a problem of scoliosis which was not addressed by earlier systems. When the spine curves sideways, the vertebrae rotate towards the concavity of the curve. Since the ribs are attached to the spine, they are dragged along and splayed out on the convex side of the curve and compressed on the concave side. (This is what creates the rib hump seen in a thoracic curve.)
With all of these systems, the surgeon bends or contours the rods to conform to the desired profile. The rods are positioned on either side of the spine and affixed to the vertebrae with multiple hooks and sometimes screws as well. The rods themselves are joined to each other by transverse rods or connecting devices.

The most important facet of the C-D, TRSH, or Isola is the ability to control not just compression or distraction and not just scoliosis correction but also to build in correction of lordosis or kyphosis.

The multiple hook and contourable rod systems differ from each other mainly in the way the hooks are attached to the rods. The C-D, for example, uses a set screw; the TSRH, a nut and bolt arrangement, and the Isola, a drop set in screw. Basically, however, they work on the same principle and accomplish the same ends. Because they provide a very stable fixation, they usually do not require the wearing of a brace.

Systems Used in Frontal Procedures

Sometimes if the curve is rigid or very severe, the surgeon will perform an anterior procedure (going in from the front of the body) in which he first removes some of the discs-the rubbery shock absorbers located between the vertebrae. This makes the curve more flexible and easier to correct.
One system specifically designed to be used anteriorly is the Zielke instrumentation, developed by Dr. Klaus Zielke of Germany. It uses a flexible rod attached to the convexity or outside of the curve with screws. Correction is achieved by compression of the curve. Other systems which can be used for an anterior procedure include the Dwyer, which is similar to the Zielke, the TSRH and the Isola, as well as others. An anterior fusion may be performed alone or frequently in conjunction with a posterior fusion.

There is significant ongoing research and development for spinal fixation systems resulting in many new product introductions. The spine instrumentation devices presented in this article are representative of the multitude of products currently available. The NSF does not recommend or promote any particular device and strongly suggests that patients address any questions they may have about instrumentation with their physicians.

“…there is no one “best” instrumentation for every patient or every physician.”

The post Instrumentation Systems for Scoliosis Surgery first appeared on National Scoliosis Foundation.

Exercise patterns of adults with scoliosis vary widely, as they do for the general population. Avoidance of exercise because of fear of causing harm to the spine is fairly common, however, in those with scoliosis, especially following spine surgery. This is certainly understandable. However, exercise or sport participation will have no effect on non-fused spinal curves. Although curves tend to increase by several degrees with advanced age, this appears to be unrelated to activity or exercise levels. For patients with solid spinal fusion, exercise and participation in recreational sports should not harm the fused segments. The segments of the spine not involved with the fusion operation are under some increased stress to make up for the loss of function in the fused segment, but this additional stress is present for all daily activities. Several hours per week of exercise or sports participation should not exert any harmful additional stress into these areas. A note of caution however may be appropriate for some adults with only one or two mobile lumbar vertebrae below their fusion. For these patients, excessive twisting or loading of the spine during sports has often been discouraged as it is theorized that this may accelerate degeneration of the discs at the remaining levels. In general however, adults with scoliosis can engage in exercise and recreational sports without undue risk.

As most of us are aware, regular exercise and sports participation has many health advantages. These include improved cardiovascular heart and lung conditioning, improved strength and flexibility of muscles and joints, and better weight control. Exercise helps prevent osteoporosis in women. Exercise has also been reported to result in an improved sense of well-being. It can relieve or reduce daily stress and most people who exercise regularly find it enjoyable. These advantages of exercise can, and should be enjoyed by adults with scoliosis.

Exercise can be therapeutic for adults with scoliosis who have had spinal fusion. When the mobility of the spine is limited because of the fusion, one can feel somewhat inflexible for normal daily movements such as bending over or reaching for objects. A potential solution to this problem can be found by realizing that most of us adults only use a portion of the potential flexibility in our hip joints. The full mobility of the hip can be developed by daily stretching of the ham-strings, quadriceps, hip flexor and muscles. This increase in hip flexibility can then be substituted for the loss in spine mobility, and make it easier to move in desired directions.

