Tag: scoliosis awareness month

Scoliosis Bracing in Older Adults, New Research

Posted on June 24, 2022 by - Blog

If you’ve been following the blog this Scoliosis Awareness month, you’ll know that Adult Scoliosis is generally defined as any scoliosis case that exists either in those over 18, or those having reached skeletal maturity – either definition is valid but most scoliosis specialists would prefer the latter since we are focused more on the condition itself than an arbitrary point of “adulthood.”

There are two main types of adult scoliosis. Pre-existing adult scoliosis is essentially a case of scoliosis which is continuing from an earlier age (usually adolescent scoliosis). In adulthood, a continuing case of scoliosis typically becomes known as Adolescent Scoliosis in Adults or ASA. ASA can be discovered in adults of any age, but many ASA cases are already known from treatment earlier in life.

The second type is Degenerative De-Novo Scoliosis– this is the development of a new scoliosis case, usually as a result of spinal degeneration.

Much recent (and not so recent) research into scoliosis treatment, especially bracing, has focused on younger patients – this is primarily because this group stands to gain the most from bracing – proper treatment of, say a 15 year old with mild to moderate scoliosis stands a good chance of allowing him or her to live the rest of their life free of the condition. Those who have reached adulthood with a scoliotic curve, or develop one through ageing have less of a chance for improvement in the cobb angle (degree of scoliosis) but equally, lower rates of progression in the curve itself. Bracing, however, has been shown to have positive effects for older individuals, primarily around daily function and pain reduction. A recent literature review of relevant studies has confirmed this view.

 

What causes Scoliosis in Adults?

Since there are two kinds of scoliosis in adults, we should take a moment to understand why and how they are different.

ASA is scoliosis carried into adulthood from adolescence, isn’t caused in adulthood – it may or may not worsen depending on a number of factors, but the condition originated at an earlier point in life.

Degenerative scoliosis, by contrast, does occur in adult life and is attributable to wear and tear on the spine, but is also strongly associated with a variety of conditions. Osteoporosis, degenerative disc disease, compression fractures and spinal canal stenosis have all been implicated in the development of degenerative scoliosis.

Since De-Novo scoliosis is a consequence of spinal degeneration with age, it rarely presents before 40 years of age. For many patients, drawing a distinction between the two types may be academic at any rate, since in patients with no known history of scoliosis it may well be impossible to say whether a newly discovered case is a Do-Novo one, or ASA. It is thought that as many as 30% of over 60’s suffer from De-novo scoliosis[1], although a percentage of these cases will be undiscovered scoliosis from earlier in life. In fact, a good number of adult scoliosis cases are discovered through an investigation for another condition (such as back pain).

 

Recent study

The newest study[2] taking a broad view of the literature on scoliosis bracing for older adults was a review of relevant papers published between 1967 and 2018 – the study investigators used standardised criteria to select relevant papers for inclusion in their work.

In total, ten studies (four case reports and six cohort studies) were included which detailed the clinical outcomes of soft (2 studies) or rigid bracing (8 studies), used as a standalone therapy or in combination with physiotherapy/rehabilitation, in 339 adults with various types of scoliosis. Most studies included female participants only. Right away, this shows one of the biggest issues with Scoliosis research, especially in older adults – there is a clear gender bias (probably due to the higher incidence of adolescents in females, about 75% of cases) and overall a lack of research, only 8 studies considering rigid bracing of the kind now most frequently employed isn’t a huge number!

In the studies, brace wear prescriptions ranged from 2 to 23 hours per day, and there was mixed brace wear compliance reported, both are consistent with our actual experience of bracing in older adults. Most of the included studies reported modest or significant reduction in pain and improvement in function at follow-up. There were mixed findings with regards to Cobb angle changes in response to bracing.

