In my last few blog entries, I discussed scoliosis. In this blog entry, I am including a few scoliosis resources for more in-depth information about scoliosis.  

Scoliosis Research Society

National Scoliosis Foundation

iScoliosis
National Institute of Arthritis and Musculoskeletal and Skin Diseases
 

Often time’s patients that have idiopathic scoliosis may also have a visible rib deformity that may be present following corrective spine surgery.  The traditional spine surgical procedure to correct this has been open thoracoplasty.  A newer, minimally invasive procedure used is video- assisted thoracoplasty.  This procedure is less invasive than the traditional spine surgical procedure.

Currently there is a scoliosis treatment study underway, entitled Bracing in Adolescent Idiopathic Scoliosis Trial.(BrAIST).  The purpose of this spine study is to compare the effectiveness of bracing as a treatment to prevent further curve progression for adolescent idiopathic scoliosis.  Bracing is the current standard of care.  This study will compare the risk of curve progression in adolescents diagnosed with adolescent idiopathic scoliosis that wear a brace versus those that do not.  This study will determine if there are factors that can predict the usefulness of bracing.  Additionally, this study will evaluate the best dosing and bracing duration schedule, and how bracing affects the quality of life; including functioning and psychosocial issues. 

Many times with scoliosis - no treatment is needed.  Once a patient is diagnosed with scoliosis it is important to observe and monitor the curve during the patient’s growing years.  Factors that affect what type of treatment is recommended include the age of the patient and how much growth they have left, the degree and pattern of the curve, and the type of scoliosis. 

Treatment options may range from observation to surgery.  If it is decided that the patient will be observed; they will be evaluated approximately every six months while the patient is still growing.  At this time, the degree of the curve will be assessed.

Bracing is a treatment option to prevent the curve from progressing.  This is recommended if the patient has an idiopathic curve, is still growing and:

• Has a curve greater than 25 degrees,
• Has two more years of potential growth remaining and the curve is between 20 and 29 degrees, (and if female has not had her first menstrual period) or
• Has a curve that is between 20 and 29 degrees and is progressing.   

This blog entry is part of a series on scoliosis, and will address commonly asked questions about screenings.

At what age should I have my children screened for scoliosis and how frequently should this be done?

In that scoliosis is typically diagnosed between the ages of 10 and 16, I generally recommend that parents have their children screened for scoliosis as a part of their annual physical.  Depending on the school system, the school nurse may do scoliosis screenings as part of their wellness / health initiatives. 

Are there any visible symptoms of scoliosis that I can look for in my child? 

There are a few visible symptoms that as a parent you may notice in your child.  Some of these visible signs may be uneven shoulders, or a protrusion of one or both of the shoulder blades, an elevated hip, or uneven waist.  Sometimes, you may notice clothes do not fit properly – that pant legs may appear longer on one side than the other.  If you notice any of these symptoms in your child, it is recommended to talk to your family doctor.    

What is the screening test called that is commonly performed – when you are bending forward?

This is one of the most common initial screening tests for scoliosis and is called the Adam’s Forward Bending Test.  For this test, the individual puts his or her feet together,  leans forward and bends at the waist 90 degrees.  Often times, they are asked to put their hands together like they are diving.  The screener will then look at the spine for any abnormal curvatures and asymmetry of the trunk.  This screening can tell if there is a curve – but not the degree of the curve.

How do you determine the degree of spinal curvature?

If an initial screening such as the Adam’s Forward Bending Test indicated that they was a curvature – further testing then measures the degree of the spinal curvature.  To determine this – an X-ray of the spine is taken.  A process called the Cobb Method is then used to measure the amount of spinal curvature. 

With the Cobb method of measuring spinal curvature, lines are drawn on the X-ray parallel to the end plates of the vertebral bodies at the beginning and end of the curve.  A perpendicular line is then drawn – and the angle between these two lines equals the degree of curvature – called the Cobb measurement.  It is important to note, that the actual measurement can vary 3 to 5 degrees, depending upon the exact positioning of the patient for the X-ray.  That is why major treatment decisions are not made on one single X-ray.

In these next series of blog entries – I will answer common questions about scoliosis – including the diagnosis, and provide an overview of the treatment options both medical and surgical treatments.

