Nonsurgical treatments can benefit adults with scoliosis - PDF

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 Vol. 219, No. 82    Published every Tuesday and Friday        Friday, October 15, 2004          609-924-3244


Nonsurgical treatments can benefit adults with scoliosis
By Haim D. Blecher
M.D. in Collaboration with Gloria N. Beck                                             “Physical therapy improves
                                                                                      muscle strength, flexibil-
  Why scoliosis occurs is often a mystery.
  Scoliosis, defined as a lateral curvature                                            ity, aerobic capacity and
of the spine, affects people of all ages.
                                                                                      posture, greatly enhanc-
  Although the normal spine, when
viewed from the back, appears straight
                                                                                      ing function and reducing
and symmetrical, all spines contain natural                                           pain.”
curves, apparent in a side view. The gently
rounded contour of the upper trunk is                                                                 By Haim D. Blecher, M.D.,
called kyphosis and the lower trunk’s                                                                          Spine surgeon,
contour is called lordosis, which follows a                                                       Princeton HealthCare System
reverse direction.
                                                 Medical Center at Princeton, notes that         Most patients who require surgery need
  To help the spine maintain balance             treating adults with scoliosis challenges the   some type of long segment correction
over its position atop the pelvis, certain       spine care team — the surgeon, physiatrist,     and fusion. Many will require combined
amounts of cervical (neck) lordosis,             physical therapist and pain management          anterior and posterior spinal fusion and
thoracic (upper back) kyphosis and lumbar        experts — to explore nonoperative               some will also need decompression to
(lower back) lordosis are present. If the        treatments, whenever possible, to alleviate     alleviate central stenosis.
spine deviates from this normal alignment        pain.
and displays side-to-side curves, this is          Fortunately, there are a variety of             After surgery, patients enter a post-
termed scoliosis.                                nonsurgical treatment options.                  operative rehabilitation period. This occurs
                                                   Physical therapy programs improve             in three stages: immediate, intermediate
  A scoliotic spine, when X-rayed, looks         muscle strength, flexibility, aerobic            and long-term. In the immediate phase,
more like the letters “S” or “C” and may         capacity and posture, greatly enhancing         patients will remain in the intensive care
be rotated slightly, causing the person’s        function and reducing pain. Epidural            unit (ICU) and receive aggressive pain
waist or shoulders to appear uneven. It          steroid injections and selective nerve root     management. Within seven to 10 days after
also often results in a rib hump deformity.      blocks may also help some patients. While       surgery, patients will work on out-of-bed
Unfortunately, these curves cannot be            nonoperative management does not halt           activities including commode training and
corrected by straightening one’s posture.        curve progression, it certainly alleviates      independence. They will also transition
                                                 the pain and improves function in many          from intravenous medications to oral
   Why scoliosis occurs is often a mystery.      patients.                                       medications and pain patches.
It is not due to poor posture or the result
of carrying heavy loads or involvement in        It is only when these options fail to             During the intermediate phase (eight
sports.                                          provide relief that a patient and his or her    days to six weeks after surgery), patients
                                                 team should consider surgery. Dr. Blecher       will slowly begin to return to daily
  According to the Scoliosis Research            likens his treatment philosophy to that of      activities. While most patients go home
Society, certain conditions such as              a train ride — nonoperative treatments are      after the immediate post-operative period,
congenital spinal column abnormalities,          station stops along the way with surgery        some require a stay in a short-term rehab
neurological disorders or genetic                being the last stop at the end of the run.      facility.
conditions can cause spinal deformity,           The majority of patients do not remain on
but in more than 80 percent of patients          board until the last stop.                     The long-term post-operative
(particularly adolescent girls), no specific                                                   rehabilitation period occurs when the soft
cause is found.                                    Surgical treatment of adult scoliosis      tissues have healed and the fusion is well
                                                 is often more extensive and the rate of      on its way to healing. This period can last
  In adults, scoliosis may be present since      complications higher when compared to        from three to six months, sometimes up to
childhood with the spinal curve increasing       the treatment that occurs with adolescents. nine months. At this point, patients should
with age, or it can develop in patients          The natural history of scoliosis suggests    begin more specific physical therapy and
who begin to develop a curvature as              that curves greater than 50 degrees at       rehab.
they age. Adolescent scoliosis is usually        skeletal maturity (which occurs during
diagnosed either by school examinations          the teenage years) progress at an average      Statistics concerning post-operative
or pediatrician visits and confirmed by X-        of one degree every year. Although the       scoliosis patients are quite positive, with
ray findings.                                     rate of back pain in those with scoliosis is high patient satisfaction reported in more
                                                 comparable to the general population, the than 85 percent of patients. Seventy to 85
  Adult scoliosis, more commonly, is             intensity and persistence of pain is often   percent of patients experience pain relief,
diagnosed after a visit to the doctor’s          greater.                                     70 to 90 percent experience improved
office; it usually follows complaint of back                                                   ability to perform activities of daily living,
pain or deformity and again, is confirmed           While surgery is the final stop, surgical   and 60 to 80 percent experience improved
with X-ray diagnosis.                            treatment of scoliosis in 2004 is a vast     ability to sleep and return to exercises and
                                                 improvement over surgical treatment that recreational activities.
  For adults with scoliosis, pain can be a       was the norm just 25 years ago.
way of life, stemming from osteoarthritis                                                       Dr. Blecher concludes, “Adult scoliosis
and muscle fatigue to instability and spinal       Today’s intra-operative techniques have is not an uncommon entity. Despite
stenosis (a narrowing of spaces in the spine     great implications on the post-operative     the great challenge it poses, a team
that results in pressure on the spinal cord      course of the patient. Addressing each part approach combining the surgeon and the
and/or nerve roots).                             of the deformity with newly developed        rehabilitation team may yield very good
                                                 instruments produces better results and      results, helping patients improve their
  Haim D. Blecher, M.D., fellowship-             virtually eliminates post-operative casting quality of life.”
trained spine surgeon at University              or bracing for the majority of patients.