 

Study conclusions

After their review, the study authors reported some key conclusions which are well worth noting. Firstly, they showed that there is evidence to suggest that spinal brace/orthosis treatment may have a positive short – medium-term influence on pain and function in adults with either de novo degenerative scoliosis or progressive idiopathic scoliosis. This finding essentially supports the use of bracing in older adults and tallies with our own experience in helping older patients to reduce and manage pain as well as improve function through bracing.

Secondly, and importantly, it was noted that a particular focus on female patients with thoracolumbar and lumbar curves made it difficult to make firm conclusions on the efficacy of bracing for males, and other curve types. It would therefore be highly desirable for further research in this area to focus on a wider variety of case types, in order for us to better understand treatment pathways for older individuals.

 

[1] ‘Scoliosis in adults aged forty years and older: prevalence and relationship to age, race, and gender‘
Kebaish KM, Neubauer PR, Voros GD, Khoshnevisan MA, Skolasky R, Spine 2011 Apr 20;36(9):731-6.

[2] Jeb McAviney et al. A systematic literature review of spinal brace/orthosis treatment for adults with scoliosis between 1967 and 2018: clinical outcomes and harms data BMC Musculoskeletal Disorders volume 21, Article number: 87 (2020)

Adult Scoliosis – How to Screen

Posted on June 18, 2022 by - Blog

This month, the UK Scoliosis clinic is raising awareness about Scoliosis in adults, as part of our work for Scoliosis awareness month. Over the last few weeks, we’ve looked at the kinds of scoliosis that impact adults, and older adults in particular. This week, we’ll take a look at how you can recognise the signs and symptoms of Scoliosis, as an adult.

 

Recap : Scoliosis in adults

There are two main types of adult scoliosis. Pre-existing adult scoliosis is essentially a case of scoliosis which is continuing from an earlier age (usually adolescent scoliosis). In adulthood, a continuing case of scoliosis typically becomes known as Adolescent Scoliosis in Adults or ASA. ASA can be discovered in adults of any age, but many ASA cases are already known from treatment earlier in life. While many Scoliosis cases which are carried into adulthood progress very slowly (and may not progress at all for some time if they are small enough at skeletal maturity)[1] cases can begin to worsen again as we age and the spine (particularly the intervertebral discs) start to degenerate. Accordingly, worsening scoliosis in an ASA case is often referred to as Adult Degenerative Scoliosis.

The second type is Degenerative De-Novo Scoliosis (sometimes noted as DDS) – this is the development of a new scoliosis case, usually as a result of spinal degeneration – the cause is essentially the same as degeneration in ASA, however, we usually refer to De-Novo separately, since there is no prior history of Scoliosis. This being said, it may not always be possible to disambiguate a De-Novo case from an ASA case, since the lack of detection of a scoliosis case does not equate to the absence of scoliosis itself!

 

Adult Scoliosis – General signs

Not all signs of Scoliosis, especially in adults, are of the specific kind which tend to be noticed in children and younger teenagers – in fact, many adult scoliosis cases are discovered as a result of an investigation for back pain rather than concerns about Scoliosis.

Adults with scoliosis very often experience more generalised symptoms than younger people, due to the degeneration of the spinal discs and joints also taking place – this commonly leads to the narrowing of the openings for the spinal sac and nerves, a condition called spinal stenosis which can range from uncomfortable to extremely painful.

Many patients with adult scoliosis may adopt unusual postures in an attempt to avoid and reduce this pain – some patients with adult scoliosis may lean forward to try and open up space for their nerves. Others may lean forward because of loss of their natural curve (lordosis, sway back) in their lumbar spine (low back). The imbalance causes the patients to compensate by bending their hips and knees to try and maintain an upright posture.

Accordingly, back pain, and specifically Low back pain and stiffness are common issues for those with adult scoliosis. Numbness, cramping, and shooting pain in the legs due to pinched nerves, as well as fatigue resulting from strain on the muscles of the lower back and legs are all common issues.

