Wednesday, January 25, 2012
15 yo young lady seen for second opinion this morning with painful thoracolumbar scoliosis for second opinion
Saw this young lady with her mom in clinic. She was seen elsewhere and told not to worry about her scoliosis, because her curve was only in the 20 degree range.
However, patient had reported significant low back pain that was greatly affecting her quality of life, and nothing was suggested for that.
When I saw her today, she had a 2 inch trunk shift to the left, causing her "hour glass" to be out of shape, with one hip appearing to stick out on the right. Her motor strength and sensation was normal, but she did have thoracolumbar hump on scoliometer.
Her X-Rays confirm that her curve was 26 degrees, which isn't huge, but because of the location of the curve, she did have nearly a 5 cm trunk shift to the left. I explained how this type of trunk shift can be associated with back pain. Note the green lines drawn along outer edge of pelvis, and relationship to her rib cage! On one side, it is shifted over 4.5 cm.
We got her started on a conservative program, including seeing a special scoliosis physical therapist for home training program, a special lightweight back brace, NSAID medications, and follow-up to recheck her trunk shift and scoliosis progression.
We also talked at length about the importance of tracking this curve as she gets older, since these thoracolumbar curves with large trunk shifts can lead to progressive painful curves in adulthood with severe progression of lumbar disc degeneration. If the curve does continue to progress, or if pain worsens despite conservative treatment, scoliosis surgery can help get her "hour glass" centered again, and thereby center the loads better so the back muscles don't have to work so hard. It can also decrease the loading on the lower lumbar discs, which might save her from needing a bigger scoliosis surgery as an adult, which might even have to include the pelvis/ilium.
Patient and mom were very appreciative and definitely understand better why she is hurting, with good conservative treatment plan underway.
Adolescents CAN have pain with scoliosis, even if the curve is below the 40 degree range. Conservative treatment is often effective to help the pain and allow them to get back into their active sport life and school life.
Dr. Lloyd Hey
Hey Clinic for Scoliosis and Spine Surgery