The Scoliosis Research Society defines scoliosis as a lateral deviation of the normal vertical line of the spine, which is greater than ten degrees when measured by an X-ray.  Scoliosis is often referred to as “curvature of the spine.”

According to the National Scoliosis Foundation (NSF), scoliosis affects 2-3% of the population.  The common age for onset is 10-15 years, old and it affects both genders equally although females are eight times more likely to have a greater degree of curvature that requires treatment the NSF indicates.  Although scoliosis is not heredity, there is an increased likelihood of an individual being diagnosed with scoliosis if a family member has had it. 

The different types of scoliosis include:

§         Idiopathic Scoliosis – This is where scoliosis occurs without a known cause.  This is the most common type of scoliosis.

§         Congenital Scoliosis – This is when an individual is born with scoliosis as a result of the vertebrae not being properly formed during pregnancy.  This malformation occurs within the first six weeks of embryonic formation.

§          Neuromuscular Scoliosis – This is caused as a result of a neurological disorder such as muscular dystrophy that results in a weak trunk and the individual can not support the weight of their body.

§         Adult Scoliosis – This is when scoliosis is diagnosed in an individual as an adult.  It can either be undiagnosed scoliosis when the individual was younger or the result of age-related degeneration.  An example of age-related scoliosis is osteoporosis. 

If you have a question on scoliosis that you would like answered in this series of blog entries, please send your question to info@indianaspinegroup.com. 

The Scoliosis Research Society is an excellent resource for individuals searching for information on spine wellness and education information on scoliosis. This web site provides detailed explanations of the types of scoliosis – as well as addresses the different life stages that one may have scoliosis; i.e. infants, juveniles, adolescents and adults. 

I recently went to Austria to attend the 16^th International Meeting on Advanced Spine Techniques (IMAST). For this spine continuing medical education conference, I was a faculty member and invited faculty speaker. This spine conference, sponsored by the Scoliosis Research Society, is an international forum where spine surgeons from around the world discussed the latest research and advanced spine technologies. The goal of this conference is to improve the quality of patient care.

While at this conference I participated in a few instructional lectures. I moderated a spine surgery education series on Options in Cervical Fixture and Motion and presented a talk on Current State of Cervical Motion Technology.  Additionally, I participated in a instructional lectures series on Cervical Trauma and presented a talk on C1 – 2 fractures. 

In addition to the instructional lectures, I participated in a round table discussion on Cervical Reconstruction. This discussion provided an opportunity for spine surgeons from around the world to discuss case studies presented. 

Other topics that will be discussed during Back Talk, the continuing medical education conference sponsored by Indiana Spine Group, are common spinal disorders. 

Dr. Paul Kraemer, a spine surgeon with Indiana Spine Group, will highlight common spinal diagnoses that affect the pediatric, adolescent and adult population. Recommended screening tests will be reviewed, and Dr. Kraemer will discuss how to differentiate between patient complaints and symptoms for effective spinal diagnosis. A few common diagnoses that will be reviewed include spinal stenosis, spondylosis, spondylolisthesis and scoliosis.

Planning continues for the annual spine symposium / continuing medical education conference Back Talk. The overall objective of this conference is to provide primary care physicians and practitioners comprehensive information for the diagnosis and treatment of their patients with spinal disorders, injuries and abnormalities. 

At the conclusion of this program, participants will:

·        Provide a comprehensive diagnostic assessment of patients that present with back and neck pain; including the physical exam, imaging and psychological assessment.

·        Review current evidence-based treatments of spinal disorders from a non-operative to an operative perspective; including medical and physical therapy, chiropractic care and when referrals are indicated. 

·        Identify the diagnostic and treatment algorithms of spinal conditions specific to life stages – from the pediatric patient to the older adult; i.e. pediatric injuries, scoliosis, osteoporosis, and the degenerative spine.

·        Discuss spinal injuries resulting from sports activities and trauma, their non-operative and operative treatments as well as preventative measures. 

·        Identify uncommon and difficult causes of spine disorders; including rheumatologic disorders and cancer.

·        Understand the key principles of spine wellness to maintain a healthy spine; i.e. nutrition, lifestyle and exercise.