Finally, while not a diagnostic indicator, it is worth noting that many older adults may also experience arthritis, which commonly affects joints of the spine and leads to the formation of bone spurs.

 

Adult Scoliosis – Traditional symptoms

The more traditional, physical symptoms associated with scoliosis of course also apply to adult cases, and it’s these which are easiest to screen for.

Degenerative Scoliosis linked to ASA can often occur in the thoracic (upper) and lumbar (lower) spine, with the same basic appearance as that in teenagers, such as shoulder asymmetry, a rib hump, or a prominence of the lower back on the side of the curvature.

De-Novo cases are typically seen more in the lumbar spine (lower back) and are usually accompanied by straightening of the spine from the side view (loss of lumbar lordosis).

 

Home Screening for Scoliosis

While the more general, painful symptoms are best investigated by a spinal professional (whether scoliosis is the cause or not), a basic home screening for the physical signs of scoliosis is easy to do. Simply follow the steps here!

 

 

 

 

[1] Weinstein SL, Ponseti IV: Curve progression in idiopathic scoliosis. J Bone Joint Surg (Am) 1983, 65:447-455.

Scoliosis Screening – For Older Adults!

Posted on June 8, 2022 by - Blog

Scoliosis screening is a topic which we regularly write about on our blog – in our view (and safe to say, in the view of most of the scoliosis treatment community) screening represents a relatively inexpensive way to detect scoliosis as early as possible. In young people, early detection is particularly important – the majority of scoliosis cases progress (at least to come extent) without treatment, whereas early intervention allows for relatively simple, non-surgical approaches to be used in preventing and correcting curve progression. Studies have shown that a large percentage of scoliosis cases are detected between the ages of 11 and 14[1] although the young people outside of this bracket certainly can and do develop scoliosis.

Young people, with their whole life ahead of them, have the highest risk of progression from scoliosis –  however, when the condition is caught early, they also have some of the best prognoses. These two factors together mean that younger patients tend to attract the attention of most medical studies. It’s essential however, that we also recognise the importance of screening in older adults – as many of 1 in 3 of whom will develop the condition in later life.[2]

 

Why screening older people matters

No matter what the age of the individual concerned, spotting scoliosis early is always a benefit, and, put simply, since there are forms of scoliosis – such as “De-Novo” scoliosis –  which begin development later in life, scoliosis is a condition which we need to be vigilant for throughout life.

It’s true that Scoliosis cases (even more significant cases) tend to progress much more slowly throughout adulthood than they do in childhood (something around 1 degree per year is a commonly cited figure[3]) however we also have to keep in mind that one spends much more time as an adult than as a child! Since conditions such as De-Novo Scoliosis are related to the natural ageing process rather than the genetic factors which (as per the latest research available) looks to be the most likely culprit for adolescent scoliosis cases, it’s also possible for someone with no history of scoliosis at all to develop the condition in their 60’s or 70’s.

The good news is that even without public health provision, scoliosis screening is quick, easy and can even be done yourself at home (although it’s easier with someone to help).

It’s for this reason that scoliosis screening is considered a beneficial stage of treatment amongst the Orthopaedic community, as it is reported in the Consensus Paper which has been published by the Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT).[4]

 

So why have I never heard about scoliosis screening?

At present, scoliosis screening isn’t widely provided in the UK – The latest review from the NHS concluded that screening for the condition isn’t worth doing – as a scoliosis clinic, you can well imagine that we disagree with this!

There are three main reasons which explain the lack of screening in the UK – unfortunately, they’re all pretty poor excuses!

The first is simply the fact that many health professionals have little or no training on Scoliosis, and the general public has even less. We don’t just mean GP’s here – while many professionals, such as Chiropractors, who specialise in spinal health can recognise a scoliosis case, most have not had the benefit of specialist training on how to treat the condition. As the UK Scoliosis clinic we’re thrilled to take referrals from concerned chiropractors from miles around, but not all healthcare professionals have a clear referral route for scoliosis cases. This is an issue for the healthcare community itself to work on as a major step toward improving outcomes for patients.

