scoliosis is an abnormal curvature of the spine that affects an estimated 9 million people in the United States most cases are mild but some curves worsen as children grow which can create serious problems later in life today we're going to discuss scol is highlight the symptoms and treatments and answer all the questions about scoliosis on Ask the doctor send in your questions to questions at allhealth tv.com or allhealth go on Facebook or YouTube or visit the ask the doc page on our website allhealth tv.com welcome everyone to ask the doctor a show where we encourage our viewers to send in questions and we'll be happy to respond to as many as possible now it's easy to send in questions you can just email me at questions allhealth tv.com or you can put them in the comment section on our Facebook page Facebook at at allhealth go or YouTube YouTube at allhealth go finally you can visit our website at allhealth tv.com I'm Dr gorgi branik a minimally invasive spine surgeon and today we are going to talk about a medical condition that affects the spinal canal the spinal column known as scoliosis being that our show is called ask the doctor let's kick things off with a Facebook question from one of our viewers Kelly asks what is a normal spine supposed to look like and what purpose does it serve thank you for your question Kelly great question so the spine does a few things it supports the human body it supports the soft tissues it allows us to move freely and bend it protects the spinal canal thereby the spinal cord and the nerves where your nerves and spinal cord descend from the brain and when the nerves spread to the extremities this allows us to control our movements so a normal spine when viewed from the side actually has a bit of an S curve you can see that there's an S curve in the portion that corresponds to your neck that faces forward a curve a c curve facing backwards in your midb and finally your lower back goes back to a c that's open to the back now that's on a side view on a frontal view a typical spine is straight side view and front view now with scoliosis on the frontal view you'll see a bit of an asymmetry and often times it's a rotational problem it looks like we have another question from our viewers this one is YouTube question from antoan antoan says I have a neighbor who developed scoliosis l later in life and I want to know what it is and what causes it so scoliosis is an abnormal condition of the spine in which the spinal canal the spinal curve uh is sort of in this s shape in a frontal plane and again it's a rotational problem uh your spine May curve to the right or to the left and there may be more than one Bend frequently we refer to it as a compensatory curve and a structural curve structural curve is the one that's there all the time and the compensatory curve is what allows uh many of us to keep our head right above the pelvis it compensates so from behind a normal spine appears totally straight and when there's scoliosis you can see that there's a bit of a Bend especially when one leans forwards you can capture a lean to the side so there are four types of scoliosis the idiopathic scoliosis that's the most common type and it's usually diagnosed in someone who is about to become or just became a teenager as these kids are about to enter the period of life where they grow really quickly this is what fuels the spine that is predisposed to a bit of a Bend to bend further and a lot of scoliosis progresses during that time now neuromuscular scoliosis sometimes develops in individuals who can walk uh due to a problem related to their muscles these uh types of curves are very severe and often times you see kids diagnosed with neuromuscular scoliosis very early in life degenerative scoliosis is the most common type in my practice now that's a type of a curve that develops later in life as the diss de generate asymmetrically often times it begin in lower back and is frequently associated with back pain as well as significant stiffness then there's also congenital scoliosis and that's a type of scoliosis that we see in little kiddos once they're born that type of scoliosis often times results in kids needing an operation and it can result from malformations in vertebra that will reliably cause the curve to progress okay so we just got our first question on the website and it's from lordus lordus asks my daughter is a healthy 10-year-old kid but after finding out that her friend's oldest sister has scoliosis she's afraid that she's going to get it too I thought scoliosis was something that only older people get is that not the case and does something like this affect the whole back lordis thank you for that question so people of any age can develop scoliosis a type of scoliosis and the majority of those Afflicted with scoliosis find that it's uh during adolescence as they enter their teenage years now scoliosis can develop an infancy or early childhood and the primary age of onset of scoliosis is 10 to 15 years old so with approximately 3 million new cases that are diagnosed every year about 3% of kids in the US develop scoliosis according to American Academy of orthopedic