Dr. Daniel E. Gelb is a board-certified orthopedic surgeon who treats adult and pediatric
spinal deformity, including scoliosis and kyphosis, as well as a full range of
degenerative spinal conditions. Dr. Gelb is an Associate Professor for the
Department of Orthopaedics at the University of Maryland. He received his
medical degree from the New York University School of Medicine, and afterward
completed his residency in Orthopaedic Surgery at the University of Rochester.
He then completed fellowships at Washington University in St. Louis, Missouri,
and in Paris, France. Dr. Gelb is a member of the Alpha Omega Alpha medical
honor society.
Ten Common Questions about Scoliosis
By Daniel Gelb, M.D.
1. What is scoliosis?
Scoliosis is commonly thought of as a lateral (or sideways) bending of the spine when it is viewed from the front. In fact, scoliosis is more complex than this because the spine can be curved in any direction, not just sideways. More precisely, scoliosis is a twisting of the spine like a corkscrew. Each individual vertebra is deviated from the midline and rotated. The deformity involves the ribs as well, which grow asymmetrically.
2. What causes scoliosis?
Many conditions can lead to the development of scoliosis. There is clearly a genetic component to scoliosis; the tendency to develop spinal curvature runs in families. However, one person in a family may have a severe curvature while others may have only mild cases. The most common type of scoliosis that is seen is called adolescent idiopathic scoliosis. Adolescent refers to the fact that the curvature develops during the adolescent growth spurt – around age 10 to 12 years. Idiopathic means that the cause of this type of scoliosis is unknown.
3. Does scoliosis affect girls more often than boys?
No. However, severe curves occur more often in girls. The reason for this is unknown.
4. Is scoliosis dangerous?
Severe scoliosis can cause restriction in lung function. However, no significant decrease in lung function is seen unless curves reach 80 or 90°. It is very unusual for an adolescent curve to reach this magnitude. Scoliosis does not affect other organs such as the heart, liver or intestines.
5. Is scoliosis painful?
Although teenagers may be self-conscious about the curvature, adolescent idiopathic scoliosis generally does not cause pain or limit activity. Any curve that is associated with significant ongoing pain needs to be investigated.
6. Does scoliosis affect pregnancy?
Adolescent idiopathic scoliosis should not affect the ability of a young woman to conceive, carry or deliver a child. Even if a young woman needs to undergo a spinal fusion surgery for her scoliosis, it should not affect her ability to have children. Significant scoliosis or previous spinal fusion may, however, make it difficult to have an epidural anesthetic during delivery.
7. When is a brace used to treat scoliosis?
A brace is prescribed when a spinal curve could progress to the point that surgery is required. Wearing a brace can help to stop the progression of scoliosis, but a brace cannot permanently correct scoliosis. Any child with 2 or more years of growth remaining and a curve of 20 to 25° is a potential candidate for a brace. In general, a brace cannot be used when spinal curves are greater than 40°. Most braces are low-profile, underarm braces that can be worn under clothing. To be effective, the brace should be worn as much as possible. The brace may be removed for personal hygiene and for participation in sports.
8. When is surgery recommended for scoliosis?
In general, surgery is recommended for adolescents with curves of 45° or more who still have growth remaining. Although scoliosis is not dangerous or painful, curves of this magnitude have a high probability of continuing to progress in adulthood. As the curve continues to progress, back function may deteriorate and become painful. Surgery for scoliosis can be performed after adolescence, but curve correction becomes more difficult in adults because the spinal curves become larger and the spine becomes stiffer with age. Adults require more time to recover from surgery, and complication rates are higher.
9. How long is the recovery from scoliosis surgery?
Patients are usually admitted to the hospital the same day as surgery. The procedure itself requires general anesthesia and lasts 3 to 4 hours (on average). Most patients spend 4 or 5 days in the hospital before they go home. Six weeks after surgery, patients are ready to return to school and are no longer taking any pain medication. At three months, patients can return to all activities.
10. Are there permanent activity restrictions after scoliosis surgery?
Patients can return to most activities after recovering from surgery. Patients should avoid high velocity contact sports such as football, rugby or ice hockey. Almost any other sport is acceptable including basketball, soccer or tennis. Spinal fusion may cause some limitation in flexibility; certain activities that require a high degree of spinal flexibility such as gymnastics may be difficult. But it is possible to still participate in cheerleading, dance and other similar activities. There are even professional athletes who have had scoliosis surgery.