Christopher R. Good, MD, a spine surgeon at the Virginia Spine Institute in Reston, discusses the challenges associated with diagnosing and treating idiopathic scoliosis as well as the most recent research and innovation in the field.
Q: What are some of the challenges of treating young patients with scoliosis?
Dr. Christopher Good: When it comes to young patients, it's always important to convey the information to the patient and the rest of the family. Young people have very high expectations as to what their activity levels will be and what level of restriction they want to avoid. They're always looking to maximize function within days and weeks, but the physician is also thinking years down the road. We also have to make sure to evaluate the young patient comprehensively and evaluate the whole spine and overall medical condition before deciding on the best treatment options.
Q: How do you identify patients with scoliosis and decide which treatment types are appropriate for each different patient?
CG: People with scoliosis often feel that they have a curvature in their spine. Some patients may also feel as though there is a difference in their shoulders or hips. Most teenage patients with scoliosis do not have any pain. The basic treatment options for adolescent scoliosis are either observation of the scoliosis, bracing or surgical treatment. In general, observation is appropriate for smaller curves, while bracing is used to help keep scoliosis from getting worse while a patient is still growing. Surgical treatment is typically reserved for curve that have continued to progress despite other treatments, usually to 45 degrees of curvature or larger.
Many times, patients with scoliosis can actually see or feel that the curve has changed over time. In the office we examine the patient clinically and we look at the x-rays with the patients, to see how things are changing and make the treatment decisions. We talk together about the different treatment options. Most of the patients I see have a small scoliosis and many don't experience a worsening curve. For most of my patients, I am able to reassure them and their families and only observation of the curve is needed. For patients with curves that are getting larger, we review treatment options for the future.
Q: How do you convince patients who need to wear the brace to keep it on if they don't want to?
CG: Most of my patients can see the curve is getting worse over time and then decide to use the brace because they want to avoid surgery. This can be a difficult decision for patients and I will commonly put my patients in touch with another patient who has had similar scoliosis so they can talk to each other and learn about what it was like to go through the treatment. That is really reassuring for a lot of patients. We try to help them understand why wearing the brace is their best option, but some still chose not to wear the brace and opt for surgery. That's something we do see and it's a reasonable decisions for the patient and the family on occasion.
Q: For surgical scoliosis correction, what are the latest innovations?
CG: Right now, the most common surgery performed is a spinal fusion procedure. The surgery involves fixing onto the spine with metal implants to correct the curvature and hold the spine in place while the fusion occurs. In the areas where there is fusion, there is no longer motion. New technologies have developed to try to treat scoliosis without the fusion. In these procedures, small staples or other implants are put along the spine to slow down the curvature.
For the patients who do need a fusion, there have been a multitude of advancements over the past few decades. In previous years, patients commonly had to wear a cast or brace for months. Now almost all patients can get up and walk the same day of surgery and most do not need any brace after surgery. The improvements allow for a much faster recovery and return to daily life and activities.
Q: What is at the forefront of research for idiopathic scoliosis?
CG: There's a lot of research in this area right now, but we still haven't identified a single cause for scoliosis. One exciting area of research involved genetic testing for scoliosis. It has been shown that scoliosis tends to run in families and recent research breakthroughs have allowed us to use genetic testing to predict which patients with scoliosis are at a high risk for the scoliosis progression. This exciting breakthrough allows us to reassure many patients that their scoliosis has a very low probability of ever getting worse and for the few patients who are likely to have progression, we can offer earlier and more appropriate treatments.
Learn more about Virginia Spine Institute on their award-winning website.
Read other coverage on spine surgery procedures:
- The Trend Toward Minimally Invasive Spine Surgery: Q&A With Dr. Bryan Massoud of Spine Centers of America
- Making the Case for the Endoscopic Approach to the Lumbosacral Spine: Q&A With Dr. Richard Kaul of New Jersey Spine & Rehabilitation
- Correcting Failed Back Surgery Syndrome: Q&A With Dr. Alfred Bonati of The Bonati Spine Institute
Q: What are some of the challenges of treating young patients with scoliosis?
