Treating Idiopathic Scoliosis in New Jersey
When the cause of a disease is unknown, it is deemed idiopathic. Many medical conditions are idiopathic, including scoliosis. Centers for Neurosurgery, Spine & Orthopedics specializes in diagnosing and treating various types of spinal deformity, such as idiopathic scoliosis. At Centers for Neurosurgery, Spine, and Orthopedics (CNSO), our team of renowned scoliosis neurosurgeons, orthopedic spine surgeons, pain management doctors, and physical therapists provide a comprehensive treatment plan tailored to each patient. Discover more about the disease and possible treatments in northern New Jersey.
What Is Scoliosis?
The body is made up of three planes — axial, coronal, and sagittal. The coronal plane is vertical, separating the body into front and back sections, while the axial plane divides the body into sections horizontally. The sagittal plane, which is key to understanding scoliosis, separates the body into sections laterally from right to left.
Normal human spine anatomy has curves visible in the sagittal plane at points throughout the cervical, thoracic, and lumbar regions. These curves support movement and shock absorption. In other words, it is normal for the spine to curve slightly in specific regions of the spine.
Scoliosis occurs when the spine curves irregularly from right to left. People with the disease often have a more pronounced spine curvature that mimics the shapes of the letters “C” or “S.” There are several known classifications of f scoliosis, such as degenerative or neuromuscular scoliosis, but the cause is unknown (idiopathic).
Scoliosis can present at any age and to varying degrees. A spine specialist will make the distinction between treating adolescent versus adult scoliosis. A pediatric practice should treat a young adolescent.
How Does Idiopathic Scoliosis Differ from Other Types?
Idiopathic scoliosis often is detected earlier in a patient’s life, particularly during childhood and adolescence growth spurts. Scoliosis screening is standard in a physical examination of a child. In the United States, more severe cases are detected during school physical examinations. Less severe cases, asymptomatic cases, do not become detected until a radiologic image or symptoms begin to occur. Consequently, adults also may be diagnosed with idiopathic scoliosis.
Degenerative scoliosis is attributed to aging and the natural wear and tear of the spine but why some individuals develop it versus others is unknown. Degenerative scoliosis stems from arthritis of the spine, which is called spondylosis. Degeneration of the spine makes it difficult for the vertebrae to remain aligned, leading to abnormal curvature of the individual vertebra.
Neuromuscular scoliosis occurs because a neuropathic condition stunts the development of muscle groups. This lack of proper muscle growth can cause asymmetry within the vertebrae. People with neuromuscular scoliosis may have a curved spine that resembles the letter “C.”
Symptoms of Scoliosis
How symptoms present depends on the severity of the disease. Physicians determine how severe scoliosis is by measuring the degree of curvature. The following are physical signs of the disease:
Uneven shoulders, hips, or waist
Appearance that the body leans to one side instead of standing upright
Head seems not centered with the pelvis
One leg seems longer than the other, possibly causing an irregular gait
Shoulder blades stick out
Hips are abnormally elevated
One rib cage is higher than the other
Unbalanced muscle growth along the spine
Changes to the skin near the affected area of the spine, such as unusual colors, dimples, or hair
If scoliosis causes a great enough curvature, a patient may experience pain throughout the body, including in the back, hips, and legs. They may have difficulty breathing, making it challenging to exercise. More severe cases can cause problems with vital organs, such as the heart and lungs, because a severely curved spine can cause the lungs to be restricted and place pressure on the heart, limiting both in their ability to expand and contract as necessary.
Risk Factors for Scoliosis
Despite most cases of scoliosis being idiopathic, researchers have noticed some factors that may compound a patient’s risk of developing the disease. These include:
As mentioned, idiopathic scoliosis often is spotted in children and adolescents. Spine specialists believe degenerative scoliosis is sometimes a manifestation of idiopathic scoliosis.
Age 10 to 15 is the primary range of onset for scoliosis. While the disease occurs equally in males and females at this stage, females are much more likely to experience a curved spine that requires treatment.
People who develop scoliosis often have a family member or close relative who also has the disease. As such, many doctors will ask patients about their family history when diagnosing them with idiopathic scoliosis.
Some neuromuscular conditions can increase the risk of scoliosis. Cerebral palsy, caused by a neurologic abnormality in the brain, permanently impacts movement and coordination. The distorted ability to move since birth can affect the growth and alignment of the vertebrae, potentially leading to scoliosis. Other conditions that may have a similar effect include spina bifida and muscular dystrophy.
Diagnosing Idiopathic Scoliosis
When first diagnosing scoliosis in adults, doctors will conduct a physical examination of the various parts of the body most affected by the disease, such as the spine, shoulders, ribs, and hips. There is a special tool called an inclinometer (or scoliometer), which enables physicians to measure the degree of a curved spine.
