Archive for the ‘Scoliosis Treatment Options’ Category

ScoliScore April 21st, 2010

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There is an interesting new non invasive technique discussed in the news recently that can predict how badly the spine will worsen in a person diagnosed with scoliosis.  Previous methods are simply to have a doctor regularly monitor the spine about two or three times a year to see if the spine curvature is gradually increasing.  This new test would give much more insight as to just how severe a patient’s scoliosis might be.

The new non invasive method is known as ScoliScore.  This test uses a patient’s saliva to screen over 50 genetic markers that are known to be associated with the progression of scoliosis.  It uses the results of the screenings to assign a calculated score.  A very low score would imply that the curvature of the spine is not expected to rapidly grow worse, and that it does not need to be monitored so closely.  On the other hand, a really high score would require more attention and treatment options should be discussed much sooner.  ScoliScore has been shown to work for genetic markers in Caucasian children.  Currently, research is being done to verify that it also works in African and Asian children as well.

Brenda Hom is a young girl diagnosed with scoliosis participating in this new study.  When the doctor told the mother, Joyce Hom that her daughter had about a 30 degree curvature of the spine she could only hope for the best that future checkups will show that it is not getting worse.  Hopefully, ScoliScore will be able to give an accurate prediction of the progression of scoliosis, rather than playing the waiting game.

This can prove to be an extremely useful test, as tens of thousands of children are diagnosed with scoliosis every year.  Unfortunately, this is still very new to the medical field and is not widely accepted.  This also means that most insurance companies will not cover the expensive cost of about $3,000 dollars to perform the test.  Hopefully, this kind of test will be accepted in the future and allow for people to better assess spine curvature progression and to discuss possible scoliosis treatment options earlier.

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Symptoms of Scoliosis and Diagnosis April 21st, 2010

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Basic symptoms of scoliosis will cause an unbalance between the two sides of the body.  A person may have uneven shoulders and shoulder blade, and look to lean towards one side more than the other.  An uneven waist and hip may also be prevalent.  The spine may not only curve but rotate as well, causing the ribs to stick out on one side.  In severe cases of scoliosis, more strain can be put on the internal organs, leading to a difficulty to breathe, back pain, and more pressure put on the heart.

Extreme cases of scoliosis can be easily seen, but to diagnose the issue, all that is needed is an X-ray scan to show the spine curvature.  In general, there must be a minimum of a 10 degree Cobb’s angle to be labeled as scoliosis.  If there is another condition that may be the cause of the scoliosis, other scans might be performed to diagnose those underlying conditions.

Additional scans include an MRI scan, CT scan or a bone scan.  MRI machines make use of strong magnetic fields to scan the inside of the body.  It is most ideal for detecting anomalies in the soft tissue.  CT scans use x-ray radiation in a more sophisticated manner than a regular X-ray machine.  CT scans are generally not as good as scanning the inner soft tissue, but it is better than the MRI when scanning the bone.  They are also advantageous in that they are faster, cheaper and more readily available.  Finally, a bone scan may be done.  This is much more informative than a simple X-ray scan, as a bone scan can reveal a lot more about bone diseases, fractures, infections and more a person might have.

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Cobb’s Angle April 21st, 2010

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The Cobb’s angle is an important measurement in diagnosing scoliosis and determining what kind of treatment is needed, if any at all.  It is the measure of curvature of the spine affected by scoliosis.

To determine the Cobb’s angle of the spine, the vertebrae that is most displaced and rotated, with the least tilted end plates.  This is known as the apical vertebrae.  The end vertebrae above and below the apical vertebrae are identified next.  These have minimum displacement and rotation, but are most tilted from its original position.

Cobb's Angle

After all of these are identified, a line is drawn parallel to the plates of the end vertebrae that are furthest away from the apical vertebrae.  Next, two lines perpendicular to the first pair of lines are drawn towards each other until they intersect and form an angle.  This is known as Cobb’s angle.  Because this only measures scoliosis in one plane, this is not useful for spinal deformities in three dimensions.  The picture to the right shows an example of an X-ray scan with lines drawn to determine the Cobb’s angle.

This measurement is used to determine what the best course of action for treatment is.  In general, scoliosis is only diagnosed with an angle of curvature of at least 10 degrees.  Anything between 10 – 20 degrees should be monitored regularly to see that it does not get worse.  Between 20 – 40 degrees, a brace is most likely recommended.  Over 40 degrees of curvature, scoliosis surgery is the best course of action.

To sum it all up, see the table below:

Cobb’s Angle Course of Action
Below 10 Not Scoliosis
10 – 20 Regular Checkups
20 – 40 Body Brace
40 and up Scoliosis Surgery/Spinal Fusion
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Scoliosis Surgery April 21st, 2010

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Scoliosis is a fairly common spine condition that affects an estimated 7 million people in the United States of America.  Symptoms can range from minor to severe, depending on the severity of the curvature of the spine.  While most cases may not require treatment or non invasive methods, such as a brace, scoliosis surgery is the best course of action for very deformed spines.

The surgery done is called spinal fusion.  It is the process of fusing two or more vertebrae together.  This is usually done using either bone or metal rods.  Scoliosis surgery is recommended for patients that are affected with a spine curvature of more than 40 degrees (measured with the Cobb’s angle.)

A spinal fusion usually involves metal rods and hooks attached to the spine to keep the vertebrae securely aligned.  With time, a portion of the spine will fuse together.  The metal rods are left in, even after the spine fuses, to avoid having to perform another surgery.

Implanting fixed rods to the spine can be a problem in children with severe scoliosis because their spine will continue to grow, while the rods will not.  To potentially solve this issue, surgeons are testing a new method involving “growing rods”, which allow the surgeon to make periodic adjustments to accommodate the growth of the spine in the future.

This is a very aggressive type of spine surgery.  A spinal fusion procedure can take up to 12 hours to complete the surgery.  It requires a lengthy recovery period of about a week in a hospital before you can be released.  Physical activities are severely limited and restricted in the months following the surgery.  Generally, it will take about 6 months before a doctor will allow the patient to continue all physical activities.

Because of its invasive nature, scoliosis surgery can result in many complications.  A spinal fusion can stunt the growth in the area it is done.  This might be a problem for certain areas of the spine in children who still can grow more.  Additionally, possible bleeding, infection, nerve damage, arthritis and disc degeneration can happen in the hands of an inexperienced surgeon.  A second surgery may be needed if the first one is ineffective.

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