Scoliosis Surgery: Alternate Options For Children And Adults

There is more than one approach to treating scoliosis, and whether a diagnosis of scoliosis is responded to with surgical treatment or non-surgical treatment will affect long-term spinal health. Scoliosis is the leading spinal condition amongst school-aged children, but it also affects adults, so let's address why patients might be interested in a non-surgical treatment alternative.

Scoliosis is a complex spinal condition that affects all ages, and scoliosis surgery is part of a traditional treatment response. The reality, however, is that many cases of scoliosis don't require surgery. Conservative treatment offers a non-surgical treatment option for children and adults.

Let's start our exploration of spinal fusion alternatives by first discussing how the condition is diagnosed, and the condition-characteristics that can make it complex to treat.

Diagnosing Scoliosis in Children and Adults

Diagnosing scoliosis involves meeting a number of parameters as there are multiple spinal conditions that cause a loss of its healthy curves.

There are three main spinal sections, and scoliosis can develop in any of the sections, or in more than one as a combined scoliosis: cervical spine (neck), thoracic spine (upper/middle back), and the lumbar spine (lower back).

Scoliosis causes the spine to bend unnaturally to the side, but it also twists, and this rotational component is what makes scoliosis a complex 3-dimensional condition.

In addition, the size of a scoliotic curve has to be specific to reach a diagnosis of scoliosis: a minimum Cobb angle measurement of 10 degrees.

A patient's Cobb angle is determined during X-ray by drawing lines from the tops and bottoms of the curve's most-tilted vertebrae, and the resulting angle is expressed in degrees:

• Mild scoliosis: Cobb angle measurement of between 10 and 25 degrees
• Moderate scoliosis: Cobb angle measurement of between 25 and 40 degrees
• Severe scoliosis: Cobb angle measurement of 40+ degrees
• Very-severe scoliosis: Cobb angle measurement of 80+ degrees

A healthy spine is already curved, but these are natural curves that make the spine stronger, more flexible, and better able to handle mechanical stress during activity; when an unnatural spinal curve develops, it disrupts the biomechanics of the entire spine.

The spine consists of vertebrae stacked on top of one another, and if the vertebrae are aligned, the spine's healthy curves are in place, but in an unhealthy spinal curve has developed, some vertebral bodies have become unnaturally tilted, shifting them out of alignment with the rest of the spine.

When the spine is not aligned, this introduces a lot of uneven forces to the spine, its surrounding muscles and nerves, and the entire body.

Scoliosis is diagnosed in both children and adults through a combined physical examination that involves taking the patient's medical history, observing their posture, gait, performing an Adam's forward bend test, and X-ray results.

An X-ray is needed to truly see what's happening in and around the spine, and as a minimum Cobb angle measurement of 10 degrees is required to reach a diagnosis, an X-ray is also needed to determine a patient's Cobb angle measurement.

The higher a patient's Cobb angle, the more severe the condition, and the more likely it is that its effects are going to be noticeable, and this is also an important factor in scoliosis surgery that's most often recommended if/when a patient's Cobb angle increases to 40+ degrees.

Now, we mentioned condition effects, so let's touch on those before moving on to specific details about treatment.

What are the Main Effects of Scoliosis in Children?

As you can see from the wide range of severity levels, scoliosis is a highly-variable condition, meaning that no two cases will be exactly the same, and when it comes to scoliosis in children, the main effect is postural deviation.

Oftentimes, the earliest signs of scoliosis in children are uneven shoulders, shoulder blades, uneven hips, arms and legs that appear to hang at different lengths, an uneven waistline, and the development of an arch in the rib cage; this is due to the condition's uneven forces disrupting the body's overall symmetry.

In addition to postural changes in children, the condition can also disrupt balance, coordination, and gait, and related complications can include migraines, sleep troubles, and digestive issues.

As scoliosis shifts a patient's center of gravity, excessive tiredness can become an issue as it takes more energy to try and maintain an economical gait, and there is also the very-real emotional effect that looking different from one's peers can cause.

Scoliosis can also cause activity restrictions as some sports and activities should be approached with caution, while others are deemed unsafe and should be avoided completely.

Sports and exercises deemed unsafe for scoliosis patients are those that involve repeated shocks from jarring impact (compression), place the spine in an unnatural position (hyperextension), and overuse one side of the body (exacerbate the condition's asymmetrical effects).

Sports such as football, gymnastics, horseback riding, and tennis should be approached with caution, or avoided by people with scoliosis, while running, walking, swimming, and condition-specific yoga can help keep the spine loose and flexible, and work its surrounding muscles symmetrically.

In children, the condition isn't always easy to recognize, particularly in mild cases with subtle symptoms, and because scoliosis isn't commonly painful for children; this is because it doesn't become a compressive condition until adulthood.

What are the Main Effects of Scoliosis in Adults?

The main symptom of scoliosis in adults, and the main reason adults come to see me for a diagnosis and treatment, is scoliosis pain, and this is because scoliosis becomes a compressive condition once skeletal maturity has been reached.

