Scoliosis

Straight up: The best in scoliosis treatments

2013-10-23T00:00:00Z 2013-10-25T13:34:07Z Straight up: The best in scoliosis treatmentsJennifer Pallay nwitimes.com
October 23, 2013 12:00 am  • 

Scoliosis, which is a sideways curvature of the spine, can be a mysterious condition with a mind of its own. In its mildest form, it can correct itself over time, but in severe cases, it can require spinal surgery. While typically thought of as occurring in adolescents, this condition can also affect adults.

Mohammad Shukairy, neurosurgeon on staff at Community Hospital and St. Mary’s Hospital, treats both adults and adolescents with scoliosis.

His adolescent patients typically have already been diagnosed and are seeking evaluation for treatment. In the adult population, the cases often present with more of a general complaint such as back pain or discomfort and he is the one who diagnoses the condition.

“Many times children and young adolescents present with scoliosis that is idiopathic, which means that it is something that we don’t have a cause for, we don’t understand why people get the curvature of the spine,” Shukairy says. “Adults often present with degenerative scoliosis. This occurs because of the aging process of the spine.”

Shukairy, who is part of the Community Spine and Neurosurgery Institute in Munster, says adolescents with mild scoliosis can be treated conservatively, but if the curve is greater than 45 or 50 degrees surgery is often recommended.

Shukairy says scoliosis is not uncommon in the young population. For adults, the risk tends to increase with advanced age. Still, he says, in the adult population, scoliosis does not have to be a debilitating problem. There are several lifestyle factors that can modified to prevent worsening of spinal problems.

The main lifestyle modifications are to quit smoking, which advances the degeneration of the spine, and to pursue weight loss. Patients can also focus on exercises that increase the strength and posture of the spine – yoga and pilates and those types of exercises.

Although it is ideal to catch adolescent scoliosis early, the disease can be “sneaky” and difficult to diagnose, says Nancy Trimboli, a chiropractor and owner of Trimboli Chiropractic with offices in Munster and Cedar Lake.

“The problem is that a lot of times by just looking at posture or looking for a rib hump, you don’t see (the scoliosis.)” The best way to see any curvature is through an X-ray, she says. Free scoliosis screenings via X-ray are offered at both of her offices.

Less than 50 percent of those she screens have it, she says, and in the general population, it would be even less. Most parents who bring their children to be checked have a reason such as the child slouching, having a high shoulder or having a family history of scoliosis.

Trimboli, who has been practicing in Munster for 20 years, says the chiropractic approach is to correct pelvic unleveling. That can involve adjustments of the pelvis and sacrum, the foundation bone of the spine.

Other times, her young patients have a short leg, which can be as short as ¾ of an inch, she says.

“They’ve been diagnosed with a spinal curvature and meanwhile, it’s the spine compensating for a short leg.” Because legs grow at different rates, they will sometimes take a “wait and see” approach to see if the legs and spine even out. Older teens may need a lift in the shoe and monitoring of their leg length as they continue to grow.

Once the scoliosis curve is at a certain point, doctors may recommend a brace, but Trimboli says the brace has its own set of physical and emotional challenges.

“The jury is still out on whether the braces do any good at all,” she says. When the child wears the brace 23 hours a day, the supportive muscles of the spine get weaker and weaker.

With chiropractic, there is a different approach, she says.

“Just like anything else, try every available option that is noninvasive that works with your body’s own healing ability,” Trimboli says. “There’s always room for surgery later but you can’t undo that once it’s done. There are no guarantees on anything so try the most logical, easiest less invasive thing first.”

Dana Andric, whose children are Trimboli’s patients, learned about scoliosis the hard way this summer.

While hugging her 13-year-old son, she felt an abnormality in his back. After having it checked, they learned he has a 48-degree curve, considered severe in the scoliosis field. He will most likely have to have surgery to correct it.

Following his diagnosis, she tested her two other children and found that her 7-year-old daughter has a 28-degree curve and her 11-year-old son has an 18-degree curve

“It really hit us shockingly. I diagnosed all my kids,” Andric says.

Her son, even with his severe curve, never complained of back pain. She says they attributed his aches to normal growing pains.

“I would really just tell people to explain to their kids to watch for anything that looks visually strange.” As children get older, they take care of their own bodies more. “We can’t see what lies underneath all that clothing. In puberty, a lot can go on.”

“When I saw his X-ray, like a backwards S, I almost passed out. It was shocking to see when you never even knew that a problem existed.”

Nitin Khanna is an orthopedic spine surgeon and founder of Spine Care Specialists in Munster, a division of Orthopedic Specialists of Northwest Indiana.

He says scoliosis treatment has undergone what he would term “revolutionary” changes over the last 10 to 15 years. While early treatments were painful and debilitating, new advances have made it possible for patients to recover quickly.

Early treatments primarily focused on bracing and traction. The early surgical procedures involved a large incision with significant amount of blood loss. They would also put patients in body casts for multiple months.

“It was arguably one of the most painful and debilitating operations that existed at its times with very mediocre results,” Khanna says. It was still done that way as recently as 15 years ago.

Internal fixation allowed surgeons to use spinal metallic implants to help create structural support for the spine and help correct the curvature. Other advances include treating the spine from both the front and back with spinal instrumentation.

“There were significant advances as both result in the ability to correct the curvature and maintain that new curvature for many patients for many years. But it was still the most painful and debilitating operation that existed.” It took up to one year to fully recover.

With the advent of the minimally invasive surgical technique over the last five years, many of these issues are resolved. These procedures only disrupt the tissue in and around the problem, diseased or pathologic segment, Khanna says. This minimizes scar tissues, minimizes operative time, decreases blood loss, decreases the length of stay for patients and allows patients to resume their every day activities in the order of weeks as opposed to months.

While the majority of scoliosis patients do not require surgery, Khanna advises seeking a decision from an expert whose entire career is dedicated to spinal treatment.

“As time goes forward and we understand some more of the genetic links associated with scoliosis we may be able to intervene at an earlier stage to treat curves that predictably will be more severe in nature,” Khanna says.

Khanna, who trained at Rush University Medical Center, says that today’s advances in scoliosis care are remarkable compared to what he saw in his training.

“I’m very proud to have been part of the design team in developing some of these minimally invasive techniques,” he says.

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