Which Scoliosis Specialist Should I See?
When parents learn their child has scoliosis, they may find themselves wondering what type of scoliosis specialist can help. Until a few years ago, orthopedic surgeons were really the only choice for a scoliosis specialist. While seeing an orthopedic surgeon for this condition is still commonplace, patients now have more options than ever before. In this post we will try to shed some light on the question, which scoliosis specialist should I see?
The scoliosis specialist you ultimately decide to see will depend on your treatment objectives and the type of treatment you are seeking.
What happens when a child is diagnosed with scoliosis?
When scoliosis is suspected or detected in kids, the typical starting point is in a pediatric office. To check for scoliosis, a qualified medical professional will request that a child bend forward at the waist. If scoliosis is suspected, the practitioner will use a scoliometer to determine angular trunk rotation (ATR), or just rotation for short. If the spinal rotation is relatively minimal, many clinicians will simply monitor the situation. Others may immediately refer the patient for a diagnostic x-ray. Patients with more pronounced rotation will almost always be referred for an x-ray to determine the Cobb angle measurement. Many doctors commonly use a 7º scoliometer reading as a starting point to refer for an x-ray but recommendations can vary. Very often, a diagnosis of scoliosis leads to a referral to a spinal surgeon who specializes in scoliosis. Our recommendation is to request a baseline x-ray, especially in a growing child, no matter how minimal the rotation may be. This is where we can help, when others will not.
Scoliosis surgeons
Spinal surgeons have been the predominant providers of scoliosis treatment since surgery came onto the scene in 1911. This, in spite of the fact that only a small percentage of scoliosis cases detected actually progress to the point of surgery.
Most surgeons abide by the SRS (Scoliosis Research Society) guidelines when managing scoliosis and making treatment decisions. These guidelines and treatment recommendations are generally based on a child’s Cobb angle and stage of growth. Treatment recommendations can be summarized into three categories: ‘watch and wait’ up to 20 or 25 degrees, TLSO bracing for moderate scoliosis, usually 25-45 degrees, and surgery for curves that progress to about 45-50 degrees or more.
While treatment guidelines are important, most parents don’t want a plan for their growing child’s spine that are based on generalized guidelines for the masses. Carefully assessing and taking an individual child’s long-term progression potential into account is absolutely essential. What’s more, many doctors and hospitals are still prescribing braces that are out-of-date, bulkier than necessary, uncomfortable or intolerable, that only focus on stopping curve progression rather than attempting to improve posture and/or Cobb angle.
What many parents begin to wonder at this point is, “Why am I seeing a surgeon if I don’t want my child to have surgery?” This insightful question is especially pertinent for parents of patients with milder curves. In these cases, simply monitoring/observing scoliosis, known as the ‘do nothing’ treatment approach, will ultimately result in progression for some children. In these cases, the next course of treatment is often bracing. SRS guidelines offer no other option for a proactive treatment approach for an at-risk child.
When it comes to surgery for advanced moderate or severe scoliosis, people usually fall on one side of this issue or the other. Many parents of kids with scoliosis simply do not want to subject their child to such a serious surgery (involving hardwiring, risks, etc.) under any circumstances. Others, follow their doctors recommendations with little hesitation. Goldberg – a surgeon – summarizes the paradox of scoliosis surgery like this, “Surgery, while an effective method of improving a cosmetic deformity, is a major undertaking with significant risks, and, rather than re-instituting normality, replaces one abnormality with another.”
For adult scoliosis patients looking for pain relief, the typical treatment suggestions from surgeons range from pain medications to epidural injections to the use of physical therapy modalities. When these measures fail, lose their impact over time or become burdensome for the patient, then sometimes surgery is the only option offered. However, as with kids, not all adults want surgery. Surgery for adult scoliosis is generally considered less successful than surgery for adolescents and long-term satisfaction rates are uncertain.
Non-surgical scoliosis practitioners
Back in 2002, we were one of the very first facilities to introduce non-surgical scoliosis-specific treatments in the United States. The methods we offer include the Schroth method (scoliosis-specific exercise) and the Cheneau-Gensingen brace. In recent years, various alternative treatment approaches for scoliosis have spread both locally and globally. When venturing into the area of non-surgical alternatives for scoliosis, there are numerous considerations. Here, we will provide an overview and elaborate in a future post.
While treatment philosophies and approaches differ, you will need to identify a scoliosis specialist whose treatment plan makes sense and is in alignment with your goals. Our approach to scoliosis management is curve-pattern specific and that belief is central to our treatment philosophy since each patient’s spinal configuration is unique.
When seeking out a practitioner for scoliosis treatment, look for someone with a track record of positive results and someone that provides realistic goals and expectations. Non-surgical scoliosis treatment requires guidance and work. You will need a caring ally to lead you in your plan of attack against scoliosis. Other things to consider are training, experience, teaching skills, overall knowledge and passion. As scoliosis is a personal and lifelong condition, a practitioner must help empower the patient and provide the tools needed to manage their scoliosis independently. We believe that these elements are paramount to treatment success.
It should be noted that there are various types of fitness experts (trainers) who now market themselves as providers of non-surgical treatment for scoliosis (ex: yoga, pilates, personal trainers, etc.). Unfortunately, these programs are often not curve-pattern specific or do not take the entire spinal configuration into account (scoliosis is more than just 1 curve in the back). Further, as fitness instructors lack the necessary medical training they are not able to properly manage scoliosis (i.e. develop or modify treatment plan if the curve changes, order x-rays when necessary, etc.). While some may provide adequate exercise instruction, not every alternative approach is in the patient’s best interest.
When we offer Schroth method training courses for professionals we limit enrollment to DCs, DOs, MDs, OTs and PTs. This is because the nuanced nature of treating scoliosis requires the knowledge and experience of a seasoned healthcare provider. Patients should be aware that Schroth practitioners and programs can vary tremendously, so please inquire with individual practitioners to learn more about their approach.
Aside from exercise-based approaches, scoliosis bracing often plays a large role in non-surgical treatment for scoliosis. The validity of bracing in adolescents has been clearly established by research studies. Unfortunately, there are some non-surgical treatment practitioners who are adamantly opposed to bracing. In our view, this should be a red flag! While it may seem easier to forego bracing advice it is the most prudent thing to do for a child at high risk of progression/with a progressive scoliosis.
One final note on this topic is regarding scoliosis and chiropractic. What’s important to know is that spinal manipulation is beneficial to help restore joint mobility, improve overall function and decrease inflammation and back pain/discomfort. However, there is no evidence that manipulation alone will improve scoliosis. We encourage spinal manipulation and chiropractic treatment for patients with idiopathic scoliosis but caution against using only regular chiropractic adjustments to treat scoliosis in a growing adolescent.
There is a lot to consider when searching for a scoliosis specialist. With all the noise on the internet it can be a confusing topic! In our next post, we will elaborate on specific things to look for when choosing an exercise-based treatment program for scoliosis.
