SPINAL STENOSIS

Spinal Stenosis Facts & Information

Spinal stenosis is a condition that typically develops very slowly as we get older, usually occurring after the age of 50. There are cases, however, where curvature of the spine (scoliosis) or congenital factors may lead to spinal stenosis in younger individuals.

The majority of cases of spinal stenosis occur in the lower or lumbar spine. Slippage and misalignment of the vertebrae, known as spondylolisthesis, can also be a cause of spinal stenosis. The most common symptom of spinal stenosis is cramping or aching in the calves. As the condition advances, it becomes increasingly difficult to stand and walk due to the intensity of the resulting leg pain.

Symptoms

Understanding the range of spinal stenosis symptoms is key. While spinal stenosis can develop any place within the spinal column, it most often occurs in the lumbar (lower) spine and, to a lesser extent, the cervical spine (neck). The location and severity of spinal stenosis determines the type of symptoms you may develop and how it is treated. Common symptoms include:

• Cramping or aching in the calves that impairs walking, often confused with a circulation problem
• Tingling, numbness, or pain that radiates from the low back into the buttocks and legs
• Neck or low back pain
• Pain, numbness, tingling, or cramping in the arms
• Weakness in the arms or legs.

Diagnosis

Proper diagnosis starts with an experienced pain management doctor. The type of pain that you may have with spinal stenosis can be similar to the symptoms of several types of disorders. Accurately determining the correct source of your pain is critical to successful treatment. Diagnosis involves the following:

• Begins with a thorough clinical evaluation
• Including a complete medical history, analysis of your symptoms, and physical examination
• Testing may include x-rays, MRI and/or CT scans, and electro-diagnosis (EMG)
• These advanced diagnostic techniques definitively pinpoint the source of pain.

CHIROPRACTIC : HELP TREAT MIGRAINE

WHAT IS CHIROPRACTIC?

(from Wikipedia)
Chiropractic is a form of alternative medicine^[1] concerned with the diagnosis and treatment of mechanical disorders of themusculoskeletal system, especially the spine, under the belief that these disorders affect general health via the nervous system.^[2] It is the largest alternative medical profession,^[3] and chiropractors often aspire to become primary care providers, though they lack the medical and diagnostic skills necessary to fulfil this role.^[4] The main chiropractic treatment technique involves manual therapy, especially manipulation of the spine, other joints, and soft tissues, but may also include exercises and health and lifestyle counseling.^[5] The "specific focus of chiropractic practice" is chiropractic subluxation.^[6] Traditional chiropractic assumes that a vertebral subluxation or spinal joint dysfunction interferes with the body's function and its innate intelligence.^[7] Some chiropractors fear that if that do not separate themselves from the traditional vitalistic concept of innate intelligence their profession will continue to be seen as fringe.^[3]

Effectiveness

There is no good evidence that chiropractic is effective for the treatment of any medical condition, except perhaps for certain kinds of back pain.^[9][10] Generally, the research carried out into the effectiveness of chiropractic has been of poor quality.^[83][84]

There is a wide range of ways to measure treatment outcomes.^[85] Chiropractic care, like all medical treatment, benefits from the placebo response.^[86] It is difficult to construct a trustworthy placebo for clinical trials of spinal manipulative therapy (SMT), as experts often disagree about whether a proposed placebo actually has no effect.^[87] The efficacy of maintenance care in chiropractic is unknown.^[13]

Available evidence covers the following conditions:

