Scoliosis is a spinal condition estimated to affect 2-3% of the population, and when severe, can threaten lung and heart function. To bring broader public awareness of scoliosis, the National Scoliosis Foundation and Congresswoman Allyson Schwartz (PA) arranged for June 2008 to be first annual National Scoliosis Awareness Month. Since then each June numerous agencies, including the prestigious Scoliosis Research Society, provide information to aid in understanding the condition, means for treatment and ways to lead to early diagnosis and treatment to reduce health risk.
Scoliosis has numerous associated causes, including diseases of the muscles or nerves and those that alter bone or cartilage, but most patients have no obvious cause and are diagnosed with idiopathic scoliosis. Idiopathic scoliosis is more common in women and tends to run in families, and there is growing evidence for a genetic basis controlling the condition, including a new commercially available genetic screening test to categorize children into low and high risk for curve progression. The diagnosis is typically suspected by the patient’s primary care physician or through friends and family noticing shoulder asymmetry and is confirmed by a spine specialist using x-rays. Scoliosis on an x-ray is measured by drawing lines along the borders of spine vertebrae and then calculating the angles that are generated; the condition is diagnosed when the angle is 10 degrees or greater on a back-to-front spine x-ray. Scoliosis is at greatest risk for rapid increase in size during the growth spurts that occur during childhood.
Treatments are tailored to a particular patient and are different for growing and adult patients. Mild scoliosis in either age group is observed intermittently with follow-up exams and x-rays on a regular basis to determine that the curve is not progressing. Moderate scoliosis (25-35 degrees) in children may require the patient to use a brace that supports the spine during growth to better ensure that the curve does not continue to increase in size. Adults are not braced commonly as they are not growing taller, and their scoliosis is usually managed with exercises. Severe scoliosis in either age group may require surgery to stabilize the spine, to restore a more normal alignment and to prevent further progression. Surgery in growing patients is commonly required due to relentless curvature progression, while adults tend to require surgery for arthritis and pain symptoms that can develop in the spine over time.
Matthew E. Cunningham, M.D., Ph.D, is an orthopedic surgeon at the Spine Care Institute at Hospital for Special Surgery. Dr. Cunningham has clinical interest in thoracic and lumbar spine care, including spinal deformity (scoliosis, flatback, kyphosis, and spondylolisthesis) for adult and pediatric patients, and degenerative problems (stenosis, herniated discs, arthritis, instability) in adults. In consideration of each and every patient, he focuses on the discovery and refinement of less-invasive, less-painful, and less-disruptive ways to correct spinal pathology.