This raises a question – why are we so ignorant when it comes to scoliosis, especially in older people?  This is the second major problem – the belief held for much of history, that scoliosis is treatable only with surgery, or (often for older adults) that progression was inevitable and simply something one had to “live with” – therefore, it followed that screening to catch it early was of little value.

Until recently, this has been a valid point – but it’s critical to recognise that today there are far more options for scoliosis sufferers, and we’re now able to help many patients overcome scoliosis without ever thinking about surgery. Much of the evidence suggesting scoliosis can only be treated with surgery dates as far back as the 1940’s[5] so it makes sense for us to re-examine the evidence and technology we now have available.

This is all the more important given the results of more recent research which show that exercise[6] and bracing[7][8] based treatments can reduce pain and curve progression as well as improve quality of life in older people, even when used as a part time treatment.

The third reason is cost – and the cost-based argument against screening also flows from the same line of thought – if surgery is the only treatment option, why invest in screening? To be fair it has been true, even in the recent past, that accessing a scoliosis screening in the UK meant attending a specialist clinic, and inevitably that meant incurring a cost. Given that screening should be done yearly at least, and many older adults are working with a fixed income this clearly makes the proposition less attractive.

Today, however, screening need not be expensive – or actually cost anything at all. There are now several guided screening apps available, which, while not a substitute for a professional opinion, are a great initial screening tool. These include our own ScoliCheck app.

 

 

[1] ‘School Scoliosis Screening Programme – A Systematic Review’
Sabirin J, Bakri R, Buang SN, Abdullah AT & Shapie A 2010, Medical Journal of Malaysia, December issue, vol. 65, no. 4, pp. 261-7.

[2] ‘Scoliosis in adults aged forty years and older: prevalence and relationship to age, race, and gender‘
Kebaish KM, Neubauer PR, Voros GD, Khoshnevisan MA, Skolasky R, Spine 2011 Apr 20;36(9):731-6.

‘The prevalence and radiological findings in 1347 elderly patients with scoliosis‘
Hong JY, Suh SW, Modi HN, Hur CY, Song HR, Park JH.,  Journal of bone and joint surgery 2010 Jul;92(7):980-3

[3] Weinstein SL, Ponseti IV: Curve progression in idiopathic scoliosis. J Bone Joint Surg (Am) 1983, 65:447-455.

Weinstein SL, Zavala DC, Ponseti IV: Idiopathic scoliosis: longterm follow-up and prognosis in untreated patients. J Bone Joint Surg (Am) 1981, 63:702-712.

Ascani E, Bartolozzi P, Logroscino CA, Marchetti PG, Ponte A, Savini R, Travaglini F, Binazzi R, Di Silvestre M: Natural history of untreated idiopathic scoliosis after skeletal maturity. Spine 1986, 11:784-789.

[4] TB Grivas, MH Wade, S Negrini, JP O’Brien, T Maruyama, M Rigo, HR Weiss, T Kotwicki, ES Vasiliadis, LS Neuhaus, T Neuhous, School Screening for Scoliosis. Where are we today? Proposal for a consensus. Scoliosis 2(1)  (2007) 17

[5] AR Shands, JS Barr, PC Colonna, L Noall, End-result study of the treatment of idiopathic scoliosis. Report of the Research Committee of the American Orthopedic Association.  J Bone Joint  Surg 23A  (1941) 963-977.

[6] ‘Scoliosis-Specific exercises can reduce the progression of severe curves in adult idiopathic scoliosis: a long-term cohort study’
Negrini A, Donzelli S, Negrini M, Negrini S, Romano M, and Zaina F 2015,, Scoliosis Jul 11 10:20

[7] Scoliosis bracing and exercise for pain management in adults—a case report
Weiss et al, J Phys Ther Sci. 2016 Aug; 28(8): 2404–2407.