In our practices, we also advise exercise for adults with scoliosis who have developed back pain symptoms. As mentioned above, the stresses on the back during daily activities can be reduced by improving the mobility of the hips. This can lead to a reduction in pain. Improving the strength of the back muscles can also help to reduce pain and improve tolerance for daily activities. This can be accomplished by performing vigorous strengthening exercises at home or in a fitness facility several times per week. Endurance levels can be improved by regular walking, bicycling or other aerobic activities. This frequently results in improved tolerance for shopping, yardwork and other sustained activities. In general, a person with a back which is flexible and strong will feel and function better than if that same back (regardless of whether scoliosis is present) is weak or stiff. Favorable results, in terms of improved functional abilities and reduced back pain, have been reported to us by our patients with scoliosis and back pain. Most have continued their stretching and exercise programs for many years.

NFS expresses sincere appreciation to co-authors James Rainville, MD, and Alexander Wright, MD. Exercise illustrations reprinted by permission of VHI, Inc. These exercises are shown as examples only. We recommend all readers to seek the advice of their physician for activities and exercise programs suitable for their situation.

The post Exercise and Adults with Scoliosis first appeared on National Scoliosis Foundation.

Nature and Practice

Chiropractic is a system of treatment based on the principle that a person’s health is determined largely by the nervous system and that interference with this system impairs normal functions and lowers resistance to disease. Chiropractors treat patients primarily by manual manipulation (adjustments) of parts of the body, especially the spinal column.
Because of the emphasis on the spine and its position, most chiropractors use X-rays to aid in locating the source of patients’ difficulties. In addition, most chiropractors use supplementary measures such as water, light, ultrasound, electric and heat therapy, and prescribe diet, supports, exercise, and rest. State laws specify the types of supplementary treatment permitted. Chiropractors do not use prescription drugs, nor do they perform surgery.

Basic Theories

Simply stated the science of chiropractic is based on the following principles:
There are two hundred and nine bones and numerous adjacent structures, such as muscle, tendon and ligamentous tissue, within the human body, most of which are capable of movement, particularly where two bones come together to form a joint, and each bone has a particular position and its own predetermined range of motion.

Many of these moving parts, like the moving parts of a finely tuned machine, may become subluxated or misaligned and deviate from their normal position.

Such misalignments are apt to occur as the result of external trauma, a sudden and forceful movement of the body such as a quick turning of the head, a whiplash injury, heavy sneezing, or the lifting, pushing or pulling of a heavy object. These deviations, which are usually referred to as a “subluxation complex”, can cause contact, irritation, pressure or tension on surrounding nerves.

Pressure or pinching on a nerve may cause abnormal function, such as limitation of movement and pain, to the locally affected area; however, the pain is also likely to radiate along the involved or nerves and cause distress and functional instability to other parts of the body.

A subluxation usually can be corrected by means of adjustment or realignment whereby the disjointed member is restored to its proper position, thereby alleviating or eliminating the pressure or irritation to the nerve that is the source of discomfort. It is also a basic tenet of chiropractic that the elimination of nerve interference and the restoration of the body to its normal and natural function in a significant number of cases enables the inherent recuperative powers of the body to operate without interference or impediment and restore the afflicted area to good health.

Of all the moving parts of the human body, among the most delicate and the most likely to fall into displacement are the numerous joints of the spinal column, and it is for this reason that the chiropractor is usually thought of specifically in terms of conditions of the spine and is not always considered when an abnormality is experienced in other parts of the body. However, the spinal column with its infinite network of branching nerves can serve as a vehicle by which pain is radiated to various parts of the body. Consequently, there are situations in which a pain in the arm, neck, hand, foot, leg or elsewhere may be properly and successfully treated by a chiropractor.

It is the function of a chiropractor, after taking the patient’s case history, to diagnose by way of physical examination, X-ray and palpation or probing by hand, a possible subluxation or a misalignment as a cause of nerve interference, and to eliminate that condition by corrective manipulative adjustment. Since the nerve system is the very essence of chiropractic healing, a brief description of its three major components is necessary.

First, the brain acts as the central computer where information from all parts of the body is processed, stored and acted upon. Second, the spinal cord, an extension of the brain, acts as a facilitator in the transmission of information between the brain and various parts of the body; Finally, the peripheral nerve system connects the spinal cord directly or indirectly with virtually all the tissues of the body. The spine is composed of twenty-four movable vertebrae, which house and protect the spinal cord, but because they are movable, they can interfere with the spinal cord and nerve roots they were created to protect.

