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A healthy spine generally has some curvatures that allow the spinal column to balance our weight and body. These curves, called kyphosis (inward) and lordosis (outward) occur in each one of the four spinal regions. In the cervical (neck) and lumbar (lower back) regions of the spine, there are normal lordotic curves, whereas the thoracic (mid) and sacrum (pelvis) regions of the spine exhibit a kyphotic curve. For individuals afflicted with scoliosis of the spine, their spine curves laterally (left and right), compromising the symmetry of the spinal column and the attached skeletal elements. What can this cause? For one, younger patients who have not reached the end of growth may have increased risk for curvature progression and worsening of the scoliosis. Generally adolescent scoliosis does not cause significant pain but may result in pain in a smaller subset of patients. Adult scoliosis may cause a variety of symptoms as a result of the spinal column deformity. Adult deformity patients may experience radiating leg pain as a result of pinched nerves and stenosis, low back pain, thoracic or mid back pain as well as many other symptoms that result from loss of the balance of the spinal column. As we age, the disc spaces may deteriorate further which at times causes progression of the scoliosis in adults.
Knowing the Difference: How a Healthy Spine Should Look
When viewing the spine straight on (from the front or back), it should appear straight. If an individual is suffering from juvenile, adolescent, or adult scoliosis, this same view is quite different, with the vertebrae of the spine curving from side-to-side, forming a “C” or “S” shape. If left untreated, spinal curvature may worsen over time as the bones grow and mature, or in adults as the disc spaces degenerate and decompensate. What’s more, scoliosis abnormalities occurring in the thoracic region of the spine often pose the biggest threat to patient health and well-being. Located in the middle of the spine, the thoracic spinal region is comprised of 12 vertebrae that connect to the ribs. As such, a lateral curvature of the spine may result in rib shifting, limiting the space of the chest cavity. This event may put pressure on the lung and/or heart, negatively impacting function.
How to Preserve the Anatomy of the Spine and Prevent Scoliosis Complications, like Scoliosis Curve Progression and its Potential Symptoms such as Back Pain, Leg Pain and Progressive Disability
Treatment of juvenile and adolescent scoliosis is dictated by the curve severity and the patient’s bone age. The smaller the curve and the older the patient, observation is usually the recommendation. The larger the curves are, especially on skeletally immature patients, brace treatment may be indicated. For the adolescent patient with a severe curve, surgical correction may at times be the main recommendation. During surgery, the spine may be approached from the anterior, posterior, or through a minimally invasive approach where the spinal column is instrumented with hooks or screws and the curvature is corrected and rigidly held in place with stainless steel or titanium rods. The vertebrae are then fused together by placing bone graft in the area that was corrected. Once the bone fusion heals, the alignment of the spine at the area of the scoliosis correction generally stays unchanged and curve progression is prevented.
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