An estimated 6 million people in the U-S suffer from scoliosis. The curved spine condition used to put people at risk for devastating side effects. But modern medicine is taming this disease. In today’s TPR Lifeline, Bioscience-Medicine reporter Wendy Rigby talked to pediatric orthopedic surgeon Dr. Alec Stall of the Children’s Hospital of San Antonio about this common health problem.
Rigby: What is scoliosis, Dr. Stall, and who does it affect most?
Stall: Scoliosis is really a symptom. It’s not a specific disease. It’s like saying someone has a fever. There are lots of different causes of scoliosis. It means that you have a sideways curvature of your spine for whatever reason. The most common types of scoliosis are what we describe as idiopathic, which means not of a discernible origin. It’s not associated with any other specific disease. And by far the most common type of idiopathic scoliosis in adolescents.
What are the implications if scoliosis is not detected and left untreated?
Small curves are at low risk for progression and larger curves are at higher risk for progressing over time. Ultimately if a curve is large enough, and by large enough I mean about 50 degrees, then they tend to progress despite being done growing. I often sort of describe this as being the Leaning Tower of Pisa.
And what happens? What are the implications of it?
The true implications for the adolescent form of scoliosis are largely cosmetic. So people’s level of function is just as high. But there is a higher level of pain compared to people who do not have scoliosis?
Back pain?
Back pain.
Are there lifestyle changes to ease symptoms?
You know, back pain is extremely common in everybody, with or without scoliosis. And it’s largely age dependent. The same rules generally apply: maintaining a healthy body weight, maintaining a good body weight and exercise.
Can sports injuries or poor posture or carrying heavy backpacks cause scoliosis?
That’s a question I get all the time and the answer is no. Scoliosis is really caused by a growth asymmetry of the spine. There is a genetic origin to scoliosis, though it’s multifactorial. There is not a single gene that’s associated with scoliosis. There is a familial association. I often describe it to parents as having two lottery tickets. There’s no guarantee of winning but your odds are higher if you have a family history of scoliosis.
A lot of people my age will remember going to the school nurse, bending over at the waist while she looks at our spines. That’s a pretty low-tech screening. How is screening performed today and by whom?
Actually, that still remains the mainstay of screening. We describe the curves as being a side to side curve. But really, the spine is twisted. I often use the analogy of a roller coaster that banks when it turns. And that rotation causes a clinical asymmetry. So we see difference in levels of shoulders and shoulder blades and waist. In the state of Texas, it’s mandated for screening in 5th and 6th grade.
So is it still performed at school?
It is still performed at school and pediatricians’ and primary care offices as well.
Is early detection important and why?
Early detection is important because we have effective treatments for preventing the progression of curves that are at risk.
What are the less invasive treatments that can be tried before someone has to go under the knife?
We watch it while the people are growing to identify those that are at risk and do have progression of their curves. Bracing is a very effective treatment option for people that are at risk for scoliosis. For children who are at high risk for progression of their scoliosis, brace treatment can effectively reduce the chance of requiring surgery from about 60 percent to less than 10 percent. We do surgery for those Leaning Tower of Pisa curves that we know will progress despite being done growing.
How do children do?
In the long term, they’re able to do almost everything that they would do before. Really the only exception to that is we recommend avoiding collision sports such as football, hockey and rugby. But really everything else is fair game. They can play soccer. They can play basketball. They can swim. And they can do gymnastics.
So if parents of adolescents out there get the news that their child has scoliosis, even major scoliosis, it is not a reason to panic.
It is not a reason to panic. We expect that every child with scoliosis will be able to lead a productive, happy, active life.
Dr. Stall of the Children’s Hospital of San Antonio…thanks for the information.
Thank you so much.