Dr. Christopher Good: When it comes to young patients, it's always important to convey the information to the patient and the rest of the family. Young people have very high expectations as to what their activity levels will be and what level of restriction they want to avoid. They're always looking to maximize function within days and weeks, but the physician is also thinking years down the road. We also have to make sure to evaluate the young patient comprehensively and evaluate the whole spine and overall medical condition before deciding on the best treatment options.
Q: How do you identify patients with scoliosis and decide which treatment types are appropriate for each different patient?
CG: People with scoliosis often feel that they have a curvature in their spine. Some patients may also feel as though there is a difference in their shoulders or hips. Most teenage patients with scoliosis do not have any pain. The basic treatment options for adolescent scoliosis are either observation of the scoliosis, bracing or surgical treatment. In general, observation is appropriate for smaller curves, while bracing is used to help keep scoliosis from getting worse while a patient is still growing. Surgical treatment is typically reserved for curve that have continued to progress despite other treatments, usually to 45 degrees of curvature or larger.
Many times, patients with scoliosis can actually see or feel that the curve has changed over time. In the office we examine the patient clinically and we look at the x-rays with the patients, to see how things are changing and make the treatment decisions. We talk together about the different treatment options. Most of the patients I see have a small scoliosis and many don't experience a worsening curve. For most of my patients, I am able to reassure them and their families and only observation of the curve is needed. For patients with curves that are getting larger, we review treatment options for the future.
Q: How do you convince patients who need to wear the brace to keep it on if they don't want to?
CG: Most of my patients can see the curve is getting worse over time and then decide to use the brace because they want to avoid surgery. This can be a difficult decision for patients and I will commonly put my patients in touch with another patient who has had similar scoliosis so they can talk to each other and learn about what it was like to go through the treatment. That is really reassuring for a lot of patients. We try to help them understand why wearing the brace is their best option, but some still chose not to wear the brace and opt for surgery. That's something we do see and it's a reasonable decisions for the patient and the family on occasion.
Q: For surgical scoliosis correction, what are the latest innovations?
CG: Right now, the most common surgery performed is a spinal fusion procedure. The surgery involves fixing onto the spine with metal implants to correct the curvature and hold the spine in place while the fusion occurs. In the areas where there is fusion, there is no longer motion. New technologies have developed to try to treat scoliosis without the fusion. In these procedures, small staples or other implants are put along the spine to slow down the curvature.
For the patients who do need a fusion, there have been a multitude of advancements over the past few decades. In previous years, patients commonly had to wear a cast or brace for months. Now almost all patients can get up and walk the same day of surgery and most do not need any brace after surgery. The improvements allow for a much faster recovery and return to daily life and activities.
Q: What is at the forefront of research for idiopathic scoliosis?
CG: There's a lot of research in this area right now, but we still haven't identified a single cause for scoliosis. One exciting area of research involved genetic testing for scoliosis. It has been shown that scoliosis tends to run in families and recent research breakthroughs have allowed us to use genetic testing to predict which patients with scoliosis are at a high risk for the scoliosis progression. This exciting breakthrough allows us to reassure many patients that their scoliosis has a very low probability of ever getting worse and for the few patients who are likely to have progression, we can offer earlier and more appropriate treatments.
Learn more about Virginia Spine Institute on their award-winning website.
Read other coverage on spine surgery procedures:
- The Trend Toward Minimally Invasive Spine Surgery: Q&A With Dr. Bryan Massoud of Spine Centers of America
- Making the Case for the Endoscopic Approach to the Lumbosacral Spine: Q&A With Dr. Richard Kaul of New Jersey Spine & Rehabilitation
- Correcting Failed Back Surgery Syndrome: Q&A With Dr. Alfred Bonati of The Bonati Spine Institute