There are many things that can interfere with the nerve system, such as drugs, physical trauma, poisons, or toxic environments. However, the chiropractor is concerned with the misalignment of the vertebrae known as the Vertebral Subluxation.

The Vertebral Subluxation is a condition where a vertebra has lost its normal juxtaposition with the one above or the one below or both, to the extent that it impinges nerves and interferes with the normal flow of nerve impulses from brain to tissue cells. The Vertebral Subluxation usually distorts the normal curves and motion of the spine, and causes interference to the nerve system.

Vertebral Subluxations are usually corrected by means of a Spinal Adjustment. The Spinal Adjustment is a specific concussion of forces given by the chiropractor along the spinous or transverse processes of the vertebra into that vertebra’s normal facet angle. The restoration of that vertebra to its proper position will alleviate or eliminate the pressure or irritation to the nerve and restore normal function to the spinal motor unit.

Chiropractic and Scoliosis

Charles A. Lantz, D.C., Ph.D. is Director of Research at the Life Chiropractic College West in San Lorenzo, California. Dr. Lantz and his colleagues are currently conducting a scoliosis research project to explore the effectiveness of chiropractic in the management of children ages 9-15 with mild to moderate scoliosis (less than 25″ curve). This is the first clinical trial ever to look at the effect of chiropractic on scoliosis.

NSF first met Dr. Lantz. and his associate Jasper Chen, D.C. in conjunction with the 1994 Northern California Spine Conference. This was the beginning of a series of dialogs regarding the need for scientifically valid information about chiropractic treatment of scoliosis and the value of working together with the Scoliosis Research Society to enhance the credibility and acceptance of the design and outcomes of such a study. We applaud Dr. Lantz in his efforts to spear- head a major randomized controlled trial with a collaborative team which includes S.R.S. members, Dr. William Bunnell, Loma Linda University; Dr. Ronald Blackman, Kaiser Hospital, Oakland; Dr. Peter Slabaugh, Children’s Hospital, Oakland; and Dr. Serena Hu, U.C. San Francisco.

“Virtually no formal research exists documenting chiropractic’s effectiveness in managing scoliosis. We are excited about the potential benefits of this study and we believe the scoliosis community is well served by a collaborative effort such as this. This is perhaps best expressed in their project grant application, “Given that chiropractic has long claimed success in treating patients with mild scoliosis, it seems reasonable and timely to validate the extent to which that claim is valid.”
In his in-depth article titled Conservative Management of Scoliosis which was published in the October 1994 issue of Chiropractic: The Journal of Chiropractic: Research and Clinical Investigation, Volume 9, Number 4, Dr. Lantz underscores the need for large randomized clinical trials for both adolescents and adults with scoliosis:

“Chiropractic management of scoliosis has classically consisted of spinal adjustments or manipulation sometimes augmented with exercise and postural counseling, as well as heel lifts. Electrical stimulation has recently come into the chiropractic armamentarium as well. Virtually no formal research exists documenting chiropractic’s effectiveness in managing scoliosis, although anecdotal reports abound. Several well-conducted case studies suggest that chiropractic is, indeed, effective in managing scoliotic curves, but the definitive studies are lacking. It is widely stated that chiropractic care is effective in alleviating the pain and discomfort associated with adult scoliosis, however, no studies to date have adequately documented this effect.”

Dr. Lantz concludes his article by pointing out the need for immediate attention by the Chiropractic community to questions such as, “Should adults with scoliosis be treated in the same way as adolescents or juveniles with scoliosis? What are the indications for care, and what types of care are most suited to which types of scoliosis for which age groups?”
Scoliosis often seems to be a condition which has more questions than answers. This appears to apply to the issue of chiropractic management of scoliosis as well. We are grateful for Dr. Lantz and others like him who are dedicated to asking the questions and committed to finding the answers.

The post Chiropractic first appeared on National Scoliosis Foundation.