surgeons a governing body for my specialty for Orthopedic spine surgeons as well idiopathic scoliosis occurs 10 times more common in girls than in boys especially over 10 and we really don't understand why that's the case so a human spine consists of five sections there is the coxics the sacrum Lumar thoracic and cervical spine the two regions that that are primarily affected here you can see on the video the this uh sacrum the lumber spine is a lower back and then we arecent to the thoracic spine that's uh held pretty stable by the ribs and finally your neck the cervical spine but the two regions that are most commonly affected by scoliosis is the thoracic spine or midback and the lumber spine despite the fact that the thoracic spine is stabilized by the rib cage it's still common to see both structural and the compensatory curve in that region especially in teenagers now the lumber spine which involves uh essentially most of our weightbearing energy and has the tallest most Dynamic Discs lumbar spine develops scoliosis uh more often later in life as those very discs lose height and result in a deformation of the human body there are some differences according to age as well adolescents most cases in a thoracic spine adults seniors mostly Lumber spine or lower back so it's not atypical for someone with adult onset scoliosis to complain of significant low back pain there are some signs and symptoms for parents to keep an eye out uneven shoulder blades uneven shoulder height uh uneven hip height opposition you can find that when your Kido bends forward you'll see some asymmetry uh with regards to the rib cage and we're going to talk about that a little more than a minute and you can actually find that the entire body kind of leans to the side and again that's more with the elderly where they don't have such flexibility to compensate for a structural curve um and finally where your head is no longer centered on top of the pelvis that's where I find l patients will have a lot of pain um for those of you keeping scored home we've gotten our second question via Facebook and this one is from Cassandra a nurse in my daughter's school called me a few days ago and said that she noticed her leaning to one side my daughter I assume Cassandra when she was walking down the hall recently the nurse suggested that I got my 12 year old that I get my 12-year-old tested for scoliosis I guess my question is this how does scoliosis get diagnosed Sandra that's a great question thank you for sharing with us so there are a number of ways how a doc may be able to diagnose scoliosis there's something called the atams forward bend test um essentially if you stand perfectly Square behind your Kido or in front of your kiddo and you have them throw their hair forward so that it doesn't obscure your view you ask them to put their hands together and sort of lean straight down with their feet square against yours in someone with without scoliosis as they lean forwards you'll see that their thorax is totally even like two equal Hills that meet right in the middle where the spine is but in someone with scoliosis because of the rotational element you'll see that uh the hills are no longer symmetrical and that is a positive atoms test now keep in mind that there's quite a bit of a margin of error probably no no less than 10 um and uh Don't Panic if that happens you can live your entire life with scoliosis please don't let that uh scare you and uh uh uh make you catastrophize if you see a curve uh a dock may also use something called a scoliometer which is essentially just an industrial level that's fitted with a round kind of convex body that allows you to lean it onto the back and then you could see a little little airball will move to one side or the other side if there is a symmetry Physicians can also use a CT scan an MRI to diagnose scoliosis and of course x-rays are probably used most often when we obtain these x-rays we use something called a cob method CB where we uh draw some horizontals at the most asymmetrical vertebra and then align those to figure out the angle between the vertebrae and again even with that there's at least a five degree margin of error um um I just want to again encourage you if you have questions don't hesitate and uh we' be happy to address as many as possible uh thank you again in advance for sending us all these questions send in your questions to questions allhealth tv.com or allhealth go on Facebook or YouTube or visit the askthe dooc page on our website allhealth tv.com welcome back so scoliosis can be graded based on its severity now this gradation is really mostly relevant to the idiopathic type the kiddos so miles scoliosis is between 0 and 25 really 10 and 25 because anything less than 10 is sort of normal physiological asymmetry uh moderate scoliosis uh uh 25 to 45 degrees many of these kids uh may also require no treatment and some actually often offered a brace to try to uh slow down the progression of scoliosis especially if they're about to go through their growth spurt severe scoliosis that's 45 and above and many of these kidos will be offered surgery uh but that in itself is a