For adult scoliosis, surgery, other treatments are viable options

For years, spine surgeons have debated the best methods for treating scoliosis in adults. Spinal curvature often results in more back pain, leg pain and other symptoms for adults than teens because adults also can have degeneration in the discs between vertebrae, and spinal stenosis—a narrowing of the opening for the spinal nerves. Still, there hasn't been good evidence regarding whether it's better for adults with scoliosis to have corrective surgery or whether nonoperative treatment, such as physical therapy or nerve injections, is adequate.

To help answer that question, doctors at nine centers in North America followed more than 200 adults who had discomfort due to lumbar scoliosis—deformities affecting the lower part of the spine. The NIH-funded trial ran from 2010-2017 and is the only government-funded study of spinal deformity in adults.

The research effort—led by spine surgeon Keith H. Bridwell, MD, at Washington University School of Medicine in St. Louis—found that surgery usually helped patients improve. It helped correct their curvature, and they had less pain. But the researchers also found that those who didn't have surgery usually did not go on to experience more severe pain or a more extreme spinal deformity during a two-year follow-up period. In fact, they found that the most important factor in deciding whether to operate was the extent of a patient's disability, and how much that disability interfered with day-to-day life.

The new findings are published Feb. 20 in the Journal of Bone and Joint Surgery.

"If patients are expecting less pain or better function, they probably won't see improvement unless they have surgery," said Bridwell, the study's senior investigator and the J. Albert Key Distinguished Professor of Orthopaedic Surgery. "On the other hand, if patients have adequate quality-of-life, and the goal is simply to keep them from getting worse, nonoperative treatment probably is fine."

Some 15 percent of adults in the U.S. have some type of spine deformity, with lumbar scoliosis being the most common. Some adults have had scoliosis since adolescence; others develop the condition as adults. Many don't experience symptoms, but a significant percentage will develop back pain, leg pain and even lose up to four inches of trunk height—measured from the waist upwards—due to the deformity.

"A fair number of doctors have suggested doing surgery before a patient's condition deteriorates," said the study's first author, Michael P. Kelly, MD, an associate professor of orthopedic surgery and of neurological surgery at Washington University. "But we found that, on average, patients are unlikely to rapidly get worse. Those who don't have severe pain and can easily carry out their daily activities seem to progress slowly and often their symptoms are not severe enough to undergo the risks of surgery."

Those risks include infection and surgical complications, such as a failure of vertebrae to fuse together, which often means patients will need another operation.

The study enrolled 286 patients, with 144 in the nonoperative group and 142 in the operative group. All were symptomatic patients ages 40 to 80 who had at least a 30-degree curve in the lower spine. Their levels of disability were measured with spinal pain and disability surveys. The nonoperative patients were treated with therapies such as physical therapy, anti-inflammatory drugs and injections that deliver pain medications directly to nerve roots along the spinal column. During the study period, 29 of the nonoperative patients changed their minds, or their conditions deteriorated, and they decided to have surgery.

Bridwell said that, in general, patients who had surgery experienced less pain following the operation and were better able to function in day-to-day life two years later. However, during the study period, 14 percent of the patients who had surgery required at least one additional operation to correct subsequent complications.

At the end of the study, the average surgery patient had improved. Meanwhile, those who didn't have surgery were functioning at about the same level after two years, but most had not gotten worse. Kelly and Bridwell said the satisfaction of individual patients with their degree of disability seems to be the best guide for determining whether they should choose to have surgery.



Source : Medical Express , 21 Feb 2019 

Schroth Method offers alternative to scoliosis surgery

The Schroth Method is also suitable for adults with scoliosis who want to correct their posture. 

At a glance, twin sisters Alvika Saniya and Alvira Saniya, 15, look similar to other teenage girls who love K-Pop bands and play with their phones. However, in the past two years, both have battled scoliosis, a medical condition in which a person’s spine is curved to the right or left. 

Their mother Pretty Meliana told The Jakarta Post on Saturday that she first noticed the abnormal curvature of their spines when the twins hit puberty. Since 2017, she had taken Alvika and Alvira to doctors and they received several treatments, such as physiotherapy and wore a Boston brace, a back brace for scoliosis. 