Because so many adults have contacted the NSF, we asked Nancy Schommer, author of Stopping Scoliosis, to provide us with an update about adult scoliosis. In the course of her research, she interviewed Dr. David B. Levine, Clinical Professor of Orthopedic Surgery at Cornell University Medical College and Director of Orthopedic Surgery at the Hospital for Special Surgery in New York City. Following are excerpts from their conversation.

Q: Dr. Levine, is it possible for an adult, a person 21 years of age or older, to suddenly “get” scoliosis?
A: It’s possible but extremely rare. When it happens, it is usually because the patient has experienced some sort of trauma, such as a fractured spine, or because the person develops a neuromuscular condition like muscular dystrophy, or a metabolic condition like osteoporosis that softens the bones. Most often, however, adult scoliosis develops in adolescence, and is the “idiopathic” variety, which means it occurs for no apparent reason.

Q: Will untreated adult scoliosis get worse year after year?
A: I’ve followed patients for over twenty years, and have found that probably 60% of adult patients do not get worse. Of the remaining 40% about 10% show a very significant progression, while the other 30% will show a very mild progression, maybe less than one degree per year.

Q: Are there any factors that can decrease or increase one’s risk of progression?
A: Yes, there are. The person who is sedentary and overweight is inviting problems.

Q: What treatments are available for adults with scoliosis?
A: First, one has to understand that many adults who have scoliosis never require treatment; they do not have obvious deformities or breathing problems, and they have no pain. But when an adult has a curvature that is approximately 50 degrees or more, then we begin to consider the possibility of spinal fusion surgery.

Q: How do you decide on who’s a proper candidate for spine surgery?
A: We look at four factors; pain, progression, appearance, and pulmonary. Pain must be significant, and must be related to the scoliosis. Regarding progression, anything under 5 degrees within a year is questionable. A 5 degree change can be the result of any number of variables. For example an x-ray taken of a 40-year-old woman early in the morning might show a 50 degree curve, but an x-ray of the same woman taken at 5 p.m. when she’s tired and slumping could show a curve that’s 5-10 degrees greater.

Q: And what about appearance and pulmonary?
A: While we cannot document appearance with x-rays, simple photographs can be helpful in revealing whether one’s vertebral rotation has gotten worse over time, whether ribs are sticking out more, or whether one has lost height due to an increased curvature. Regarding pulmonary, patients who are at risk for restrictive lung disease are usually those individuals who have a scoliotic curvature of more than 75 degrees in the thoracic (upper back) area. Patients who have lumbar (lower back) or thoraco-lumbar (mid back) curves will usually have pulmonary functions that are normal.

Q: What factors increase the complication of surgery?
A: If surgery involves correction of two curves instead of just one, the patient may have to undergo two surgeries, which of course increases the odds for complications. The patient’s general health is a factor that can affect complication rates, as is the experience and skill level of the surgeon performing the operation.

Q: We know that healing time will vary depending upon the type of surgery performed, and the age and health of the patient. But in general, when can adult surgical patients expect to return to work?
A: You’re right, it is quite variable. But a motivated person, living a reasonable distance from an office location, could return to work in six weeks. Of course, a patient should follow the advice of his or her orthopedist.

Q: Any suggestions for helping patients heal properly?
A: In addition to proper rest, and whatever exercise is recommended by their orthopedist, surgical patients should consume foods that are high in calcium and vitamin D skim milk, for example as well as foods such as yogurt, cheese, bony fish, vegetables such as broccoli, even Japanese seaweed. Avoid excess alcohol, coffee, and tobacco; these will decrease the rate and quality of bone formation

Q: Any other guidelines for adult surgical patients?
A: Each patient’s surgeon will make his or her own recommendations, but during convalescence, one should avoid strenuous physical activities and heavy lifting. Six weeks after surgery, it’s all right to have sex, but actual details of positions should be discussed with one’s surgeon. In my opinion, women who’ve had scoliosis surgery should not consider delivering a child until at least two years after the surgery; it takes that long for fusion to become as hard as it should.

Q: One last question. Will you set the record straight for us about exercise and what it can do for scoliosis?
A: Exercise can help pain that may be associated with scoliosis; the best you can do is swimming the sidestroke and the backstroke. But exercise is not a treatment for scoliosis it cannot stop a cuve from progressing.

The post Adult Scoliosis first appeared on National Scoliosis Foundation.