If the spine angle exceeds 10 degrees, it suggests a patient has scoliosis. Measurements between 25 and 30 degrees indicate a more serious case of scoliosis, and those higher than 45 to 50 degrees are the most severe, often requiring aggressive treatment.
Imaging modalities can give physicians more insight into the angle, shape, direction, and location of a curved spine. A primary care doctor may order an x-ray to confirm their suspicion of scoliosis and then refer the patient to a neurosurgeon or orthopedic spine surgeon to review the imaging and decide if any further imaging is necessary.
Below is a review of the types of imaging necessary based on the level of scoliosis initially detected on the x-ray:
An X-ray — or a radiograph — is a medical imaging technology used to view bones and organs, enabling the doctor to confirm diagnoses. With spine conditions and deformities such as scoliosis, a doctor trained to review x-ray images, will assess the presents of scoliosis or not.
MRI stands for magnetic resonance imaging, a common diagnostic test for diagnosing diseases and monitoring a patient’s treatment progress. An MRI scan allows physicians to look at the spinal cord, nerve roots, and nearby structures, and highlights areas of degeneration and deformity.
MRI technology allows for detailed, three-dimensional images of the body through the use of electrical magnetic force fields. The technology allows the viewing of soft tissue, which nerve tissue is considered, along with other vital organs.
MRIs do not rely on radiation. During an MRI, the patient lies on a flatbed that slowly moves within a large magnet. Depending on which aspects of the anatomy the treating physician is seeking to evaluate, the patient may receive a contrast dye to generate a brighter image of the anatomy to be evaluated. In general, contrast dye is not required for the evaluation of scoliosis.
Computed tomography (CT) uses X-rays to generate images of the body, but instead of a fixed snapshot of one image, the CT scan takes multiple image slices, either axial, coronal, or sagittal. The CT machine rotates and takes pictures of the body, which are collected by the computer as slices. These slices can be combined to craft three-dimensional models of the body.
With scoliosis, CT scans can reveal the size and shape of the spinal canal, as well as adjacent structures. It is particularly beneficial for visualizing bone and can help identify multiple diseases and injuries.
As with MRIs and X-rays, patients may receive a contrast agent to assist with the results, however, contrast is not necessary when evaluating scoliosis. The entire scan should take only a few minutes, and some can be completed in less than 30 seconds. Individuals will need to remain still during the procedure and may need to hold their breath for several moments to ensure an accurate reading.
As with other X-rays, patients who undergo CT scans will encounter radiation. While it is possible to develop cancer from radiation exposure, the risk is relatively small. Other complications to consider include:
Pregnancy: If a pregnant woman needs a CT scan in or around the abdomen or pelvis, there is some risk the test can affect the fetus.
Allergic reaction: The contrast dye used to aid with CT scans can spark an allergic reaction in some patients.
Treatment for Idiopathic Scoliosis
Before settling on treatment, a doctor trained as either a neurosurgeon or an orthopedic spine surgeon will consider several factors. These aspects help determine the most viable treatments:
Bone maturity: If a patient’s bones have stopped growing, the probability that the curvature of scoliosis will continue to worsen decreases.
Curve location: If the spinal curvature occurs in the thoracic region, however, some expert researchers believe scoliosis may continue to worsen beyond adolescence.
Curve severity: A more severe curve will warrant more aggressive treatment.
Curve shape: How the spine curves will dictate treatment (the “S” shape is more common with idiopathic scoliosis)
After considering these variables, plus the general health of the patient and the biomechanics necessary to improve the patient’s symptoms, a spine surgeon, either a neurosurgeon or an orthopedic spine surgeon, will recommend treatment. Treatment options include:
Observation may not seem like much of a treatment, but it can be vital for determining when to intervene. Children and young adults with scoliosis whose symptoms are mild may undergo observation for some time to confirm symptoms are improving. This may involve getting an X-ray every few years to confirm whether the curvature is staying the same, or worsening. If symptoms are advancing, doctors may reevaluate other treatments.
Physical therapy is a trusted non-surgical treatment for many injuries and diseases. This hands-on solution helps strengthen the body and increase mobility and flexibility. For patients with scoliosis, physical therapists provide exercises to help patients minimize or eliminate any of the pain of living with a curved spine. Physical therapy often involves back and abdominal core strengthening.
At Centers for Neurosurgery, Spine & Orthopedics, the certified physical therapists work with board-certified neurosurgeons, orthopedic spine surgeons, and pain management to develop exercises tailored to the patient’s situation. In addition to physical exercise, other methods include:
Heat and cold therapy: Heat can stimulate energy and oxygen to affected areas of the body, reducing the sensation of pain and potentially increasing healing. Cold (ice) can lower inflammation and swelling.
Manual therapy: This technique involves applying pressure to affected areas and moving them manually to alleviate pain.
Ultrasound therapy: Ultrasound uses sound waves to energize muscles and tissue impacted by scoliosis. Energizing these muscles and tissues can accelerate healing.