“In the beginning, Alvika’s spine curve was 48.5 degrees, while Alvira was 45 degrees. Now, it’s below 40 degrees,” she said. However, the doctor recently mentioned that her daughters might need to undergo surgery if there was no further improvement, which led her to bring the twins to the Spine Clinic Family Holistic in West Jakarta, the only place in Indonesia that offers the Schroth Method, a customized exercise to return the curved spine to a more natural position.

“Money is not the issue, but I’m scared of [the surgery],” said Pretty.  

Founded in 1921 by German-born physiotherapist Katharina Schroth, it is a nonsurgical option for scoliosis, featuring 3D treatment designed to correct the curvature of the spine, vertebral rotation and lordosis (a healthy inward curve of the lower back). 

Dr Budi Sugiarto Widjaja studied the Schroth Method in Germany. (JP/Jessicha Valentina)

In Indonesia, the method was introduced by Dr Budi Sugiarto Widjaja in 2015, who studied the treatment in Germany. 

During the Schroth Best Practice seminar at the clinic on Feb. 23, Budi said scoliosis usually appeared during puberty, between ages 10 and 14, and 80 percent of the cases were idiopathic, meaning the causes were unknown.

Budi stressed the importance of early detection, saying that it was best to do the treatment during puberty, especially if the patient also used The Gensingen Brace by Dr Weiss® , a scoliosis brace made from polythene, which is designed for specific curve patterns, following the user’s posture.  

“Scoliosis is manageable,” he said. 

However, the Schroth Method is also suitable for adults with scoliosis who want to correct their posture.  

The method features various exercises, including physiology and activities daily living. 

During the treatment, the patient will learn how to correct their posture while standing, sitting, walking and even breathing.  

“The method shift the [bones], not bend it,” said Budi, adding that it targeted specific muscle based on the curvature of the spine. 

Budi said the Schroth Method was also useful for adults. “After puberty, the development of scoliosis might slow down. However, if [the patients] do not know how to maintain the right posture, it could get worse,” he said. (asw)

Source : Jakarta Post , 24 Feb 2019 

Technological advancements, desi implants make spine surgeries safe and cost-effective

Fit and fine after scoliosis (spine) surgery on February 14, a confident Khilari is five feet tall now and needs only a pillow to sleep Less Until early February, Ajinath Khilari (27) from Shanisingnapur needed four pillows to sleep. When standing against a wall, his head would be 30cm ahead away because of the hunch on his back. Barely three feet tall then, his self-confidence was at the nadir Fit and fine after scoliosis (spine) surgery on February 14, a confident Khilari is five feet tall now and needs only a pillow to sleep Thanks to neuromonitoring and advanced Indian implants, curing scoliosis through surgery has become safe and affordable these days. Khilari is one of the beneficiaries of the revolutionary advancements in the medical science technology in India. Khilari showed signs of ankylosing spondylitis five years ago, leading to kyphosis — a forward curvature of the spine. Khilari’s back initially got stiff and then curved forward, making any movement difficult for him. His spine gradually became rigid like a bamboo.

A farmer, Khilari approached a local doctor for treatment. “He told me that spine surgery could rectify my posture, but I could be paralysed after it,” Khilari said, adding, “My condition worsened with each passing day. I didn’t know what was happening to me. Gradually, I was fixed like a sickle.” When his breathing started getting affected, Khilari’s family took him to another doctor in Ahmednagar. This doctor referred Khilari to Sancheti

Hospital, where he met spine surgeon Ajay Kothari. After a detailed examination, special x-rays, MRI scans, Khilari went under the knife following an extensive planning. Kothari completed the complex deformity correction surgery well under three hours. “I am a relieved and happy man now,” Khilari told TOI two days after he underwent the surgery at Sancheti Hospital. 

Kothari finds it more challenging to clear misconceptions about spine problems than the complicated surgery he conducted on Khilari. He said, “There is a taboo about coming forward with scoliosis because the patient and their family members frequently face superstitious statements like it is a curse of god. 

Patients usually come to doctors at late stages because of stigma and lack of knowledge that scoliosis is completely curable.” Laying stress on social awareness about hunchback, Kothari said, “Our aim as spine surgeons is to spread awareness about scoliosis and other such conditions. Special importance should be given to kyphoscoliosis because it starts early in a person’s life as compared to other spine conditions like prolapsed or ‘slipped’ disc.” He said schools in the US conduct screening programmes to detect deformities early. “This is the need of the hour in India,” Kothari added. 