[8] ‘Effects of Bracing in Adult With Scoliosis: A Retrospective Study‘
Palazzo C, Montigny JP, Barbot F, Bussel B, Vaugier I, Fort D, Courtois I, Marty-Poumarat C, Arch Phys Med Rehabil. 2016 Jun 22. pii: S0003-9993(16)30256-8. doi: 10.1016/j.apmr.2016.05.019

 

What is scoliosis anyway?

Posted on June 9, 2020 by - Blog

As you may – or may well, or well not ­– be aware, June is Scoliosis awareness month. Since so many of us are working from home, or simply having to take a break from normal life at the moment, you may well have noticed some talk about this online, so, what is Scoliosis, and why should be you be aware of it?

 

What is Scoliosis?

Simply put, scoliosis is a spinal disorder which causes the spine itself to be curved from side to side. A normal spine does indeed have a forwards and backwards curvature, so that viewed from the side it looks like an “S” shape – but in scoliosis, the spine also has a side to side curvature, so that viewed from the front or the back, it has an “S” or “C” shape. In fact, scoliosis is more complicated than this – there’s typically also a rotation of the vertebra (the spinal bones), but the general shape is what you might be able to notice in someone’s posture.

 

Can I see Scoliosis?

Scoliosis is sometimes possible to see, usually in more severe cases. In some individuals with very low body fat, it may be possible to notice the curvature of the spine – however, most common signs (like uneven shoulders and hips, or a rib hump when bending forward or one shoulder blade seeming to stick out more than another) tend to be the only noticeable change. It’s true that the worse a scoliosis case is, the more visible it will tend to be – but scoliosis can remain almost invisible for a long time before reaching this point.

Like all conditions, scoliosis is much easier to treat if it’s spotted early –  this is where scoliosis screening comes in. Scoliosis screening is a fast, painless and simple procedure which you can even try at home. In fact, many countries include scoliosis screenings as part of their public health measures, however, this isn’t the case in the UK.

 

Who can get Scoliosis?

Anyone can get scoliosis – on average, about 3% of children will develop scoliosis, whereas some forms of scoliosis, common amongst the older population can affect up to 30%.[1]

There are many different sub-types of scoliosis, but for ease of explanation we typically divide them into two groups – these are adult, and childhood scoliosis.

Adult scoliosis is caused either by the degeneration of the spinal bones, ligaments & discs with age or as a result of childhood scoliosis which was not treated. Childhood scoliosis (affecting infants through to young adults) is more of a mystery – right now the exact cause for about 80% of cases is unknown. This is termed “Idiopathic” scoliosis. The remaining 20% of cases are typically caused by congenital or genetic conditions, spinal malformations, underlying neuromuscular conditions, metabolic conditions or trauma.

Idiopathic scoliosis in children is typically classified according to the age that it is diagnosed. It is most common in adolescents (over 10 years) but also occurs in infants (under 3 years) and juvenile’s (3-10 years).

Approximately 3-4% of children are affected by scoliosis, that’s about one in each class at school. In adults over the age of 50, this figure increases to 30-40%.

The earlier scoliosis is detected, the more effective a treatment and management plan will be. This helps reduce the risk of progression and the potential need for surgery. If scoliosis specific exercise and/or bracing are used early enough in the development of scoliosis, curve progression can be stopped, and surgery avoided. In some cases, near-complete correction of the curve is possible.

 

How do I screen for scoliosis?

Screening for scoliosis is easy to do and takes less than 5 minutes – remember that early detection is the most important factor, so screen regularly and if you have concerns, get in touch with a scoliosis professional.

 

 

[1] Scoliosis in adults aged forty years and older: prevalence and relationship to age, race, and gender‘

Kebaish KM, Neubauer PR, Voros GD, Khoshnevisan MA, Skolasky R, Spine 2011 Apr 20;36(9):731-6.