Scoliosis - Medical specialists

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Scoliosis - Further information

In which specialist field are scoliosis specialists active?

Scoliosis is often first noticed by a primary care doctor, or sometimes a paediatric physician, who will then refer the problem on to a scoliosis specialist. There are different forms of scoliosis, which in turn can influence the type of specialists who are consulted. Thus, a typical scoliosis care team may consist of some of the following specialists:

  • an orthopaedic surgeon, who will focus on congenital deformities and general spinal causes of scoliosis
  • a neurosurgeon, who will become involved if it appears there may be neurological and muscular issues to consider
  • a geriatrician, who may be consulted in the case of degenerative forms of the disease involving older adults
  • a neurologist, who may treat an underlying condition relating to the nervous system
  • a physiatrist, whose focus will be upon patient rehabilitation after the diagnosis of a musculoskeletal disorder
  • an occupational therapist, who may be needed to help with braces and supports

Which illnesses do scoliosis specialists treat?

There are several different types of scoliosis, determined by their actual cause and the age of the patient when the curvature begins to develop. Pain is often not a symptom, and in many cases, the cause of a patient’s scoliosis cannot be positively identified.

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The main types of scoliosis include:

  • congenital scoliosis, which is a type of scoliosis that becomes apparent at birth, and is thought to be caused when the spine is unable to fully develop inside the womb.
  • early onset scoliosis describes cases where a spinal curvature appears between birth and 10 years of age, or else before puberty occurs.
  • adolescent idiopathic scoliosis, which is a type of scoliosis found when the spine changes shape during periods of adolescent growth. The spine characteristically tends to twist as it curves sideways.
  • degenerative scoliosis, which occurs in older adults, primarily because of changes caused by spondylosis (a type of arthritis), which cause the spine to weaken and curve with ageing. Spinal curvature can also be attributable to osteoporosis, vertebral compression fractures and disc degeneration.
  • neuromuscular scoliosis, which occurs when spinal curvature is the result of a neurological or muscular condition. This can be associated with diseases such as cerebral palsy and spinal muscle atrophy, though it can also develop as a result of spinal injury.
  • Scheuermann's kyphosis, which is a type of scoliosis where the front sections of the vertebral bones (small bones which form the spinal structure) grow at a slower rate than the corresponding back sections, during childhood.
  • syndromic scoliosis, which occurs when a sideways curving of the spinal column develops as part of a syndrome (a syndrome being a condition where lots of different symptoms appear in combination).

Medical terminology often uses further descriptions to indicate additional aspects of the disease:

  • kyphoscoliosis means there is a curve in two different planes
  • dextroscoliosis indicates a spinal curve to the right
  • rotoscoliosis describes a curvature where the spinal column appears to rotate around its axis
  • levoconvex means a spinal curve to the left
  • thoracolumbar indicates a curve in both the chest (thoracic) and lumbar regions of the spine

What treatment methods are used by scoliosis specialists?

Any treatment recommended by a scoliosis specialist is likely to be determined by the maturity of the patient.

The treatment options for children and adolescents are:

  • observation (watch and wait)
  • bracing
  • surgery

Adult options, which usually focus on pain relief, are:

  • pain-relieving medication
  • bracing
  • surgery

Braces are fitted to the torso, though they may sometimes extend to the neck. Bracing is usually considered when further bone growth is likely, and aims to prevent any further curvature, which might require surgery. Adult braces are occasionally used to relieve pain.

Surgery is often recommended in cases where:

  • curving is likely to progress
  • curvature is cosmetically unacceptable for an adult
  • curves associated with spina bifida and cerebral palsy cause discomfort
  • curves impair physiological functions, such as breathing

The two surgical methods employed are:

  • anterior fusion, which requires an incision on the side of the chest.
  • posterior fusion, which requires an incision on the back and uses a metal framework to correct the curvature.

What additional qualifications are required by scoliosis specialists?

A scoliosis specialist will first of all qualify as an orthopaedic surgeon, a process that requires a four-year period of training, plus one more year completing a broad-based accredited residency program focused on general surgery, internal medicine or paediatrics.

At that point, scoliosis specialists will almost certainly opt for an additional two-year fellowship in spinal surgery. However, it is worth noting that qualified neurosurgeons also have a career option to specialise in spinal surgery. Given that both of these disciplines can be involved in the surgical and non-surgical care and management of scoliosis, it is perhaps the successful scoliosis-related experience of any particular surgeon that will prove to be of greater significance.

The Scoliosis Research Society have adopted strict SRS Fellowship requirements, which stipulate that surgeon members must devote a minimum of 20% of their practice to spinal deformities, and many other national organisations will have similar requirements.