Crooked of Joint, Bent of Bone… (Scoliosis)

Scoliosis is not some far-off or uncommon disease, although many people are unaware they even have it. It has been found that a large number of Thai people have scoliosis and may have had it since adolescence, but have never received treatment.

The spine has a natural, healthy curvature slightly inward and gently outward, which helps to balance the body. When you bend over, the spine should be in a straight line forward. However, for those with scoliosis, the spine is twisted, misshapen or curved to the left or right, causing the shoulder, waist and/or hips to be uneven. Scoliosis may occur in any part of the spine, although in children, the curvature will frequently be found in the upper back, while in adults, it is often found in the lumbar region.

In more than 80% of scoliosis cases, the cause is not known. In children under the age of 18, scoliosis may be due to defects present at birth because of uneven bone growth or neuromuscular disorders. A curvature of more than 60 degrees can be dangerous. If the scoliosis is in the upper or thoracic spine, patients can have difficulty breathing and become tired easily as their ability to breathe in and out is limited due to rib deformities causing incomplete expansion of the lungs. If the curvature is in the lower part of the spine, the lumbar region, this can cause problems with the digestive system, flatulence, digestion and proper bowel functions, etc., as the rotation may put pressure on organs in the abdominal cavity.

For many adults, scoliosis may have been a problem since adolescence but one that was never treated, resulting in even greater curvature developing. This, when coupled with the bone degeneration that often occurs with age, can cause back pain that may also radiate down the leg. In some patients, if the scoliosis was treated but they had not fully recovered, it can be recurrent as well.

You may not yet even know whether you have scoliosis or not, as if it is a mild case without visible symptoms, you may not have noticed it. Try looking in the mirror and observing whether one shoulder is higher than the other and whether your hips tilt to one side or the other. If you notice a misalignment or that one side is higher than the other, then it is possible you may have scoliosis. There is another method to help examine for scoliosis, but you may need to rely on the help of someone else to check. With this method, stand up straight and then bend forward as far as you can and try to touch your toes with your fingers. In this position, the horizontal plane of the spine can be viewed clearly to see whether or not there are any abnormalities in the spinal curve. If you have any suspicions, you should make an appointment with a doctor to confirm diagnosis with an x-ray, as an x-ray can provide the clearest confirmation of the results and can measure the degree of the curvature as well.

Patients with mild cases, involving a very minor curvature and no real symptoms, are usually able to carry on with their normal lifestyle and daily activities. They should, however, be careful to observe whether there is any increase in the curvature or worsening of the condition and, if symptoms occur, they should see a doctor immediately. However, patients should seek out treatment immediately if they have more severe back pain that may also be radiating down their leg, as this can be due to spinal stenosis, disc herniation, or pressure and squeezing of the nerves.

Treatment for scoliosis has 2 main purposes:

• Treatment to maintain the appearance of the back
• Treatment to relieve pain

A large number of people with scoliosis do not require treatment, due to a low degree of curvature. However, they should, nonetheless, continue to monitor their condition closely. For those who do require treatment, this can be accomplished via the following:

Non-surgical Treatment
In cases of scoliosis with mild curves and relatively minor pain, treatment can involve the use of pain-relief medications, the wearing of a brace to help increase flexibility and to prevent spinal curvature from worsening, and the monitoring of the condition with a follow-up visit approximately every 6 months.

Surgical Treatment
Children should generally wait until their bones have stopped growing before undergoing surgical treatment. There are some cases, however, where surgery must be carried out urgently before even greater deformity develops and causes other serious complications.

In adults with symptoms of severe pain and/or pain radiating down the leg, the main principles of surgical treatment are as follows:

• To remove the intervertebral disc or bone spurs to help reduce some of the pressure on the nerves.
• To strengthen and stabilize the affected area with fusion using the placement of a metal rod and screws into the spine.
• To reduce the deformity and improve and straighten the affected area of the spine.

The heart of surgical treatment for scoliosis is the lengthening of the spine. Therefore, the length of the spinal instrumentation for fixation of the spine must be correct and appropriate to the individual patient. If fusion is too rigid, nerves can become stretched. If it is too little, curvature may develop again in other portions of the spine.

The Evolution of Scoliosis Surgical Treatment
Surgical treatment for scoliosis originally did not involve the use of metal implants to splint the spine, but rather a body cast to help straighten the spine. A window was then cut in the back of the cast and surgical fusion was performed through this window.  Later, the method of internally fixing a metal rod was introduced to immobilize and hold the spine in place, after which the patient was kept in a plaster cast until they recovered, at which time it would be taken off. In spinal fusion procedures today, however, doctors can perform internal fixation of the spine using metal rods held in place with hooks and screws. These metal implants do not need to be removed after surgery, which means there is no need for the pain of a second surgery for the removal of the implants.

The Scoliosis Research Society (SRS)
The Scoliosis Research Society is an international society that was founded in the United States of America. Current membership includes a distinguished group of 1,000+ world-leading doctors and allied health personnel committed to research and education in the field of spinal deformities and scoliosis.

The Scoliosis Research Society was founded because many doctors were encountering the problems of scoliosis in their patients but, at the time, did not have effective treatments. They therefore joined together to perform joint study and research, particularly in order to better understand the disease in those for whom no cause could be found. For example, one group carried out eye research, and another researched hormones, while yet another researched ways to prevent and treat the disease. In this way, they made it possible to treat patients more effectively.

Membership in the society allows doctors to become more knowledgeable as they share from their wide variety of individual experiences, which in turn enables treatment to continuously develop and improve.

“The problem of scoliosis may seem to be a distant subject for many people, but no one should neglect the issue of proper care for their spine and back. Scoliosis may not always require treatment, but proper knowledge and care of ourselves can help to prevent future problems. Parents should always help to look out for any unusual physical signs or symptoms, so that any disorder or abnormality can be treated promptly and correctly.”