• Low back pain. A 2013 Cochrane review found very low to moderate evidence that SMT was no more effective than inert interventions, sham SMT or as an adjunct therapy for acute low back pain.^[11] The same review found that SMT appears to be no better than other recommended therapies.^[11] A 2012 overview of systematic reviews found that collectively, SM failed to show it is an effective intervention for pain.^[88] A 2011 Cochrane review found strong evidence that suggests there is no clinically meaningful difference between SMT and other treatments for reducing pain and improving function for chronic low back pain.^[89] A 2010 Cochrane review found no current evidence to support or refute a clinically significant difference between the effects of combined chiropractic interventions and other interventions for chronic or mixed duration low back pain.^[90] A 2010 systematic review found that most studies suggest SMT achieves equivalent or superior improvement in pain and function when compared with other commonly used interventions for short, intermediate, and long-term follow-up.^[91] Specific guidelines concerning the treatment of nonspecific (i.e. unknown cause) low back pain are inconsistent between countries.^[92]
• Radiculopathy. A 2013 systematic review and meta-analysis found a statistically significant improvement in overall recovery from sciatica following SM, when compared to usual care, and suggested that SM may be considered.^[93] There is moderate quality evidence to support the use of SM for the treatment of acute lumbar radiculopathy^[94]and acute lumbar disc herniation with associated radiculopathy.^[95] There is low or very low evidence supporting SM for chronic lumbar spine-related extremity symptoms and cervical spine-related extremity symptoms of any duration and no evidence exists for the treatment of thoracic radiculopathy.^[94]
• Whiplash and other neck pain. There is no consensus on the effectiveness of manual therapies for neck pain.^[96] A 2013 systematic review found that the data suggests that there are minimal short- and long-term treatment differences when comparing manipulation or mobilization of the cervical spine to physical therapy or exercise for neck pain improvement.^[97] A 2013 systematic review found that although there is insufficient evidence that thoracic SM is more effective than other treatments, it is a suitable intervention to treat some patients with non-specific neck pain.^[98] A 2011 systematic review found that thoracic SM may offer short-term improvement for the treatment of acute or subacute mechanical neck pain; although the body of literature is still weak.^[99] A 2010 Cochrane review found low quality evidence that suggests cervical manipulation may offer better short-term pain relief than a control for neck pain, and moderate evidence that cervical manipulation and mobilization produced similar effects on pain, function and patient satisfaction.^[100] A 2010 systematic review found low level evidence that suggests chiropractic care improves cervical range of motion and pain in the management of whiplash.^[101]
• Headache. A 2011 systematic review found evidence that suggests that chiropractic SMT might be as effective as propranolol or topiramate in the prevention of migraine headaches.^[102] A 2011 systematic review found evidence that does not support the use of SM for the treatment of migraine headaches.^[103] A 2006 review found no rigorous evidence supporting SM or other manual therapies for tension headache.^[104] A 2005 review found that the evidence was weak for effectiveness of chiropractic manipulation for tension headache, and that it was probably more effective for tension headache than for migraine.^[105] A 2004 Cochrane review found evidence that suggests SM may be effective for migraine, tension headache and cervicogenic headache.^[106]
• Extremity conditions. A 2011 systematic review and meta-analysis concluded that the addition of manual mobilizations to an exercise program for the treatment of knee osteoarthritis resulted in better pain relief then a supervised exercise program alone and suggested that manual therapists consider adding manual mobilisation to optimise supervised active exercise programs.^[107] There is silver level evidence that manual therapy is more effective than exercise for the treatment of hip osteoarthritis, however this evidence could be considered to be inconclusive.^[108] A 2008 systematic review found that the addition of cervical spine mobilization to a treatment regimen for lateral epicondylosis (tennis elbow) resulted in significantly better pain relief and functional improvements in both the short and long-term.^[109] There is a small amount of research into the efficacy of chiropractic treatment for upper limbs,^[110] limited to low level evidence supporting chiropractic management of shoulder pain^[111] and limited or fair evidence supporting chiropractic management of leg conditions.^[112]
• Other. A 2012 systematic review found insufficient low bias evidence to support the use of spinal manipulation as a therapy for the treatment of hypertension.^[113] A 2011 systematic review found moderate evidence to support the use of manual therapy for cervicogenic dizziness.^[114] There is very weak evidence for chiropractic care for adultscoliosis (curved or rotated spine)^[115] and no scientific data for idiopathic adolescent scoliosis.^[116] A 2007 systematic review found that few studies of chiropractic care for nonmusculoskeletal conditions are available, and they are typically not of high quality; it also found that the entire clinical encounter of chiropractic care (as opposed to just SM) provides benefit to patients with cervicogenic dizziness, and that the evidence from reviews is negative, or too weak to draw conclusions, for a wide variety of other nonmusculoskeletal conditions, including ADHD/learning disabilities, dizziness, high blood pressure, and vision conditions.^[117] Other reviews have found no evidence of significant benefit for asthma,^[118][119] baby colic,^[120][121] bedwetting,^[122] carpal tunnel syndrome,^[123] fibromyalgia,^[124] gastrointestinal disorders,^[125] kinetic imbalance due tosuboccipital strain (KISS) in infants,^[120][126] menstrual cramps,^[127] or pelvic and back pain during pregnancy.^[128]

Chiropractic for Headache/Migraine

Several clinical trials indicate that spinal manipulation therapy may help treat migraine headaches. In one study of people with migraines, 22% of those who received chiropractic manipulation reported more than a 90% reduction of attacks. Also, 49% reported a significant reduction of the intensity of each migraine.

In another study, people with migraine headaches were randomly assigned to receive spinal manipulation, a daily medication (Elavil), or a combination of both. Spinal manipulation worked as well as Elavil in reducing migraines and had fewer side effects. Combining therapies didn't work any better.

In addition, researchers reviewed 9 studies that tested chiropractic for tension or migraine headaches and found that it worked as well as medications in preventing these headaches. More research is needed to say for sure whether chiropractic care can prevent migraines.

Migraines and Chiropractic Treatment

It often starts with lines or spots or different colored lights performing a dance in front of your eyes. After a short period of time these symptoms develop into a whole raft of more serious symptoms such as general irritability, visual hallucinations, emotional depression, a sensation of numbness, gastrointestinal changes such as constipation and diarrhea. Finally the pain begins and it can range form a mild pain through to more intense feelings of agony that can last for hours or days.

If you get migraines, then you'll know that a migraine is more than just a headache. It's an intense and throbbing pain, which often occurs in one side of the head, although it can be more generalised. This is the classic migraine that people all over the world suffer with on a daily basis. Migraines fall into two main categories,

1. Without aura which is commonly known as a common migraine
2. With an aura which is commonly known as a classic migraine.

Around 1 in 6 cases of migraine are classic and are preceded by an aura. 80% of migraines are common with no aura. An aura is a warning sign that appears between 15 minutes to one hour before the headache starts. Auras are symptoms of the nervous system that is usually visual disturbance or olfactory (smell) disturbance. About 60% of classic migraines report a prodrome which develops in the days to hours before a headache.

Signs and Symptoms:

Migraine without aura common symptoms

• Nausea/vomiting
• Sensitivity to light (photophobia)
• Sensitivity to noise (phonophobia)
• Sensitivity to smell (osmophobia)
• Headache

Migraine without aura additional symptoms

• Feeling cold or hot
• Inability to think clearly or perform normal activities
• Loss of concentration

Migraine with aura has additional symptoms

• Visual disturbances - wavy lines, flashing lights, blind spots
• Stiffness or tingling in neck, shoulders, or limbs
• Lack of co-ordination
• Slurred or muddled speech
• Loss of consciousness (very rare)

Post migraine

• Feeling "washed out"
• Fatigue
• Poor concentration
• Either lethargy or full of energy and revitalised

Causes of Migraine

The causes of migraines are not fully understood. There are a number of different theories as to the cause.

1) Vascular Theory. It is thought that the initial vasoconstriction of the arterioles causes the prodromal and aura symptoms in advance of the headache. The lack of oxygen causes the localised release of serotonin and this results in vasodilation that causes arteries here to widen, leading to the headache. As the arteries widen the pain gets worse and worse. Migraines appear at intervals with days, weeks or months between attacks rather than being a daily headache.

2) Nervous System Nervous system theories suggest that rapid changes in activity of nerve cells in the brain cell and in particular the brain stem have been implicated in migraine and a chemical messenger called seratonin is also thought to be involved. This can be the result of an unstable autonomic nervous system, reduced magnesium levels that result in destabilised nerve membranes or abnormal brain electrical activity ( EEG.

Although migraine is not life threatening, we know how it can impact on your quality of life.

How will Chiropractor be assessed for Migraine?

Your Chiropractor will conduct an extensive background history as well as a thorough examination and possibly even x-rays.

History: 
Usually there is some specific triggering factor may include any one following:

• Physical exertion
• Tension headaches
• Emotional stress
• Rapid blood sugar changes
• Vasoactive foods such as histamine in citrus juice, tyranine in chocolate nuts cheese and red wine, MSG in processed foods coffee tea and alcohol
• Some medications
• Environmental toxins, allergies and sensitivities, chemicals

Pain can be mild, moderate or extremely severe, throbbing in nature, unilateral or bilateral.

Examination: 
Your Chiropractor will assess your posture and look for the underlying cause of the headaches which will look at all of the following factors:

• General posture and flexibility,
• Palpation may reveal muscle tenderness and tightness,
• Specific orthopedic tests to the neck ,
• Muscle tests to determine the extent of weakness,
• Neurological assessment if required,
• X-rays of the neck and or spine may be conducted depending on the extent of your problems and the examination findings.
• Your Chiropractor will discuss with you exactly what examinations will be appropriate and will require your consent before undertaking an examination.

Once a diagnosis has been confirmed then specific treatment options can be discussed.

SCOLIOSIS : On Adults

Adult Scoliosis

What is Adult Scoliosis? The normal, healthy spine is straight when seen from the front or the back (frontal plane). When seen from the side, the healthy spine has several mild curvatures. By obtaining an X-ray of a standing person, the exact contour of the spine can be measured and then compared to normal values to determine if a significant spinal deformity is present. Scoliosis is defined as a lateral deviation of the spine. More precisely, if the spine, seen on an antero-posterior radiograph (abbreviated as "AP", ie. seen from the front), has a curvature that measures more than 10 degrees then a scoliosis is present. (figure 1) When a curvature, or scoliosis, is mild then one may not be able to detect any abnormality without an X-ray. On the other hand, moderate or severe scoliosis can be noted due to an asymmetry of the back. A tilted waistline and skin folds may be present, as well as a hunching, or protrusion of the back. Frequently, such an asymmetry in the back is more noticeable with leaning forward. There are many types of scoliosis, and people of all ages can be affected by scoliosis. In adults, scoliosis can result from several conditions, but most types fall into two different categories. In the first category is a person who had a scoliosis as a child/adolescent and the abnormal spine curve has increased into adult life or is becoming painful with aging. The second category of adult scoliosis is seen in patients who have never had a scoliosis as a child but begin to develop an abnormal curvature with aging. The spinal deformity in degenerative scoliosis is usually a mild side curvature involving predominantly the lower levels of the spine. Symptoms related to adult scoliosis are mostly due to degeneration (wear and tear) of structures that support the spine. These changes which are often called "arthritis of the spine" can occur at all levels of the back (neck, upper back and lower back). With aging and arthritis, a gradual narrowing of the discspaces between vertebrae, wearing out of the joints, as well as narrowing of the space available for the nerves (a condition known as stenosis) can develop.  Spinal stenosis is a narrowing of the open spaces within your spine, which can put pressure on your spinal cord and the nerves that travel through the spine to your arms and legs. Spinal stenosis occurs most often in the lower back and the neck. While spinal stenosis may cause no signs or symptoms in some people, other people may experience pain, tingling, numbness, muscle weakness, and problems with normal bladder or bowel function. Spinal stenosis is most commonly caused by wear-and-tear changes in the spine related to osteoarthritis. In severe cases of spinal stenosis, doctors may recommend surgery to create additional space for the spinal cord or nerves Although degeneration of the spine is part of the normal aging process in all people, it appears that in most people the spine becomes stiffer with age but does not develop a lot of abnormal curvature and causes only minimal or no pain. In other people the spine loses its structural stability with aging and gradually develops abnormal curvatures that can be painful and lead to symptoms including back pain, stooped posture, leg problems (numbness, heaviness, tingling, pain and weakness) and progressive difficulty in walking which requires frequent rests and activity limitation. How is Scoliosis evaluated? An evaluation by a spine specialist is important when scoliosis is present. In addition to a comprehensive medical evaluation and examination, scoliosis is assessed by obtaining X-rays of the entire spine in the standing position. Scoliosis is confirmed when an X-ray reveals a lateral deviation (curve) measuring more than 10 degrees. (Figure 2) In patients who have leg symptoms or difficulty walking, further tests may be ordered by your physician to more closely evaluate the spinal canal and the nerveswhich lead from the spine to the legs. This may require an MRI or CAT scan, and possibly a myelogram. Who needs treatment, and what are the treatment options for Adult Scoliosis? Treatment of adult scoliosis is directed at the particular problem, which is causing symptoms in a patient. In some patients the leg numbness or weakness is most bothersome while in others it may be back pain alone. The fact that someone has a scoliosis does not necessarily mean that pain or disability is present. Many people have scoliosis and require no particular treatment. Prior to any treatment a clear diagnosis and discussion of treatment options with a specialist is necessary. Non-operative treatment options Most commonly the first approach to treatment for adult scoliosis is 'conservative treatment' (ie. non-surgical). In general, patients who are experiencing back pain and fatigue, and are otherwise in good health, pursue a guided back strengthening program. With a rehabilitation program for re-conditioning muscles of the spine it may be possible to improve support and posture leading to a reduction of abnormal alignment and motion in the spinal column, thereby reducing pain. In order for the exercises to be effective they must be performed regularly. It may take weeks or months for exercises to lead to an improvement in symptoms. In addition to strengthening exercises it is important to maintain overall good health by eating properly, sleeping well and not smoking. For patients with severe pain, and evidence of instability the addition of a back brace may be very helpful. Bracing may help reduce motion across the spine and provide the sensation of increased support. Bracing does not eliminate the need for physical therapy, and exercises can often be performed while wearing the brace. Practical tips on living with a brace If your physician has recommended a brace you must understand that this is not an easy treatment method and does not replace the need for other treatments such as physical therapy. It is essential that you have a customized brace made which will fit your body shape. Everyone has a unique body shape, and particularly a patient with scoliosis will have a shape that requires detailed attention in the making of a brace. There are many types of braces and your physician will determine which is most suitable for you. Initially, any brace will seem awkward to wear and may even be quite uncomfortable. To give bracing a fair chance be patient and get used to wearing your brace in a gradual manner. It may be a good idea to start wearing the brace for only an hour at a time and then increasing this daily until after a week or so you can tolerate the brace for most of the day. During bathing and while in bed the brace can usually be removed, your physician will guide you in specific instructions. Injection therapy has been applied to cases of adult scoliosis. Although injections have not been clearly proven to lead to long-term success for many patients, there are particular cases where some relief can be obtained. Surgical treatment Surgery should be reserved for those cases when a specific cause for discomfort has been identified and all non-operative treatments have failed. The patient must carefully consider the risks of surgery against the possible benefits. Detailed discussions with a spine specialist are essential prior to considering invasive treatments. What types of surgery are performed for Adult Scoliosis? Any surgical procedure for adult scoliosis should only be considered after careful review of all non-surgical options and failure of the 'conservative' treatment approaches. Only very rarely is surgery an emergency or first treatment. The type of surgical procedure performed for adult scoliosis will depend upon several factors. Most importantly, a detailed pre-operative evaluation is essential to clearly define the problems at hand. The goal of surgery is to correct the abnormalities while providing a stable spine to avoid future problems. Depending upon the main problems of a particular person, one of a variety of different surgical procedures may be performed. For instance, if the primary problem is spinal stenosis (narrowing of the spinal canal which leads to nerve compression/irritation) then decompression alone may be performed. For a problem of spinal instability such as spondylolisthesis (forward slippage of one portion of the spine over another),  Spondylolisthesis (spon + dee + lo + lis + thee + sis) is a condition of the spine whereby one of the vertebra slips forward or backward compared to the next vertebra. Forward slippage of an upper vertebra on a lower vertebra is referred to as anterolisthesis, while backward slippage is referred to as retrolisthesis. Spondylolisthesis can lead to a deformity of the spine as well as a narrowing of the spinal canal (central spinal stenosis) or compression of the exiting nerve roots (foraminal stenosis). Spondylolisthesis is most common in the low back (lumbar spine) but can also occur in the mid to upper back (thoracic spine) and neck (cervical spine). a surgeon may recommend a decompression accompanied by a fusion and possible instrumentation (placement of screws and rods). In cases of progressive deformity with severe pain and nerve symptoms a surgeon may recommend a correction of the scoliosis and a spinal fusion from the front and back of the spine.

PROGNOSIS

In general, the severity of the scoliosis depends on the degree of the curvature and whether it threatens vital organs, specifically the lungs and heart.

• Mild Scoliosis (less than 20 degrees). Mild scoliosis is not serious and requires no treatment other than monitoring.
• 
  
• Moderate Scoliosis (between 25 and 70 degrees). It is still not clear whether untreated moderate scoliosis causes significant health problems later on.
• 
  
• Severe Scoliosis (over 70 degrees). If the curvature exceeds 70 degrees, the severe twisting of the spine that occurs in structural scoliosis can cause the ribs to press against the lungs, restrict breathing, and reduce oxygen levels. The distortions may also cause dangerous changes in the heart.
• 
  
• Very Severe Scoliosis (Over 100 degrees). Eventually, if the curve reaches over 100 degrees, both the lungs and heart can be injured. Patients with this degree of severity are susceptible to lung infections and pneumonia. Curves greater than 100 degrees increase mortality rates, but this problem is very uncommon in America.

Some experts argue that simply measuring the degree of the curve may not identify patients in the moderate and severe groups who are at greatest risk for lung problems. Other factors (spinal flexibility, the extent of asymmetry between the ribs and the vertebrae) may be more important in predicting severity in this group.

EFFECTS ON BONES

Scoliosis is associated with osteopenia, a condition characterized by loss of bone mass. Many adolescent girls who have scoliosis also have osteopenia. Some experts recommend measuring bone mineral density when a patient is diagnosed with scoliosis. The amount of bone loss may help predict how severely the spine will curve. Preventing and treating osteopenia may help limit further curve progression.

If not treated, osteopenia can later develop into osteoporosis. Osteoporosis is a more serious loss of bone density that is common among postmenopausal women. Adolescents who have scoliosis are at increased risk of developing osteoporosis later in life.

Osteoporosis is a condition characterized by progressive loss of bone density, thinning of bone tissue, and increased vulnerability to fractures. Osteoporosis may result from disease, dietary or hormonal deficiency, or advanced age. Regular exercise and vitamin and mineral supplements can reduce and even reverse loss of bone density.

SPINE PROBLEMS IN PREVIOUSLY TREATED SCOLIOSIS PATIENTS

After 20 years or more, scoliosis patients who were previously treated with surgery experience small but significant physical impairments (mainly mild back problems), compared to their peers without scoliosis. More people with a history of scoliosis report having to take days off from work, compared to people who never had the condition. In general, however, most patients experienced a similar quality of life to peers who never had the condition.

The following are some possible causes of later back problems in people with a history of treated scoliosis:

• 
  
• Spinal fusion disease. Patients who are surgically treated with fusion techniques lose flexibility and may experience weakness in back muscles due to injuries during surgery.
• 
  
• Disk degeneration and low back pain. With disk degeneration, the disks between the vertebrae may become weakened and rupture. In some patients, particularly those treated with the first generation of the Harrington rods, years after the original surgeries the weight of the instrumentation can cause disk and joint degeneration severe enough to require surgery. Treatment may involve removal of the old rods and extension of the fusion into the lower back. Still, most patients do not experience significant back pain from these problems.
• 
  
• Height loss. Fusion of the spine may inhibit growth somewhat. However, much of the growth takes place in long bones, which are not affected.
• 
  
• Lumbar flatback. This condition is most often the result of a scoliosis surgical procedure called the Harrington technique, which eliminated lordosis (the inward curve in the lower back). Adult patients with flatback syndrome tend to stoop forward. They may experience fatigue and back and even neck pain.
• 
  
• Rotational trunk shift (uneven shoulders and hips).

Evidence suggests that previous treatment with braces may also cause mild back pain and more days off, but problems appear to be less than with surgery. In one study, dysfunction was comparable to people without a history of scoliosis.

PROBLEMS IN ADULT-ONSET OR UNTREATED CHILDHOOD SCOLIOSIS

Pain in adult-onset or untreated childhood scoliosis often develops because of posture problems that cause uneven stresses on the back, hips, shoulders, necks, and legs.

Many individuals with untreated scoliosis will develop spondylosis, an arthritic condition in the spine. The joints become inflamed, the cartilage that cushions the disks may thin, and bone spurs may develop. If the disk degenerates or the curvature progresses to the point that the spinal vertebrae begin pressing on the nerves, pain can be very severe and may require surgery. Even surgically treated patients are at risk for spondylosis if inflammation occurs in vertebrae around the fusion site.

LONG-TERM EMOTIONAL IMPACT OF SCOLIOSIS AND ITS TREATMENTS

Emotional Impact in Childhood. The emotional impact of scoliosis, particularly on young girls or boys during their most vulnerable years, should not be underestimated. Adults who have had scoliosis and its treatments often recall significant social isolation and physical pain. Follow-up studies of children who had faced scoliosis without having strong family and professional support often report significant behavioral problems. Fortunately, current treatments are solving many of the problems that previous generations had to deal with, including unsightly bracing and extremely painful surgeries with little pain control.

Emotional Effects in Adults. Of some concern are the growing numbers of adults with scoliosis. This group experiences considerable problems in general health, social functioning, emotional and mental health, and pain.

Older people with a history of treated scoliosis may carry negative emotional events into adulthood that have their roots in their early experiences with scoliosis. Patients who were treated for scoliosis may often have limited social activities, a poorer body image, and slight negative effect on their sexual life. Pain appears to be only a minor reason for such limitation.

EFFECTS ON PREGNANCIES AND REPRODUCTION

Women who have been successfully treated for scoliosis have only minor or no additional risks at all for complications during pregnancy and delivery. A history of scoliosis does not endanger the child. Pregnancy itself, even multiple pregnancies, does not increase the risk for curve progression. Women who have severe scoliosis that restricts the lungs, however, should be monitored closely.

RESPIRATORY IMPAIRMENT

Patients with severe deformities, particularly those with underlying neuromuscular disorders, may develop what is called restrictive thoracic disease. This term refers to problems in breathing and, at times, trouble obtaining enough oxygen due to a smaller chest cavity. This smaller chest cavity results from the deformities or surgery. The restricted chest cavity is also less able to expand when breathing.

RISKS OF CANCER FROM MULTIPLE X-RAYS

Some evidence suggests a slightly higher risk for breast cancer and leukemia in patients who had multiple x-rays. Risks are highest in patients who had the largest radiation exposure, such as those who had been surgically treated.

Patients who simply received x-rays for untreated idiopathic scoliosis, or scoliosis caused by uneven length of the legs or hip abnormalities have a very low risk for future complications.