Scoliosis

Scoliosis Overview

It is important to understand normal spinal alignment. The thoracic spine viewed from the front to back (coronal plane) should be straight. The shoulders should be symmetrical, the hips level and the head squarely centered in the midline of the body. If a curvature in the spine is introduced in the front to back plane, it will throw off this balance unless an equal and opposite curve develops somewhere else in the spine. Thankfully, this secondary curve develops quite frequently.

A curvature in the spine (curve in the front to back plane known as coronal plane) of greater than 10 degrees is called a scoliosis. If the curve is less than 10 degrees, it is not considered scoliosis. This curve can be idiopathic (an unknown cause commonly seen in adolescents), a degenerative spine condition (caused by typical disc disease but with asymmetric wear instead of common symmetric wear), antalgic (caused by pain and not structural) or congenital (abnormal formation of the spine from birth). Deformities of the spine such as scoliosis may or may not need to be treated depending upon the grade of the curve and the symptoms that are generated by the curve. Pain with scoliosis can occur with those who have the condition.

Scoliosis Problems

The problem with scoliosis is that curves can advance over time and wear can occur from asymmetric loading. Gravity is of course always pushing down on us. Gravity therefore pushes down on the spine. If there is an abnormal curve, the weight of the body above this curve will try and enlarge it.

This is somewhat like a bowling ball balanced on top of a spring attached to the ground. If it is perfectly balanced, the ball will stay right on top of the spring. If you push the bowling ball off of midline, gravity will tend to push if further off midline. In fact, the further the bowling ball is from midline, the greater gravity’s push is to carry it further away.

Asymmetric wear is the other problem associated with scoliosis. The wear of the spine is analogous to car tire alignment. If the tire on a car is well aligned, you could expect to get 40,000 miles of wear from it. If the tire is misaligned, wear will be uneven and the tire may wear out after 5,000 miles. With scoliosis, uneven wear can cause premature degenerative disc disease and facet arthritis. Eventually, bone spur formation can cause nerve or even spinal cord compression.

Scoliosis Symptoms

Normally, scoliosis of the spine is asymptomatic (meaning the curve should generate no symptoms). The reason for treatment especially in adolescents with a growing spine is that the curve can advance (remember the bowling ball on the spring?). Over many years, we have been able to understand that curves over a certain magnitude at a certain age will continue to advance. This is why scoliosis screening is performed in schools. When the spine becomes degenerative in the face of scoliosis because of asymmetric wear, pain will occur depending upon the structures involved. Back pain or neck pain occurs from degenerative disc and facet disease, leg pain from nerve compression and fatigue from an unbalanced curve that requires chronic muscle contraction to stand upright.

(Click to Enlarge Image) This is an x-ray of a patient with degenerative scoliosis of the lumbar spine. In this front to back (AP) view, the spine should be straight up and down.

(Click to Enlarge Image) This is a patient with scoliosis. You can see from this view how the patient’s torso is shifted and the folds of skin in her back are not symmetrical.

(Click to Enlarge Image) This is an AP X-ray (scoliogram) of a patient with severe scoliosis. The white line depicts the center of gravity line from the head. It should intersect the center of the pelvis. The black horizontal line demonstrates how far off the patients balance is. The amount of energy expended necessary to walk made her use a walker for balance.

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(Please keep reading below for more information on this condition.)

Scoliosis Treatment

Non-Surgical

Treatment and surgery for scoliosis depends upon the age and the degree of curvature in the spine present. Most curves are discovered by a school screening or parents who notice unevenness of the torso of the child. This article is not designed to cover every curve degree and age but general rules do apply. Bracing is used to prevent progression of the curve-not to cause correction. A child with a curved spine under 20 degrees needs to be watched closely. A child placed in a brace with a 25 degree curved spine should come out of the brace at skeletal maturity with a 25 degree curve. A curve over 40-45 degrees normally would have to be fixed surgically in an immature patient. For scoliosis of the spine with degenerative changes, normally found in an older population, treatment is based upon the presenting disorder. If foraminal stenosis develops, the treatment centers on that diagnosis. If degenerative spondylolysthesis develops, treatment is focused to relieve those set of symptoms.

Surgical

Surgery for scoliosis is normally used for progressive scoliosis in the adolescent with curves over 40 degrees. In the older population, surgery for scoliosis to deal with the curved spine is addressed if the curve increases over time or creates pain that cannot be controlled with conservative spine treatment. There are other deformities of the spine that case a curvature in the spine. This video: “Hump-back, Increased Thoracic Kyphosis, Scheuermanns and Degenerative Kyphosis” demonstrates the importance of normal balance and how the normal curves of the spine (cervical and lumbar lordosis and thoracic kyphosis) balance each other out.

For additional information on scoliosis, or to discuss scoliosis treatment with a back specialist and spine surgeon in the Vail, Aspen, Denver and Grand Junction, Colorado area, please contact Dr. Donald Corenman.

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Donald Corenman, MD, DC

Average rating:

81 reviews

Eric S

Sep 26, 2021

by Eric S on Donald Corenman, MD, DC

Successful pars repair at 46 years old

Back in November of 2018 (at 46 years old) I came from Vancouver BC to have a pars repair done with Dr. Donald Corenman at the Steadman Clinic in Vail Colorado. I'm finally posting this review nearly three years later in late 2021. The reason I waited so long was I wanted to know the final result before I posted my review. Unfortunately in that time Dr. Corenman has retired. Nevertheless, I want to post this review of Dr. Corenman and his staff at the Steadman Clinic in their excellent treatment of my L5 pars interarticularis.

