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June 06, 2014

National Scoliosis Awareness Month

Q&A on scoliosis with Drs. Gary T. Brock and B. Steve Richards

Gary T. Brock, MD, of Houston, Texas, an orthopaedic surgeon with Fondren Orthopedic Group and Texas Orthopedic Hospital, also is a clinical instructor of orthopaedic surgery at the University of Texas Health Science Center. He specializes in pediatric orthopaedics and spine surgery, and has treated Stacy—a top-ranked American professional golfer on the U.S.-based LPGA Tour.

B. Steve Richards, MD, chief medical officer at Texas Scottish Rite Hospital for Children, is a professor in the department of orthopaedic surgery at The University of Texas Southwestern Medical Center at Dallas, an active staff member at Children’s Medical Center Dallas, and a consulting staff member at Presbyterian Hospital in Dallas. He is a past president of the SRS and past chairman of the Pediatric Orthopaedic Society of North America.

Both Drs. Brock and Richards are members of the AAOS.

Q:   Stacy Lewis has worked hard to overcome the challenges she faced with scoliosis as a teen, and even won the North Texas LPGA Shootout last month—her ninth career LPGA Tour victory. Her story illustrates what's possible for young people with scoliosis. For the general public who may not know, what is scoliosis?
Dr. Brock:   Scoliosis is a condition that affects children, adolescents and adults of all ages, both male and female. Simply defined, scoliosis is a rotational deformity of the backbone also called the spine. Instead of a straight line down the middle of the back, a spine with scoliosis curves, sometimes looks like a letter "C" or "S" and has an asymmetric prominence when the child bends forward.
Q:   What are the long-term effects of scoliosis?
Dr. Richards:   Most people with childhood scoliosis go on to live normal, active lives. When problems do arise, they often are related to the size and location of the curve in the spine. In general, people with curves less than 30 degrees have the same risks for back pain as people without scoliosis. People with larger, untreated curves (over 50 to 60 degrees) may experience back pain later in life, particularly in the lower back.
Q:   What are some visual indicators for which parents should watch?
Dr. Richards:   Some of the visible findings include an uneven waistline, shoulders that are not level, a prominent scapula (wing bone), or the body being shifted off-center when looked at from behind. The most sensitive evaluation is to have your child bend over to touch her toes, look at her from behind, and see if one side of the ribs is more prominent than the other—this is the best indicator for the presence of scoliosis.
Dr. Brock:   Also asymmetry of the back, especially when the child bends over.
Q:   What are some physical symptoms of scoliosis that children can feel/experience?
Dr. Richards:   Usually, the children don't feel anything abnormal. Having pain with scoliosis is uncommon, but not unheard of. Once children recognize that their spine is curved, however, they are understandably concerned about their back.
Dr. Brock:   Occasionally, children will experience some lower back pain depending on the curve type and severity.
Q:   If parents suspect curvature of their child's spine, what should they do?
Dr. Richards:   Usually, spinal curvature is picked up by scoliosis screening at school, during a routine physical examination at the doctor's office, or when summer comes around and bathing suits regularly are worn. If the family physician is not aware of this finding, he or she should be notified.
Dr. Brock:   Consult a spine expert, recommended by the Scoliosis Research Society, if possible. Sometimes it's easiest to have their family physician, pediatrician or local orthopaedist evaluate the child first.
Dr. Richards:   Once the child is examined, an x-ray may be obtained, which will confirm the presence of a curvature. From there, the child usually is referred to a scoliosis specialist.
Q:   What are the treatment options for scoliosis?
Dr. Brock:   Observation, brace treatment or surgery depending on the curve type and severity. There is some interest in scoliosis-specific exercises, in some cases, but good controlled studies are still lacking.
Dr. Richards:   Treatment is dependent on the size of the spinal curve and how much growth is remaining. Usually curves worsen the most during growth spurts, so knowing the measurement of the original curve is important. Depending on the size of the curve and the adolescent's physical maturity, treatment may vary from simple reassurance and observation, to wearing a brace in an effort to prevent the curve from worsening, or even to having surgery if the curve is substantial.
Q:   How likely is it that a patient will need surgery to treat scoliosis?
Dr. Richards:   The vast majority of children with scoliosis will not require surgery. Most curves are small, and will remain so. Moderate sized curves may be successfully managed with a brace, and avoid the need for an operation. Relatively few children will have curves that progressively worsen to the point of requiring surgery.
Dr. Brock:   Surgery is indicated when the curve magnitude exceeds 45 -50 degrees in growing children. In mature patients other factors also will contribute to the final decision as to what is best for the patient.
Q:   What are your patients/parents of patients most surprised to learn about their child's condition/scoliosis diagnosis?
Dr. Brock:   Usually the diagnosis itself is a big surprise. Maybe the medical community has done a poor job of educating the public about a very treatable condition. It's usually painless so the need for treatment in certain curve types comes as a surprise to many families including the patient.
Dr. Richards:   They may be unaware that this condition can be present in other family members. If that turns out to be the case, scoliosis may be an inherited condition in some families. And, an individual who has scoliosis that does not require surgical intervention, can be expected to live a full, normal live with no more likelihood of back pain than the general population.
Dr. Brock:   They are usually relieved when we let them know that sports participation still is possible.
Q:   What advice can you give young scoliosis patients, and their parents, who hope to play a high level of sport before, during and after scoliosis treatment?
Dr. Richards:   Many young scoliosis patients with small curves require no treatment and can participate without any limitations. Those children who require brace treatment can take time out of the brace during the day to participate in their sport, again without activity restriction.
Dr. Brock:   We expect them to continue with their sport. Even at a high level. They may have to do some additional trunk strengthening exercises since the brace tends to weaken trunk muscles with prolonged use. We encourage swimming out of the brace and bicycle crunches to keep those abdominal muscles strong. We've had champion marathon runners, college soccer players, high school football players, basketball players, track participants, gymnasts, dancers, softball players, swimmers, marching band members, cheerleaders and even the top golfer in all of women's professional golf continue with their sports while successfully treating their scoliosis.
Dr. Richards:   Many patients (though not all) who need to have surgery for a large curve can return to vigorous sports-related activities and perform at a high level. Just look at Stacy Lewis. She had surgery for her scoliosis, fusing five levels of her spine, and has become one of the best women professional golfers in the world!

The straight truth about scoliosis

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