SERVING THE PRINCETONS, WEST WINDSOR, MONTGOMERY, PLAINSBORO, ROCKY HILL AND SURROUNDING AREAS
Vol. 219, No. 82 Published every Tuesday and Friday Friday, October 15, 2004 609-924-3244 princetonpacket.com
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
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.