Electrical stimulation: Electrical stimulation enables contractions in inactive muscles to help restore function.
Chiropractic adjustment also may be viable for alleviating the pain of scoliosis. Similar to physical therapy, this alternative involves using manual techniques and special tools to affect joints, ultimately reducing discomfort and setting the body in greater alignment. Methods chiropractors use include:
Exercises and stretches
Soft tissue therapy
Chiropractic treatments can be beneficial for improving symptoms of idiopathic scoliosis that impact the musculoskeletal system, such as lower back pain, without medication. However, patients should consider this solution only to help boost their quality of life. Chiropractic adjustment cannot cure scoliosis, and research is still in development regarding the actual benefits of the treatment for this spinal deformity.
Therefore, patients considering seeing a chiropractor for help should ensure they choose a practitioner who specializes in scoliosis or the spine. Patients who choose general chiropractors may find treatment can worsen their symptoms.
If conservative treatments prove ineffective for treating idiopathic scoliosis, physicians may recommend patients seek spine surgery. The indication most medical professionals rely on is the degree of spinal curvature. If it exceeds 40 to 45 degrees and shows signs of progression, surgery may be necessary. The following are several descriptions of the types of surgical procedures necessary if the scoliosis curvature is so severe that it requires scoliosis surgery:
Laminectomy (Decompression Surgery)
The spine is comprised of vertebral bones. On the posterior area of the vertebrae are bony arches called laminae. When performing a laminectomy, neurosurgeons or orthopedic spine surgeons remove a portion of the lamina to access a portion of the spine or alleviate pressure off the spinal cord and surrounding nerves.
A routine procedure, the laminectomy typically takes about one hour but depending on the number of vertebrae involved with the curvature of the scoliosis, more than one level may need to be corrected. If it is only one level, the patient can usually go home the same day. The spine surgeon will schedule a follow-up appointment in one week. Patients will need to restrict their activities for a period following the spine surgery, and those whose jobs involve physically demanding responsibilities may need to wait longer to return to work.
Fusion surgery is necessary to restructure and support the vertebral bones and spine joints impacted by a spine disease such as scoliosis. A fusion surgery secures vertebrae in the correct alignment, promotes greater strength and stability, and provides pain relief. This surgery is required for patients whose vertebral bones have become severely misaligned, deformed, damaged, or arthritic, as with scoliosis and spondylolisthesis.
During fusion surgery, the neurosurgeon or orthopedic spine surgeon will make a small incision above the affected area to gain access to the damaged spine vertebrae and remove the pathology. The spine vertebrae are then aligned properly, and surgeons may insert a bone graft into the fusion area to ensure it maintains the correct height. Hardware, such as titanium plates or pedicle screws, is added to keep the bones in the right position and nurture bone growth.
The neurosurgeons and orthopedic spine surgeons at Centers for Neurosurgery, Spine & Orthopedics strive to use minimally invasive spine surgery techniques including robotics when treating scoliosis. Fusion surgery takes about two hours, with many patients capable of walking independently only a few hours following the procedure. In most cases, patients are free from pain after just one month of recovery.
Recovery will require avoiding certain activities, such as bending, lifting, and twisting, for at least two weeks. Although strenuous activity is not recommended, patients are encouraged to stay active by walking. By 12 weeks, most patients can return to normal activities, but those whose jobs require heavy lifting and similar tasks may need to wait longer. Spine surgeons generally prescribe post-operative rehabilitation medicine, as well, within a couple of weeks after the surgery.
As with all types of spine and back surgery, spinal fusion comes with some risks. Complications of the procedure may include bleeding, infection, nerve damage, and spinal fluid leak. However, these reactions are rare, and the team of neurosurgeons and spine surgeons at Centers for Neurosurgery, Spine & Orthopedics works diligently to ensure the safety of patients and the efficacy of surgical treatments.
Seek Comprehensive Treatment of Idiopathic Scoliosis in New Jersey
Dealing with adult idiopathic scoliosis can be difficult, especially if the disease continues to progress. Patients can find relief and peace of mind about their care by visiting Centers for Neurosurgery, Spine & Orthopedics. The surgical and non-surgical teams follow a conservative approach to pain management and treatment of spine conditions and deformities, such as scoliosis, empowering them to experience less pain and a higher quality of life.
The comprehensive care team consists of neurosurgeons, orthopedic spine surgeons, interventional pain management physicians, physiatrists, rehabilitation specialists, and certified physical therapists. These dedicated providers coordinate care to ensure patients receive personalized treatment at all stages, from pain management and physical therapy to surgery if necessary.
CNSO has office locations throughout northern New Jersey, including Bergen, Passaic, Essex, Morris, and Hudson counties, making it easier for patients across the region to seek treatment.
For more insight into the symptoms and diagnosis of idiopathic scoliosis, or to learn more about the various treatment options for any spine condition, contact Centers for Neurosurgery, Spine & Orthopedics today to schedule an appointment.