Prior to skeletal maturity, the spine is growing and experiencing a constant lengthening motion that counteracts the compressive force of the unnatural spinal curve, and it's compression of the spine and its surrounding muscles and nerves that causes the majority of condition-related pain.

Adults can also experience postural changes, such as developing a prominent lean to one side, but the main effect is back pain and pain that radiates into the extremities due to nerve compression; it's most often pain in the hands and feet that bring adults in to see me.

The reality is that most adults diagnosed with scoliosis have likely had it for years, but were unaware, and by the time they receive a diagnosis, significant progression has occurred, and their spines aren't in the best shape; in many of these cases, increasing spinal rigidity, due to progression, can make it difficult for patients to perform therapeutic exercises as part of treatment.

Progression makes the spine less responsive to treatment: another reason it's best to start treatment as close to the time of diagnosis as possible.

As the spine and brain work together to form the central nervous system, the spine is involved in the function of virtually every part and system at work within the body, which is why spinal conditions can cause such a wide range of symptoms.

An important condition-characteristic to understand about scoliosis in all ages is that it is a progressive condition, meaning that its effects are likely to change over time; it's also important for patients to understand that the way scoliosis is treated will affect the spine differently.

Scoliosis is a Progressive Condition

The progressive nature of scoliosis means that it has it in its nature to worsen over time, and this means that where a scoliosis is at the time of diagnosis isn't indicative of where it will stay; only proactive treatment can work towards counteracting the condition's progressive nature.

Mild scoliosis can easily progress to become moderate, severe, and very severe if left untreated, or not treated proactively, which is why how a diagnosis is responded to with treatment is so important.

We don't always know what causes scoliosis to develop, but we do know what triggers its progression: growth and development.

So for patients who are still growing, they are the most at risk for fast progression due to the constant trigger of growth, and in adults, the focus of treatment isn't as much on monitoring for progression as it is on stabilizing the spine and pain management.

With adults, there is also natural age-related spinal degeneration that can come into play, and while scoliosis is more commonly diagnosed in children, spinal degeneration is why the actual rate of scoliosis increases with age.

So as a progressive condition, different treatment options approach this factor differently; traditional treatment has the end goal of stopping progression, while conservative treatment has the goal of preventing progression and achieving corrective results.

In addition, there are also different types of scoliosis that further complicate the treatment process and necessitate the customization of treatment plans.

Are There Different Types of Scoliosis?

Different types of scoliosis are determined by causation, and in the majority of cases, scoliosis is classified as idiopathic, meaning not clearly associated with a single-known cause; idiopathic scoliosisis the most common type to affect both children and adults and accounts for approximately 80 percent of known diagnosed cases.

The remaining 20 percent are associated with known causes: neuromuscular scoliosis, congenital scoliosis, and degenerative scoliosis.

Neuromuscular scoliosis is caused by the presence of a larger underlying neuromuscular condition such as spina bifida, muscular dystrophy, and cerebral palsy; these cases are among my most complex to treat because it's the underlying neuromuscular condition that has to be the focus of treatment.

Congenital scoliosis is caused by a malformed spine that develops in utero and is a rare form, affecting approximately one in 10,000.

Degenerative scoliosis is caused by natural age-related spinal degeneration, so this type affects adults over the age of 50, and is more common in females due to changes in hormones and bone density related to menopause.

Adolescent idiopathic scoliosis, diagnosed between the ages of 10 and 18, is the most prevalent type overall, and this age group is the most at risk for rapid-phase progression due to the rapid and unpredictable growth spurts of puberty.

Different types of scoliosis have different characteristics and treatment needs, and when it comes to how to respond to a diagnosis of scoliosis, this is the most important decision to be made; as a progressive condition, scoliosis is incurable, but it can be highly treatable.

How scoliosis is treated can affect life-long spinal health and function, so patients need to be aware of all treatment options available to them to ensure they are making an informed decision.

Scoliosis Treatment Options

When it comes time to correct the curve, this is when treatment-approach comes in, and there are two main scoliosis treatment approaches for patients to choose between: traditional and conservative.

The former offers a surgical response to scoliosis, while the latter offers a non-surgical treatment alternative, and for those on the path of traditional treatment, oftentimes, an immediate referral to an orthopedic surgeon funnels patients into spinal surgery for scoliosis.

As mentioned, the reality is that many cases of scoliosis can be treated successfully without surgery, and there is no such thing as minimally invasive scoliosis surgery because every surgical procedure is going to come with risks, but because of the spine's many important functions, spinal surgery comes with some particularly-high potential risks, side effects, and complications, so should be considered carefully.

For those wanting to forgo a recommendation for surgical intervention, modern conservative treatment has proven results that show how responsive scoliosis can be to non-surgical options.

Spinal Fusion Surgery: What You Need to Know

What every patient needs to know about spinal fusion surgery is that it's an invasive and costly procedure that can shape long-term spinal health.

