Scoliosis is one of the more common disorders of the spine. Most people experience few symptoms or problems, but for those with a progressive curvature, problems can be severe.
If you or someone you know has been diagnosed with scoliosis, you may have questions. We have provided answers to the most common questions below. If you would like further information, please call the Baylor Scott & White Scoliosis Centers at 469.814.2464.
What is scoliosis?
Scoliosis is a disorder of the spine in which the vertebrae rotate, creating an “S” or “C”-shaped curve in the upper or lower back. Patients can experience a mild case of scoliosis with little pain or disfigurement or while a more severe case of scoliosis can result in pain and disfigurement that can cause difficulties walking and even breathing.
What are the symptoms of scoliosis?
Scoliosis can be a hidden disorder with no obvious symptoms, or it can cause severe disfigurement, pain and disability. Some patients can go for many years have with undetected scoliosis for many years until their curve starts to increase resulting and cause in pain. Some common symptoms include:
- Idiopathic Scoliosis - This literally means “of undetermined cause.” This type of scoliosis is thought to be genetic, involving involves multiple genes and a concept called variable penetrance meaning. This means that in each generation there is variability in how strongly the genes are expressed—or how severe the curve is.
- Infantile Idiopathic Scoliosis - Scoliosis that occurs from birth to three years of age.
- Juvenile Idiopathic Scoliosis - Scoliosis that occurs from three to 10 years of age.
- Adolescent Idiopathic Scoliosis - Scoliosis that occurs from 10 to 18 years of age. This is the most common scoliosis diagnosis in children, representing nearly 90 percent of cases.
- Adult Idiopathic Scoliosis - Scoliosis that occurs at 18 years and older.
How long does recovery take?
If you talk to our patients, what you will hear is that there are milestones of improvement. There is the first week leading up to discharge from the hospital: when a person can walk again and is eating regular food and putting on and taking off their brace, they really feel they've made a great steps forward. Probably the second big milestone is likely to be discharge from rehab, and that's typically about two to two-and-a-half weeks total time from after surgery. The next big milestone patients typically achieve is driving independently—some patients may start to drive as soon as a month following surgery. After that, milestones become harder to define and some patients return to us requesting to transition off of their pain medication. At the three-month mark, many people begin to regain control of their own lives, and may even return to work in a light-duty capacity about five weeks after surgery. There continue to be long-term gains, so we follow patients for years afterward, and review re-evaluating them at six-month or yearly intervals, depending on their individual situation.
For adults in pain, what can you do?
Pain prevention is one of the main reasons your scoliosis should be treated. Pain can be disruptive and unrelenting. It not only affects an individual’s personal and emotional life, but it can have major effects in many other aspects as well. Our most important job is to find surgical solutions to attempt to remove or alleviate pain.
How many physicians across the country specialize in scoliosis surgeries?
There are a small number of physicians in the United States who truly specialize in scoliosis surgery. What’s unique about the Baylor Scott & White Scoliosis Centers is that we provide care to patients with complex spinal curvatures and those who have had prior spine procedures.
Why do so few doctors say adult scoliosis is treatable?
Scoliosis treatment technology has changed very rapidly, and there are ways to treat patients now that weren’t available in the past. Unfortunately, there is a lack of education, even in the medical community, about concerning the treatment of scoliosis. Our physicians are often featured speakers at national conferences and events to help educate pediatricians, primary care physicians and internal medicine specialists to help and to clarify some of the misinformation. The core strength of the Baylor Scott & White Scoliosis Centers is its staff. We have a dedicated group of individuals, including anesthesiologists, nurses, spinal cord monitoring individuals personnel and implant specialists that work with the surgical team. Our operating time, and our time for each case, has decreased, and the benefit to the individual patient is that their outcomes are better. Plus, in an era when a lot of many patients report that their doctors' offices are very impersonal, we have managed to preserve our emphasis on patient care and personal treatment.
Is scoliosis surgery covered by insurance?
Scoliosis surgery is an appropriate medical treatment and is, therefore, so it is covered by most insurance. Last year alone, we worked with 106 different insurance companies nationwide. We have significant skill in managing the maze that is the modern health insurance company industry.
When you meet with scoliosis patients, what do you tell them?
Scoliosis patients typically bring two things to their initial office visit: the physical pain their scoliosis is causing and the emotional toll it is taking on them. One of the most rewarding parts for our team is helping patients manage the emotional issues they are enduring: how they feel about themselves and how they feel about their cosmetic appearance. In an effort to help provide our current patients with additional emotional support, we connect new patients with previous patients who are in various stages of their journey.
Is there much scoliosis research going on? What does the future hold?
There's been a dramatic explosion in the amount of research that is conducted in the field of scoliosis treatment. The goal of this research is to further understand the causes of scoliosis and the most beneficial clinical treatments. We're learning more and more about the fundamental molecular, genetic, and foundational causes of this disease. The future of scoliosis treatment lies in early genetic diagnosis and biopharmaceutical treatment of the growth abnormalities that can lead to the curvature of the spine. Learn more about clinical trials and research activities at the Baylor Scott & White Scoliosis Centers.
Is scoliosis surgery required for all adults who have it?
Scoliosis surgery is a serious procedure. Before any patient has any a scoliosis operation, the physician should explain what the risks and benefits of the procedure are. Our physicians spend a significant amount of time with patients to discussing the risks, benefits and possibilities of having undergoing scoliosis surgery. Our goal is to give them patients a complete understanding of the risks and outcomes.
