Managing Adult Scoliosis
A Patient's View On Dealing With Deformity
By Rhonda Mann
The worst part of my day comes at the very beginning.
I open my eyes and the pain hits me immediately-- a jabbing into my right ribcage. Somehow, I have to do it. I have to get out of bed.
I take a deep breath and with both hands physically lift my right leg off the side of the mattress, then gently glide my left leg onto the floor. I sit up and stay there for about a minute before attempting to stand. Sometimes the sharp pain or stiffness overcome me and thrust me back to sit on my bed, and start again. Sometimes my legs don't feel like they can hold the rest of me.
This is what it is like to be age 45 and have scoliosis -- a spine that dances into an "S" shape in my lower back, pushing and rotating my right ribs and throwing off the balance of the rest of my back, shoulders and neck.
Scoliosis affects some 2-3 percent of the population, or about 6 million people in the US, according to the National Scoliosis Foundation. It most commonly appears during adolescent years, between the ages of 10 and 15. And according to Dr. Paul Glazer, scoliosis specialist and researcher at Beth Israel Deaconess Medical Center in Boston, the exact cause remains unknown.
"If you have a family member who has scoliosis, you are at increased risk of developing a spinal curvature as well. But it remains a mystery why some young teens develop idiopathic scoliosis and others do not," says Dr. Glazer.
I was diagnosed when I was 13. As a young gymnast, my leotard couldn't hide the deformity. I was put into a back brace for 8 years, 23-hours-per-day which seemed to halt the progression of the curve. But after I had my third child, at age 36, the scoliosis returned, and since has worsened by about 2 degrees per year.
Treatments can include physical therapy and pain medications and injections. For those with more than a 50 degree curve, surgery can be an option. But it is not an easy solution.
"Surgery involves a correction of the deformity and a fusion to hold the spine in a corrected position. This is accomplished by using instrumentation such as screws and rods which allow for the immediate post-operative mobilization of the patient," says Dr. Glazer. "It can be a difficult recovery, which can take up to six months. Patients need to be mentally and physically ready for it."
Complications can include infection (2-20 %), neurological problems (less than 5 percent) and death (less than 5%). About one-quarter of patients will need a second surgery because of the failure of the bones to fuse and about a third of patients will still have lasting pain even after the procedure and recovery. Still, some 38,000 scoliosis patients undergo spinal fusion surgery each year.
The good news is that there have been advances in these surgical procedures. Many correction surgeries are now done with incisions not thru the patient's back, but through the anterior or front, allowing for quicker healing and reducing the number of levels fused. There are also advances in bone grafting, a necessary part of the surgery to hold the spine permanently in the corrected position. Unlike past procedures, which transplanted bone from the hip, Dr. Glazer says new, synthetic bone morphogenic proteins can facilitate healing.
"Bone Morphogenic Protein or BMP is applied anteriorly where the discs were removed," explains Dr. Glazer. "The BMP rapidly stimulates bone growth."
As for me, my curve is about 52 degrees but my doctor points out that despite my moderate pain that I control with medication, I still am doing pretty well. I get to the gym most days, and am able to work. Overall, it hasn't impacted most of what I do on a daily basis. Plus, I'm hoping that if I can wait a few more years before surgery, there may be newer implants and techniques that make recovery even easier.
"Advances in this field are happening all the time and extensive research is being performed to understand the genetic cause of scoliosis," notes
I am looking forward to that day when I can open my eyes, swing my feet over the bed and know I have a great day in front of me - one without pain.
Above content provided by Beth Israel Deaconess Medical Center.
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