·        Discuss emerging technologies and the future of spine care. 

For more information, visit the Back Talk information page on Indiana Spine Group's web site.

Planning on the third annual spine symposium / continuing medical education program continues.  This conference entitled, Back Talk:  Comprehensive Concepts in the Diagnosis and Treatment of Spinal Disorders - will address one of the key reasons people visit their physicians, back pain! 

This symposium will discuss the latest spinal diagnostic and treatment information for back and neck problems.  Overall conference objectives include:  

·        Provide a comprehensive diagnostic assessment of patients that present with back and neck pain; including the physical exam, imaging and psychological assessment.

·        Review current evidence-based treatments of spinal disorders from a non-operative to an operative perspective; including medical and physical therapy, chiropractic care and when referrals are indicated. 

·        Identify the diagnostic and treatment algorithms of spinal conditions specific to life stages – from the pediatric patient to the older adult; i.e. pediatric injuries, scoliosis, osteoporosis, and the degenerative spine.

·        Discuss spinal injuries resulting from sports activities and trauma, their non-operative and operative treatments as well as preventative measures. 

·        Identify uncommon and difficult causes of spine disorders; including rheumatologic disorders and cancer.

·        Understand the key principles of spine wellness to maintain a healthy spine; i.e. nutrition, lifestyle and exercise.

·        Discuss emerging technologies and the future of spine care. 

For more conference infomration, visit Indiana Spine Group's web site, or call (317) 228-7000.

At some point, in your children’s school years – they will be screened for scoliosis by the school nurse.  They are also screened for scoliosis at their annual physical.

This screening is for idiopathic scoliosis – which is an abnormal curvature of the spine, with an unknown cause.  Idiopathic scoliosis often develops during childhood and adolescence.  A normal spine appears like a straight “I”.  With scoliosis, there is a curve to the left or right and the spine looks will have either a S-shaped or C-shaped curve. 

The standard screening for scoliosis, conducted by pediatricians and in school screenings, is the Adam’s Forward Bend Test.  According to the American Association of Orthopaedic Surgeons, this is the most specific test for true scoliosis.  With this screening, the individual holds his or her feet together, and bends 90 degrees at the waist.  The trained professional looks for any sign of curvature or any asymmetry of the trunk.  If curvature is detected, the individual will be referred for additional evaluation.

Early detection is important in the treatment of scoliosis.  Many times with early treatment, the progression of scoliosis can be stopped or slowed down. 

During this education session, Dr. Rick Sasso will discuss common spinal deformations which affect younger patients; including scoliosis.  This will include the latest diagnostic information and screening guidelines as well as treatment information.  Additionally, Dr. Sasso will discuss when spine surgery is a treatment option.

Did you know that the most common cause of scoliosis is unknown – or idiopathic? 

More prevalent in girls than boys, scoliosis most commonly affects adolescents and teens aged 10 – 16 years of age.  That is why it is important for a scoliosis screening be a part of their annual physical.

Early detection is important to stop or slow the progression of scoliosis. 

With scoliosis, an individual has a curving of their spine, generally a C- or S- shaped curve.  These curves are easily seen when the person bends forward.  One common screening tool that physicians will use is to have the patient bend forward – this will usually show any deformities in the spine.  If there is curvature present, this will be confirmed with an X-ray.  

Indiana Spine Group is a center of excellence for the treatment of spinal disorders and abnormalities.  Located in Indianapolis - with offices in Kokomo and Anderson, we provide comprehensive spine care – including interventional pain management treatments, nonsurgical spine treatments, minimally invasive spine procedures, minimally invasive spine surgery and spine surgery.  Treating both adults and children, some common diagnoses that we treat include degenerative disc disease, spinal stenosis, herniated cervical disc, failed back syndrome, osteoporosis and scoliosis. 

Physicians with Indiana Spine Group include:

§          Ken Renkens, MD (neurosurgical spine surgeon)

§           Rick Sasso, MD (spine surgeon)

§           Kevin Macadaeg, MD (minimally invasive spine specialist)

§           Thomas Reilly, MD (spine surgeon)

§          Jonathan Gentile, MD (minimally invasive spine specialist)

§          John Arbuckle, MD (minimally invasive spine specialist