How long is an actual scoliosis surgery?
Scoliosis surgeries are complex and there are many steps to each operation. The operation in typically takes four to six hours. If the surgery must be performed from the front and back simultaneously, the surgery will take additional time.
Are two scoliosis surgeries ever needed?
In some cases, adults need more than one procedure—meaning they need a specific type of procedure that is performed from the front and back simultaneously. Sometimes this can be accomplished simultaneously in a single combination operation, but other times it is best to separate the process into two procedures.
What happens after surgery?
Following scoliosis surgery, technology and treatment options have dramatically changed for the better following scoliosis surgery. After surgery, patients are typically admitted to the intensive care unit (ICU) where they receive focused nursing care—one nurse per patient. A lot of emphasis is placed on patient management during this phase. The pain is treated precisely where it exists. A catheter is placed against the spinal cord and pain medication is pumped directly onto the cord, which reduces drowsiness so that the patient can follow requests or commands. The day after surgery some patients may actually sit in a chair and take one or two steps. By the third day, the patients will typically stand and walk, and by the fourth day they will often be walking in the hallway. After the fifth day, they patients are typically discharged and are sent to the rehabilitation hospital to spend another week regaining their abilities to accomplish activities of daily living. During this phase, some patients may need a supportive back brace. Modern braces are made from a light thermo-plastic material so they can easily be taken on and off. Patients do not have to sleep or bathe in the brace, which is a drastic improvement from the casts that patients had to wear years ago following scoliosis surgery.
Is the incidence of scoliosis the same among men and women?
The incidence of scoliosis in men and women is approximately the same. What is interesting, however, is that the progression rate is seven to eight times more common among females who were diagnosed with scoliosis as an adolescent or young adult than among boys who were diagnosed at the same age. We don't yet understand what causes this phenomenon.
Is scoliosis a progressive disease?
What we know about scoliosis is constantly changing. In the past, the accepted teaching was that, once a patient reaches adulthood, their curves become static and do not progress. For many patients, this is true. However, there is a subgroup of individuals whose curves continue to progress during adulthood. Years ago, physicians were taught that a 50-degree thoracic curve typically does not increase in adulthood, but now we know that it can progress in some cases. There has been an evolution in what is known about scoliosis, but many general practitioners, internal medicine specialists and pediatricians do not have access to the latest information, which makes care much more difficult and challenging for their patients.
What is the prognosis for an adult with scoliosis?
With adults, the prognosis can be more complicated. We typically see adult patients, particularly women, who fall into one of several categories:
- Young women with very large curves who have no pain.
In these patients, the probability of the disease progressing is 80 or 90 percent, and if it remains goes untreated they may experience problems in later life. With these women, we discuss their treatment options on a case by case basis.
- Young women with a history of scoliosis who were advised their curves would not progress in adulthood.
These patients typically did not experience back pain and were told their curve was stable. However, many of these women go on to experience symptoms during and after their second pregnancy. The primary hormone produced during pregnancy is progesterone, which may cause their scoliosis to progress. Also during pregnancy, the ligaments and joints become loosened in order to allow the pelvis to develop appropriately. During this time, a woman’s curve may start to progress leading her to experience pain from her scoliosis.
- Women with a small curvature of the spine that progresses throughout adulthood.
In these cases, the progression of scoliosis does not seem to be related to pregnancy, but rather, in middle age, the patient experiences some spinal deformities which causes her clothes to fit differently and alters her physical appearance. The pain in such cases usually progresses and severely affects the woman’s quality of life.
Can spinal injuries be caused from diseases such as a virus?
Polio was once one of the most common neurological causes of scoliosis. During the polio epidemic in the 1930s through the 1950s, it was very common for children to develop scoliosis. We see many of those patients as adults at the Baylor Scott & White Scoliosis Centers.
Are there environmental factors that contribute to scoliosis?
Research into the environmental causes of scoliosis is ongoing and, while there have been some findings, a clear connection has not been established between scoliosis and medications or environmental factors yet.
What other factors contribute to scoliosis?
The vast majority of patients with scoliosis fall under the category of what’s called idiopathic scoliosis. This simply means that we don't know what causes it as opposed to cases that are due to neurological causes, congenital abnormalities, developmental issues or as the result of a traumatic injury to the spinal cord. In some cases, either the vertebrae are congenitally malformed or congenitally fused together, or the spinal cord developed incorrectly from birth, leading to very severe curves. Typically, there is an environmental cause for this such as drug abuse during pregnancy, or complications from medications and other environmental causes which put children at risk while they are developing during pregnancy.
Does scoliosis always appear in childhood?
Most people typically think of scoliosis as a childhood disease. In fact, scoliosis is commonly diagnosed in the juvenile and adolescent stages—ages 9, 10, 11 or 12. There is, however, adult onset or degenerative scoliosis, which develops as a result of disc degeneration and is different from adolescent idiopathic scoliosis.
Is scoliosis hereditary?
Scoliosis is thought to be genetic and tends to run in families. However, with each generation, there is a variability of how strongly the genes are expressed, which determines how severe the curve may be. For example, a mother may have a mild curve, but her daughter may have a very severe curve or a mother may have a severe curve and her grandchildren may develop scoliosis, but their parents did not.
What are other common spine conditions?
The bones of the spine are arranged to give the spinal column stability. Damage or defects within the supporting structures of the lumbar spine (the lower part of the back) can often be the source of back pain resulting from: