Category Archives: Scoliosis

What is Kyphosis?

By  aenriquez  published  August 27, 2020

Kyphosis is a seldom-occurring genetic disorder of the spine marked by a forward curvature in the upper back. Technically kyphosis is diagnosed for a spine with an upper back curvature of 50 degrees or greater. In comparison, a normal spine can bend between 20 and 45 degrees.

The spinal curve can develop simply from poor posture. If that is the case, it can often be treated with physical therapy. The outlook for improvement (the prognosis) for postural kyphosis is usually favorable.

A more serious version of kyphosis is called  Scheuermann’s Kyphosis. This occurs if the vertebrae that make up the bony infrastructure of your back develops in a wedge shape. While rare, the wedge shape of the vertebrae forces the patient to bend forward. The bony structure can worsen until you reach your adult size and have stopped growing.

Congenital kyphosis is often diagnosed at birth. While noticeable at birth, the curvature can increase until the child stops growing.

Causes of Kyphosis

There is more than one cause for Syphosis to develop. Metabolic issues could be the cause. Neuromuscular disorders can also cause the upper back to develop a forward curve. Osteogenesis imperfecta, a disease marked by brittle bones, can cause kyphosis. Spina bifida, poor posture, and Scheuermann’s kyphosis can cause kyphosis. The cause of Scheuermann’s kyphosis is unknown.

The condition of spinal osteoporosis can also cause a humpbacked condition. Osteoporosis is a natural condition that develops as we age. Our bones become brittle as we age. When this occurs in the spine, the vertebrae can crack from age or injury. If the front of the vertebrae weakens first, the vertebrae will lean forward and develop a wedged shape.


The symptoms of kyphosis can be subtle or pronounced. The common symptoms are:

  • back pain
  • hamstring pain in the back of your thigh
  • a noticeable hump, especially when bending forward
  • comparing left and right, shoulders or shoulder blades form at different heights
  • a head tilted forward


           The most common test used to diagnose kyphosis is an X-ray. This allows doctors to get a look at your bony structures. Doctors can then check to see how severe the curve of your spine might be.


For severe cases of youth who have kyphosis, surgery may be recommended. This likely will involve vertebrae fusion, which binds neighboring vertebrae with the help of surgical screws. The operation can take several hours and will include the help of a neurophysiologist, who will observe closely to ensure the screws do not interfere with the spinal cord.

Alternative options for less severe cases could involve a combination of pain medication and physical therapy or exercises to strengthen muscles in the back or abdomen.

Braces are also prescribed. While this is a non-evasive technique, the improvements for growing children can be pronounced. Surgery is always considered a last resort measure taken if other options fail.

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Non-Surgical Scoliosis Treatment

By  aenriquez  published  September 19, 2017

Scoliosis Check for the Curvature of the spineAlthough researchers have not determined the specific causes of scoliosis, treatment with braces and surgery have remained the same for more than a century. Scoliosis is a very complex condition involving bone, muscles, ligaments and other body systems, and most cases are idiopathic, meaning there is no known cause. The traditional treatments have fallen short in treating all aspects, and these treatments have repercussions of their own. Amazingly, some doctors are even still using an outdated two-dimensional tool called the Cobb angle to measure spinal curvature. New 3-D methods like MRI or posturography are much more reliable.

Surprisingly, surgery is not even necessary in most cases of scoliosis. Very rarely is scoliosis a life-threatening condition; this is only seen in young children with severe spine deformation that interferes with the lungs and heart. Scoliosis sufferers sometimes have back pain, but beyond that, there are no physical consequences and adults with untreated scoliosis are usually very high-functioning. The surgery is largely done for cosmetic reasons alone.

In teenagers, surgeons typically recommend surgery with curvature over 40 degrees. Teens are the largest surgical population for this surgery, and teens as young as 14 have had the surgery, before they’ve stopped growing; that can cause serious consequences down the road. Surgery is often presented as an immediate need, and surgeons reassure parents that the surgery is so much better than it used to be.

But every surgery is invasive, creating a great risk of infection and other complications. Spinal fusion of vertebrae should only be a last-resort option.

The good news is that there is now a much better, non-invasive scoliosis treatment that involves teaching the brain to hold the spine in a straighter position. The treatment is effective for both children and adults with scoliosis.

It is a neuromuscular training technique that treats not only the bone in the spine, but also the corresponding supporting muscles, tendons and ligaments. Scoliosis’ cause is unknown, but research studies have shown that lack of communication between the postural control center in the brain and the body does make it worse.

Basically, there should be signals that the body posture isn’t balanced, but those signals never occur. This non-surgical approach uses exercises to retrain the brain to tell the body about postural imbalances. Over time, muscles are less resistant to the spine, and the body and brain learn how to hold the spine straight.

The method has been shown to reduce or stop pain, stop the progression of scoliosis and reduce the abnormal curvature of the spine. The technique is effective in both adults and children. Ideally, in children, if the treatment is started before a child has a 25-degree curve, that child will never have to have surgery.

The technique is non-surgical, and back braces are not required. There are no sports or activity restrictions either.