Spinal fusion has the end goal of stopping progression, so it doesn't focus on how to reduce a scoliotic curve on a structural level, but rather on stopping the condition from getting worse.

Spinal fusion surgery involves fusing the curve's most-tilted vertebrae, at its apex, into one solid bone, and commonly, rods are attached to the spine with screws to hold it in place; this can also involve the removal of intervertebral discs between adjacent vertebrae being fused and a bone graft.

Now, a spine that's fused can be straighter, and while there are no guarantees, it can stop progression, but the way those results are achieved is contrary to the spine's natural movement-based design.

The fused vertebrae can't become more tilted over time because they can't move.

Some risks associated with the procedure of spinal fusion itself can include nerve damage, excessive blood loss, an adverse reaction to hardware used, and infection.

What I really want patients to be aware of, however, is how spinal fusion can affect the spine's long-term health, strength, and function, and there are also gaps in the research on what it's like to live with a fused spine 30, 40, 50+ years down the road.

While some patients maintain enough flexibility above and below the fused portion of the spine, others experience a noticeable loss in spinal flexibility and range of motion that can disrupt a patient's quality of life.

In addition, a fused spine is simply not as strong so is more vulnerable to injury, and this can mean further activity restrictions, and the knowledge of vulnerability to injury can have a psychological impact that shouldn't be discounted.

For children, their spines are still growing, so although they are young and likely to respond better, the fact that growth is still occurring can pose an additional challenge.

When it comes to spinal fusion in adults, the older a patient is, the more risky invasive spinal surgery is, and in both children and adults, if the procedure is unsuccessful, the only recourse is more surgery, and the risks only increase with age and each subsequent procedure.

A fused spine is fused for life, and the younger a patient is at the time of the spinal fusion, the longer the hardware used has to function optimally inside the body, and any damage caused by the procedure can't be reversed.

Now, let's explore a non-surgical scoliosis treatment option.

Conservative Non-Surgical Scoliosis Treatment

Here at the Scoliosis Reduction Center, my patients benefit from a proactive conservative non-surgical treatment approach that combines multiple condition-specific treatment disciplines to impact conditions on every level.

As a progressive condition, I want to be proactive by starting treatment as close to the time of diagnosis as possible; one thing patients need to understand about traditional treatment is that it isn't started early because it doesn't have a strategy for treating scoliosis while mild.

While there are never treatment guarantees, scoliosis that's treated while mild is more likely to be responsive as the condition only gets more complex to treat the more it progresses, and it's virtually guaranteed to progress at some point.

Conservative treatment has the goal of managing progression, but the focus is on achieving corrective results, and this means a curvature reduction on a structural level; as a structural spinal condition, scoliosis has to be impacted, first and foremost, on a structural level.

Condition-specific chiropractic care involves a series of chiropractic techniques and adjustments that work towards adjusting the most-tilted curve's vertebrae back into alignment with the rest of the spine.

Once I start to see structural results, I can shift the focus to increasing core strength as this means the spine's surrounding muscles can provide it with better support, and this is worked towards through condition-specific physical therapy and exercises that can also address any related muscle imbalance, improve posture, and activate areas of the brain for improved brain-body communication.

When it comes to treating scoliosis in children, corrective bracing can be particularly effective on growing spines, so the ultra-corrective ScoliBrace can help augment corrective results by pushing the spine into a corrective position.

The final and ongoing phase of treatment is rehabilitation, and this involves continued chiropractic care and a series of custom-prescribed home exercises for further stabilizing and healing the spine.

A benefit of conservative non-surgical treatment is that it's less invasive and costly, and more importantly, it preserves as much of the spine's natural strength and function as possible.

Conclusion

Traditional scoliosis treatment and spinal fusion surgery was the dominant treatment choice for many years, but that doesn't mean it's the best, nor only treatment option available.

Traditional treatment tends to funnel patients towards surgery because it does little to prevent progression into the severe classification, and when/if that happens, patients become surgical candidates.

While there are never treatment guarantees, when conditions are detected early and responded to with a proactive treatment approach, there are fewer limits to what can be achieved; it's more effective to proactively work towards preventing progression and increasing condition-effects, than it is to attempt to work towards reversing those effects once they're established.

When it comes to treating scoliosis non-surgically in adults, the focus is on reducing the curve back to where it was prior to becoming painful, pain management, and further stabilizing the spine.

When it comes to treating scoliosis non-surgically in children, the focus is on achieving a significant curvature reduction and holding it there despite the constant trigger of growth.

Scoliosis surgery has the same end goal for both children and adults (stopping progression), and achieving this by fusing the spine and holding it in place through artificial means isn't the same as actually correcting a scoliosis on a structural level.

While there is still a place for spine fusion as a form of scoliosis treatment, for those wanting to try a less-invasive treatment approach that's more aligned with the spine's natural function and design, conservative chiropractic-centered treatment can be an effective alternative.

If you or someone you care about has been recently diagnosed with scoliosis, don't hesitate to reach out for guidance and support to ensure you are informed on the different treatment options available and their effects.