I fractured my pars at age 42 back in 2014 when rolling on the gym floor, and was denied treatment by the Canadian healthcare system, probably due to my age. First my GP told me there was no surgical option for a pars defect, which was quite incorrect! I tried to live with it, but the symptoms worsened (periodic random spine slippage and weeks of resultant pain after just bending over to tie my shoe, so I eventually learned to mostly squat and hardly bend). When I finally consulted with Canadian spine surgeons, I was told they believed my pars defect had been congenital (since birth). This was absurd, considering I had done extreme martial arts (including jiu jitsu) for years prior, as well as 5 years of reinforcing steel full time in my 20s, probably the hardest job on the back you can find. No pars defect like mine would possibly have allowed this--ergo it was impossible that I had had the defect since birth. I did however have an asymptomatic congenital spina bifida occulta that made me more susceptible to a pars fracture. In 2014 in one instant, I went from having the strongest back people I knew said they'd ever seen, to being unable to safely bend over and tie my shoe without a non-negligible risk of my spine slipping randomly (which would lead to weeks of pain after each occurrence). This was due to the unilateral L5 pars defect, otherwise known as spondylolysis. It was when lying in pain on the floor 4 years later after maybe the 6th spine slippage event post injury, that I had had enough, and resolved to have surgery. If Canada's "universal health care" said no, I would make lemonade from lemons, and find the very best surgeon in the world at pars repairs. That was Dr. Donald Corenman. Dr. Corenman back in 2018 ran a website https://neckandback.com/ that dedicated many pages to the science of every aspect of pars repairs, from eligibility (good discs on MRI), to best surgical techniques (minimal open compared to minimally invasive), best imaging to use (i.e., O-Arm with Stealth imaging vs. older fluoroscopy), the ideal amount of BMP to use and why not use too much or too little, and much more, all to do with pars repairs, pages upon pages of his site just on the pars, with scientific references and his own extensive expert opinion. As a health research statistician, I was very impressed with this. It was in stark contrast to the websites of other spine surgeons which barely gave the pars a word or two, focusing almost exclusively on fusions. I had found the best surgeon in the world for pars repairs, and so after Dr. Corenman personally screened my MRI to ensure my discs were healthy, I booked the surgery.

Being 46 years old at the time of surgery in 2018, with a 4-year-old pars fracture from 2014 combined with a congenital SBO meant my pars fragment was somewhat atrophied, but it was "very solid", said Dr. Corenman in the operative report. Nevertheless, it was challenging with two things to fix, the pars and SBO, and OR time was around 4 hours. Recovery over the following months was guided by a very clear "Spine binder" from the Steadman Clinic with strict rules of "no BLT" (no bending, lifting or twisting), and illustrated physiotherapy guidelines. They even warned patients to avoid fish oil supplements, which could excessively dampen inflammation and hence slow bone healing. They answered many questions I had during months of recovery, with responses coming from the very supportive Lori Fugate (then director of Dr. Corenman's practice), and Ehrich Bean (then physician's assistant at the practice), as well as a couple calls with Dr. Corenman himself after two of the CT scans. Ehrich Bean offered great advice for taking the spine binder conservatively due to the nature of pars repairs vs. fusions. The final post-op CT scan I had was a couple weeks ago at 34 months post-op, and Dr. Corenman had retired, but I got a very positive and informative call from Eric Strauch (current PA at the Steadman Clinic under Dr. Corenman's replacement there, and who had also worked with Dr. Corenman previously). The staff at the Steadman Clinic were extremely supportive all the way through the process. I should mention, the local Canadian spine surgeon did offer me very good post-operative support including antibiotics as needed to deal with a mild surface incision-site infection early on, booking numerous x-rays when I felt something was amiss, as well as booking all four of my post-op CT scans. I am very grateful for that support also.

My final result shows plenty of solid bone across the pars and a healed SBO, with my vertebral body now a solid bone ring instead of being broken at two places as it was pre-op. Does my spine hold up in the real world? You bet! I have recently dug and moved several yards of dirt and sand and gravel by myself (shovel and wheelbarrow!) to fix our water main, pulled roots from the yard, moved several "portable" (these are HUGE) air conditioners up several flights of stairs my myself, and lifted weights. I now run 2 miles (3.2 KM) several times weekly with a hard 100 meter dash in the middle. I bend deeply before each run I go on, with no spine slippage. My spine feels amazing. I can bend over to do exercise, or real word tasks, with no risk of spine slippage.

My sincere thanks to God, Dr. Donald Corenman, Lori Fugate, Ehrich Bean, Eric Strauch, and the Steadman Clinic, as well as the Canadian spine surgeon who offered me excellent post-operative care back in Canada. You have all given me a new lease on life.

Sincerely,
Eric S

Robert S

May 11, 2021

by Robert S on Donald Corenman, MD, DC

Back Fusion Surgery

I had my entire lumbar spine fused in November of 2018. I had scoliosis , with pinched nerves that were so painful I could hardly walk - and standing for more than a few minutes was impossible. Even sitting was painful.
The fusion surgery produced immediate relief! And the recovery was much easier than I expected.
To this day I can do all the activities I love from hiking, to standing in a stream fly fishing to riding my bike long distances - or just walking down the street with my wife.
Kudos to Dr. Corenman and his staff, (including the two Erics) for taking such good care of me!

Leslie R

Jul 9, 2020

by Leslie R on Donald Corenman, MD, DC

TLIF

I had my TLIF surgery on 6/24/2020 by Dr. Corenman, I can not say enough good things about the Dr or his staff. I was always treated with respect and explained everything throughly, that made it easy for everyone to understand. I highly recommend Dr. Corenman and the Steadman Clinic.

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