Contact us to learn about this technique before you try surgery. Although scoliosis surgery has become less invasive, it is nevertheless a surgery, and that comes with inherent risks. The surgeries have a high failure rate involving implant failure, and surgery often does not eliminate back pain or offer improvements like better breathing function. Many suffer nerve damage, infection and chronic pain as a result of the surgery, only to find they have no improvement in quality of life. And don’t forget about the scar that runs the entire length of the back.

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Swedish Study Regarding Use of Brace for Scoliosis

By  aenriquez  published  September 13, 2017

A study was conducted whereby Swedish patients had been involved in an SRS brace study had been invited for a long term follow up. The objective of this study had been the investigation of the rate of scoliosis surgery and its link to the progression of curves from baseline, as well as after maturity. In this study, brace treatment was concluded to be superior to electrical muscle stimulation. It was found to be superior to observation alone, as in the original brace study. There have been very few other studies that have been able to show that brace treatment is indeed effective in the treatment of scoliosis.

Scoliosis Bracing TechnologyThe method used in this bracing study involved both the Boston brace treatment (this was applied to 41 patients in Malmö) and observation alone as a treatment method (applied to 65 patients in Göteborg). The total number of patients was 106, out of which only 87% attended the follow-up in which radiography and chart review was included. The radiographs were all measured for curve size using the Cobb method. This was done by an unbiased examiner. Patients who had undergone the surgery after maturity were identified from the mandatory national database.

The mean age at the first follow-up time was 16 years, and 32 years was the mean age at the second follow-up. Both treatment groups were shown to have equal curve size at the inclusion. The patients who were treated with a brace from the start, had their curve size reduce by 6 degrees during the course of the treatment. The curve size returned to the same level over the follow-up period.

The primarily braced patients underwent surgery. In the observation alone group, 20% due to progression were braced during adolescence. The other 10% underwent surgery, and the remaining 70% of the patients were observed alone, with an increased by 6 degrees from inclusion till now. Surgery after maturity was not performed on any of the patients, and progression was related to premenarchal status.

The conclusion of the study showed that the moderate or smaller size curves of patients with adolescent idiopathic scoliosis did not show deterioration beyond their original curve size in this 16-year follow up. Patients treated with a brace did not need surgery; however, 6 patients, which was a 10% of the total in the observation group, needed surgery during their adolescence. Thus, it was concluded that curve progression was related to immaturity.

Parent SNewton PO, & Wenger DR.
Danielsson AJHasserius ROhlin A, et al.
Richards BS, Bernstein RM, D’Amato CR, et al. 


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Orthopedic Bracing and Adolescent Idiopathic Scoliosis

By  aenriquez  published  August 24, 2017

A three-dimensional deformity of the spine is referred to as adolescent idiopathic scoliosis. Different research teams have made great efforts to actively get to the etiology of scoliosis, but it still remains unclear. Treatment of this condition requires a sound clinical judgment and also a thorough understanding of the natural history of this disorder.

Bracing can present a challenge to the orthopedic surgeon in the evaluation of adolescent idiopathic scoliosis, an institution of conservative treatment, and the monitoring stages. Most patients, however, only require clinical monitoring. The review of the patient’s history, as well as a thorough physical examination, can help make for an easier diagnosis and help establish the risk for the progression of this condition as well.


idiopathic scoliosisDiagnosing Adolescent Idiopathic Scoliosis

The factors that can help the orthopedic surgeon assess the likelihood of the progression adolescent idiopathic scoliosis are gender, curve location, skeletal maturity, growth velocity, and the magnitude. Bracing has been identified as being the only nonsurgical measure currently proven to be effective in helping to halt the progression of scoliosis. Other types of conservative treatments do not have any effect in modifying the natural history of this condition. The results of bracing have a direct relation to being compliant with the brace treatment itself, optimal results can only be achieved with cooperation from the patient and from full support from their families.

Between 2% to 4% of adolescents are affected by adolescent idiopathic scoliosis, which is the most common form of scoliosis. In both male and females, the incidence of scoliosis is the same. In females, however, the risk of curve progression is ten-fold greater. Most young people with the condition will not develop clinical symptoms. However, scoliosis can progress onto rib deformity and respiratory problems, causing cosmetic problems which can be significant in the long term and may also be a cause of emotional distress to some of the patients.


Scoliosis Screenings

Scoliosis screenings had been a routine part of the physical examinations for adolescents for decades. However, this was not recommended by the U.S Preventive Services Task Force and American Academy of Family Physicians, as the harm from the screening can outweigh the benefits by exposing many of the low-risk adolescents to radiographs and referrals which are unnecessary.

The Scoliosis Research Society, however, declares that the potential benefits resulting from the detection of scoliosis early will justify the screening programs. They further add that greater care should be exercised when making the decision as to which of the patients detected with positive screening results, will be in need of further evaluation.

Primary care physicians have the main duty, which can be defined by identifying patients who seem to be at a risk of developing further problems as a result of scoliosis. Further care has to be taken by the primary care physicians, so as not to overtest or over-refer the patients who are not likely to develop any further problems. The Adam’s forward bend test and a scoliometer measurement are two types of physical examinations which can provide a guide to the judicious use of radiologic testing for orthopedic referrals and Conn angle measurement. The options that can be employed for treatment of the same are surgery, braces, and observation.


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