Recommended By Colombia Barely 12, Tanmay Chaudhary from Shirur had severe kyphoscoliosis, which went undetected for long in the absence of screening programmes in schools. He would often miss classes due to the excruciating pain. After a corrective surgery at a city hospital six months ago, Tanmay is now like any other bubbly child of his age. 

A public works department (PWD) engineer from Nagpur, who did not wish to be named, is also a beneficiary of the modern technology in the medical field. A scoliosis patient, he was afraid of surgery fearing that he might not be able to walk again. However, Kothari put all his fears to rest. Postsurgery, he is a happily married man now. “Spine surgery is looked at as a dangerous and crippling procedure in the society, primarily due to the lack of knowledge, prompting false beliefs. It has become absolutely safe after the advent of neuromonitoring. 

A team of spine surgeon, anaesthetist and neurophysician keeps a close eye on the patient’s nervous system during the surgery, completely cancelling out the fear factor during the pre-neuromonitoring era, when the success of the surgery was found out afterwards,” he said. 

Another factor which prevents patients, especially Indians, from opting for much needed surgeries is the cost factor. “Now, with good Indian implants available, complex spine surgeries have become affordable. In the US, spine surgery costs over $25,000, whereas in India it is done well within $6000,” he added

Source : TOI , 24 Feb 2019 

 

Take a break, rotate your neck and look up

It’s a common sight to spot people with frozen neck. Doctors say that today, youngsters in their early 20s complain about stiff neck and bad backs which is normally associated with people in their late 40s and 50s. Thanks to smartphones, tablets and other electronic gadgets that the millennials are addicted with.

Reports and statistics reveal that while adults check their smartphones on an average of five times a day, youngsters tend to browse around 110-115 times per day. Nearly 60 per cent of adults spend five or more hours per day in front of their computers as compared to the 40 per cent of youngsters who spend 9-11 hours in front of their devices.

Dr K Naresh Kumar, consultant orthopaedic and limb reconstruction surgeon, at Parvathy Hospital says, “The term text neck or tech neck or turtle neck syndrome is being used to describe tightness of neck muscles, which is due to prolonged forward head position while using or staring at the electronic devices such as mobile phone, laptops and computer monitors resulting in undue stress on the vertebrae of the lower neck. This leads to early degeneration of disc material which is the precursor of cervical spondylosis if left untreated.”

Doctors say that at zero degrees of head tilt, a human head weighs about 5 kg, the further forward the head tilts and the neck bends, the heavier the head becomes. By 30 degrees of head tilt, human head weighs 18 kg. By the time the head is at 60 degrees, it weighs about 27 kg. It’s just like holding a small child on shoulders.

“People are unaware of the fact that sitting for long periods of time causes up to twice as much pressure on discs on the spine as to standing as well as weakens the gluteal and thigh muscles which exaggerates the problem. One of the major reasons for such problems are wrong posture of the spine due hunching and slouching that most of us have while using our devices which in turn increases the risk of neck and back pain,” says Dr Naresh.

Symptoms of tech neck are shoulder pain, tingling or numbness in the fingers, headaches and increased thoracic kyphosis (rounded upper back).

Tips:

1. Pay attention to posture: Sit up straight as staying in the same position for longer period can cause unnecessary strain on the back.

2. Keep devices at eye level: Adjust computer screen, sit with screen level with eyebrows and chair tipped slightly forward so that knees are slightly higher than hips.

3. Use a headrest: A chair with headrest will ensure you aren’t looking down with your neck flexed forward.

4.Take breaks often: Don’t sit for longer than 45 minutes at a time and try to look up from the device often. Follow the 20/20/20 rule. Every 20 minutes, give your eyes a 20-second break by focusing on something at least 20 feet away.

5. Stretch neck: Do some chin tuck for 10 times, stretch your neck by side bending, tilt head to the right, bringing your ear close to the shoulder and hold it for 20 seconds, bring your head back to the center, and then tilt it to the left, again hold for 20 seconds. Repeat 3-5 times on each side.

Source : TOI , 18th March 2019