bit controversial as well and there's definitely uh a need to have a long discussion with your doc about the long-term repercussions of scoliosis surgery here's another email from one of our viewers this time it's from mareline Marine asks my son was recently Di diagnosed with idiopathic scoliosis his doctor said that he has a curve of 37 and he wants him to begin wearing a brace my son is pretty upset about having to wear a brace because he thinks other kids are going to make fun of him I'm so sorry that's terrible and I'm sure a lot of kids feel that way that said does he really need to wear braid at this juncture mine thank you for sharing with us this story um unfortunately due to the severity and the timing it may be reasonable to consider a brace but keep in mind that a brace is only effective if it's worn at least 20 hours a day so if you think that that's going to be an absolute impossibility it'd be good to have another discussion with your doc about whether it's even worth it living with scoliosis is not a sentence so remember this is not something that's dangerous or scary but it would be worth it to get a second opinion bracing if your Growing Child um is going to go through the growth Spirit it may be reasonable the brace tries to hold the body in in in a stable position um but uh again the relevance of bracing is with the amount of hours of use in the past casting has been tried as well obviously you can't take the cast off and it really commits somebody to a treatment casts also have to be changed changed every two to three months so again not a minor procedure and then finally surgery despite everyone's best efforts some curves do progress and there is a significant argument about addressing scoliosis where there's clear evidence of progression now the way that surgery addresses scoliosis is with something called a spinal fusion there are actually a few other methods but the spinal fusion is the most common so in this approach uh as you can see here in an x-ray a curved spine uh is exposed screws are placed into a curved spine and then rods are introduced that are bent in only one plane so the rods are introduced at an angle and then they are rotated to provide a sweeping immediate correction to the spine spine then appears much more straight but that segment of the spine will lose motion now a fused spine is is not a normal spine but if that means that we stuff the progression which may have its own delerious effects it's a reasonable thing to consider usually there's going to be about a 6 to 12 month recovery period after surgery many of these kidos will then need Rehabilitation physical therapy and there are repc there are repercussions long term as well as you lose Motion in that large segment of your spine other discs see more stress and we do see a significant number of patients as many as 10% come back with problems above or below uh Physical Therapy has been tried uh and physical therapy may be beneficial uh in the hands of some providers I personally am a bit more skeptical uh uh but if a child is not in pain and you see a mild scoliosis you may want to reconsider whether therapy is reasonable I would rather my kid play sports and please don't worry about things like having a child wear backpacks on one side or slouch uh the reality is uh we have great studies where kids with scoliosis were tracked for years and years and we just do not find that these type of asymmetrical activities produce worsening of scoliosis we have another YouTube question this is from Carmel Carmel asks I was diagnosed with scolio IIs as a child but I guess mine was pretty mild because it never really bothered me but now I'm I'm in my 60s I'm feeling pain in my back and I'm wondering if it's a problem now that's a really great question Carmela these are the kinds of patients who I help in my practice we spend a lot of time addressing scoliosis and kids but let's address scoliosis and seniors in fact I have a guest today Peter who had scoliosis surgery it would be great um for you to hear his perspective hi Peter welcome to ask the doc hello doctor how are you today thank you for having me thank you so much for joining us Peter tell us what was your experience like what were you experiencing before scoliosis surgery what was rehab like and how do you feel now okay uh my story is very much like carmelas I was diagnosed very typically with scoliosis when I was probably 12 years old gym class a gym teacher came around or a doctor came and checked everyone's backs and I had it but it wasn't bad enough that they felt the need to do something right then so I just the diagnosis then was just kind of like live with it and I did and I lived a very normal life yes I had a slight curvature I did not really have pain uh I like to think it made me shorter than I would like to have been but in truth maybe that's just how it is it wasn't until I got to my late 40s that it became like I started getting pains like car melis and she made to 60 I made it to about 49 when I was closer to 50 I started seeing doctors again about my scoliosis and they decided you should start thinking about surgery I said well when