The spine is a curved structure. This helps with weight-bearing, balance and shock absorption. Scoliosis is a three-dimensional, abnormal curvature of the spine often affecting the thoracic and lumbar regions. This condition may be present during adolescence or as an adult.
When significant enough, it is associated with uneven appearance of the shoulders and/or hips, uneven appearance of the shoulder blades, or a prominence of the ribs (“rib hump”), often most noticeable when bending over forward. Many patients have no other symptoms, but in advanced cases or when another underlying condition is involved, patients may have a wide variety of problems including back pain, leg numbness/tingling or weakness, bladder symptoms, compromise of heart or lung function, etc. Some patients do not get worsening over time (“stable”), while others develop increasing symptoms or curvature over time (“progressive”).
For children, treatment options for scoliosis are based on age, gender and the location and severity of the curve. The curvature is monitored closely and, if necessary, managed with bracing. Bracing does not cure scoliosis, but it may impede further progression of the curve. If the curve advances despite conservative measures or the measurement of the curve is greater than 40° to 50°, surgical correction is often considered. With adult scoliosis, treatment planning is generally based on severity of pain and functional limits. Because of the malalignment of the spine, pain may arise from the facet joints, sacroiliac joints or nerve root compression. The pain from these conditions is managed with physical therapy, medication, facet injections, sacroiliac joint injections or epidural steroid injections. If pain persists or physical function is significantly limited, surgery may be considered. Posterior lumbar fusion (PLF), combined with pedicle screws and rods, is used to re-align the spine. Sometimes, anterior lumbar interbody fusion (ALIF) is also done to create a 360° fusion (fusing the front and back portions of the spine). It is important to discuss treatment options with your doctor in deciding which treatment, if any, may be best for you.