Scoliosis involves a 2- or 3-dimensional curve in the spine that can cause visual and/or functional abnormalities. It can involve curves that may go completely unnoticed in some and may impair lung function and daily activities in others. Scoliosis is a condition that has gone through a continuum of "best practice" treatments for decades. From requiring surgery to preventative bracing to minimal management, scoliosis continues to involve different severities of treatment. In PT school I remember learning I had scoliosis after learning how to perform the Adam's Forward Bend Test. I called my mother (a physician) after class to let her know, and she immediately started thinking I needed a consultation with an orthopaedic surgeon. Thankfully, my scoliosis is mild and I am past the developmental stage of life, so it hasn't required any specific management.
Different Treatment Options for Scoliosis
When the scoliosis is severe enough in an adolescent, either a Milwaukee Brace or TLSO (depending on curve location), can be used for treatment to prevent curve progression until the individual matures and the spine is less flexible; however, there are times when surgery is performed due to severity of curve or progression. Yet, when the curve is minimal, it is either ignored, "watched, " or sometimes physical therapy is prescribed (while some advocate exercises to correct imbalances associated with scoliosis, the research has not been shown to correct the asymmetry).
Emerging Research in Scoliosis
There are a variety of treatment methods for adolescents with scoliosis, but it is a condition that is managed later in life as well. While some surgeons will perform complex surgeries to correct/prevent progression of the curve, others choose to just monitor (similar to adolescents). However, with more imaging studies being performed, scoliosis appears to present as a possible normal asymptomatic spinal development in many individuals, in regards to its association with pain. Due to these developments, it is likely that a patient may be educated on pain and its lack of correlation with imaging findings.
A 2018 article on idiopathic scoliosis found a link between thoracic scoliosis and lung function. In the study, thoracic scoliosis and hypokyphosis was correlated with decreased lung function. This is worth noting due to the importance of normal oxygen levels and proper function of the majority of systems in our body. For example, abnormal lung function may lead to cardiovascular disease. While the study had some faults in design, it should still get us thinking about if we should consider managing scoliosis differently. The first step would be to develop some additional research to determine the validity and strength of the correlation between scoliosis and lung function (and possibly cardiovascular disease later in life). Should the correlation be validated, indications for bracing/surgical/PT implementation would have to be developed. This may be based off measures like pulmonary function tests, Cobb angles, or other findings that can help with decision making on treatment strategies. Regardless, there is still a lot to be done in research regarding scoliosis, lung function, and its impact on mortality, but it may have more significance than we associate with many imaging findings these days.
-Dr. Chris Fox, PT, DPT, OCS
Farrell J1, Garrido E2. Effect of idiopathic thoracic scoliosis on the tracheobronchial tree. BMJ Open Respir Res. 2018 Mar 25;5(1):e000264.
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