do I get surgery I've avoided it all this time and I lived the very normal life play sports did everything like normal people and I and eventually they just said you'll know when it's time and eventually structurally my back just wasn't holding me up anymore I was 50 years old and it was becoming hard to stay on my feet for more than two hours a day before the pain was too much and then I went in and I got my surgery they did the surgery like you talked about I got the the titanium rods put in it was a big surgery and it is a big recovery and um you know it took me I'd say six months before I started feeling myself and now that it's over it's not perfect I do not have back pain anymore and I can stand on my feet all day and I can walk all day but I'm not going to be hula hooping there's a lot of physical activities I'm not going to be mountain climbing there's a lot of things I can't do uh anymore and that's a little bit of the tradeoff right they repaired a lot but it's not a perfect fix in my case the doctor I'll wrap it up by by saying I felt there was a necessity because it was affecting my day-to-day life and I was also very lucky or my doctors were wise that I lived a pretty full life until 50 years old before I took such a a drastic step that was my journe uh Peter I really appreciate you sharing the story with us and uh thank you so much for joining us on ask the dock thank you here are my thoughts regarding scoliosis surgery especially for the elderly I'm a proponent of surgery but only if conservative care has been met and if the surgery corrects the problem that brings the patient to the office it is not a onetoone relationship between back pain and scoliosis some patients suffer from degenerative diss some suffer from stenosis or other conditions so it would be very important for your doc to truly understand indeed with certainty that yes I can tell you your back pain comes from your scoliosis because so many patients who come to see me find that that is not the case it could be a number of other problems as I mentioned and uh um with spinal degeneration other structure degenerate nerves get compressed so it's very very important before you rush into surgery that you obtain a solid diagnosis that you know for sure that if you have scoliosis surgery you will recover and you will no longer have the original symptoms um there are a number of ways to try to avoid surgery there are facet injections that aim at back pain that results from the rotational element of scoliosis that hurts the joints in the back of the spine uh the facet injections uh not only aim to help the patients they also similarly solidify the diagnosis and if you are sure that your pain is coming from those joints there's something called radio frequency ablation they can desensitize those joints and again avoid surgery physical therapy may help and if you do decide to have surgery the modern way to address scoliosis is not with sort of like a single swooping correction but with these small incisions done on the side of the patient's body where we sneak in remove each of these trapezoidal discs one at a time and implant symmetrical cages which will even the patient and make the patient back to straight in a frontal plane in a much more gentle and sort of a slow way um this may result in a faster recovery and in many of patients who have the surgery also lowers the risk of problems above and below early diagnosis and treatment can improve the Outlook of many children with scoliosis and monitoring is particularly important during growth spurts I just want to remind you uh growth spurts occur between 10 and 14 years old for boys and 12 and 14 for girls so if you're worried about scoliosis in your Kido please don't hesitate and talk to your doc most children and teens diagnosed with scoliosis can look at a normal life life without surgery so don't rush into anything aggressive and uh for the elderly again I just want to make sure that uh before you rush into surgery definitely get a second opinion for those of you who already had spine surgery for scoliosis and continue to suffer that's still not the end of the game many patients who continue to have symptoms after scoliosis surgery can still be corrected in a in a modern minimally invasive way just a reminder you can catch our show every weekday at 12:30 and we'd really like to encourage you to send in more questions you can send in questions at questions allhealth tv.com or you can put them in the comment section of our Facebook page Facebook at allhealth go or on YouTube YouTube at allhealth go and finally please consider visiting our website uh I appreciate you joining us remember surgery is the last resort if you are being rushed into surgery get a second opinion and if you've had surgery and you are still suffering you can still get it corrected and you can still have normal life thank you again for joining us on uh all Health go on ask the doc and I look forward to talking to you again thank you again Peter send in your questions to questions allhealth ttv.com or allhealth go on Facebook or YouTube or visit the ask the do page on our website allhealth tv.com e