Scoliosis

General

Scoliosis is a side to side curvature of the spine. It occurs equally between males and females, but females tend to require more interventional treatment. Typically, the curvature begins to develop during the growth spurt just before puberty, which is usually between the ages of 9 and 15. This problem can run in families indicating there is a genetic component to this disease, but most children diagnosed have no family history.

Most cases of scoliosis are considered mild, but occasionally the curvature continues to progress and can even become disabling. Severe curvatures can even diminish the space where vital organs exist, such as heart and lungs. “S”- shaped curves tend to progress faster than “C”- shaped curves. Curves in the mid-back area (thoracic spine) tend to progress faster too.

Very severe cases may lead to bracing or surgery, but milder cases may be treated conservatively with chiropractic or physical therapy in an effort to limit further progress of the curvature. Wear and tear of discs and other degenerative changes may cause chronic pain, which can be treated fast and effectively at Novocur.

Symptoms

Uneven shoulders, uneven hips and one shoulder blade that protrudes further than the other are common symptoms that a doctor looks for. In severe cases there may be rotation of the spine and rib cage, which be evident by ribs that protrude more on one side of the body that the other. Severe scoliosis can lead to difficulty breathing and of course back pain.

X-rays can help determine angle of curvature and be used to monitor progress over time. MRI’s or CT scans may be used in initial diagnosis to rule out tumor, infection or other underlying pathology that sometimes leads to scoliosis.

Treatment

  • Therapy. Chiropractic and Physical Therapy are often utilized while children are still growing to prevent progression of curvature.
  • Bracing. Various types of braces, including Milwaukee braces and Underarm braces can be used to slow progression in more severe cases. Bracing is discontinued when bones stop growing, which is when a child stops growing, or about two years after onset of menstruation for girls, or when boys need to shave daily.
  • Surgery. Severe cases of scoliosis may require surgical intervention. Fusion of adjacent vertebral segments is generally recommended. This may require the use of hardware, such as rods, screws, hooks and/or wire to hold the segments together while the fusion occurs over time. Surgery is best performed after growth has stopped, but may be required in children with rapidly advancing curves.
  • Facet Injection. Side to side curves can place excessive pressure on the facet joints on one side of the spine and will cause inflammation, degenerative changes and pain in that joint. An injection of a corticosteroid medication at that joint can rapidly diminish pain and inflammation.
  • Epidural Steroid Injection. Discs and nerve roots can be inflamed or damaged because of the curvature of scoliosis. Getting pain relieving medication to the source of the pain can be accomplished by various types of epidural injection.
  • Trigger Point Injection. Sideways spinal curvatures often stretch muscles on one side of the spine and cause muscles on concave side of the curve to overwork in contraction. Overworked muscles may develop painful knots or trigger points. Injection of a corticosteroid mixed with a local anesthetic helps to quickly release these points, reduce inflammation and quickly improve pain levels.
  • Radiofrequency Ablation. Painful facet joints accompanying scoliosis may only get very temporary relief from facet injection. Radiofrequency Ablation of the median branch nerve, which supplies pain signals from facet joints to the brain, can provide longer lasting relief. Six to twelve months of pain relief following RFA is expected.

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