Posts tagged adolescent

What is scoliosis?

Scoliosis is a disease of the spine. It is a disorder in which the vertebrae actually rotate, and a curve is either created in the upper or the lower back.

What causes scoliosis?

We have a number of observations, a number of findings, but there is no unified theory. We are hindered in this, we can not all observations and put them into a roadmap that is why a child with a curve, complex surgical care while on the other with a curve, which has apparently reached the same age and needs explained, need not our services.

Is scoliosis hereditary?

Scoliosis is thought that genetic. It is a result of the expression of several genes, but it has something that is more variable penetrance, which means that in every generation there is a variability in how strongly the genes are expressed, that is, how severe the curve.

A legitimate question to ask is: Can it be shared? Is it something that runs in the family? And the answer is yes, scoliosis tends to run in families. It tends to have for generations in the family, but variable effects in each generation. That is, you can a mother with a mild course, has a daughter with a very difficult course, or you can have a mother with a severe curve, then their grandchildren have scoliosis, but in the meantime generation is not really a significant problem.

Is it a violation of scoliosis?

Children can get scoliosis secondary to spinal cord injury. One of the categories for scoliosis – one of the reasons – is a degenerative neurological disease that affects some unfortunate children. The other source can be traumatic. We often treat beautiful young children, who either already had a car accident or motorcycle accident or other trauma. And as a result of loss of normal muscle control in the spinal cord, they then develop a malformation that is secondary to their spinal cord injury.

Can the spinal cord injury by viral or similar diseases are caused?

Polio was one of the most common neurological causes of scoliosis. certainly occurred in the 30′s, 40′s and 50′s, when the great epidemics of polio in this continent, it was common to see children with scoliosis. Now I see many of those polio patients in my clinic with adult scoliosis as a result of her paralytic condition.

Are there any ecological factors that contribute to scoliosis?

Research into the causes of scoliosis environment is underway, and while there are some provocative findings, I do not think we established clear links between a drug, a drug or environmental factors yet.

What other factors contribute to the outbreak of the scoliosis curve?

The vast majority of patients with scoliosis fall under the category of idiopathic scoliosis. This simply means we do not know what causes it. We do not have the unified field theory that tell us the mechanism.

But there are cases in which neurological are where there is a kind of spinal cord or brain injury, cerebral palsy, polio myelitis – one of these neurological disorders.

And there is trauma – induced spinal cord injury.

There is cause congenital malformations of the spinal cord and spine, scoliosis.

And finally there are the so-called developmental disabilities, and those are the ones who are most of us. My way to describe, is that there are components that are wrong are in the factory – either malformed or congenitally fused vertebrae together, what is wrong with strong curves and the underlying spinal cord, “produced in the factory.” And in some of these situations we are for links to drugs, medicines, environmental features, environmental causes, which bring the children in danger if they are looking into the womb of the mother.

Is scoliosis always show his face in the childhood?

We think of scoliosis as a child’s illness, and we were taught in the rule that it was so. And indeed, most commonly, scoliosis presented at the boundary between the juvenile and adolescent stage – 9, 10, 11, 12 years old. There are, however, diabetes or degenerative scoliosis, we think, is developing as a result of disc degeneration, and is probably a completely separate entity from what we commonly think of as idiopathic scoliosis.

Is the incidence of scoliosis the same in men and women?

The incidence of scoliosis in men and women almost equally. What is very interesting, however, that if you are female and you have scoliosis as a teenager or young adult, the progression rate is seven to eight times more common in girls than in boys. And that fact is completely unknown. We do not yet understand, what issues lead to differential progression.

Scoliosis is a progressive disease?

Details of scoliosis is changing. The accepted theory be used as soon as you reach adulthood, the curves are static and no progress. And for most patients that might be the case yet.

However, there is a subgroup of individuals, where the curve continues to progress in adulthood, when I was in training we were taught that a 50-degree thoracic curve probably no greater in adulthood. Well, now we know that it can. We were taught that 40-degree curves could not be greater lumbar spine in adults, but I see in my office that they do frequently.

So there is a development in what was known about scoliosis. And one of the problems is that many family doctors, internists and pediatricians, have no access to the latest information supply make much more difficult and challenging design.

What is the prognosis for a child with scoliosis?

The prognosis for most children who come into my office, is generally very good. The majority of children can be found in scoliosis does not need complex treatments, but they must be evaluated. Mostly, we can assure you that we are either the parents need their children to watch in four to six months, or is in fact their risk so low that they really do not need to come back.

What is the prognosis for an adult with scoliosis?

In adults, the situation is even more problematic. I see adult patients, especially women, fall into one of several categories:

I often see young women with very large curves, no pain. I tell them that statistically, especially the likelihood of the disease, 80 or 90 percent, and that left untreated, they can also have problems in later life. With these women we discuss their treatment options on a case by case.

I see young women who have a history of scoliosis, the curves were not told their progress in adulthood. And the story goes like this: “My curve was stable. I had no back pain. My first pregnancy was not that complicated, but happened after my second pregnancy, something.” Now pregnancy is a very complicated physiological state. The pregnancy hormone progesterone, and what we believe, that women who have curves that were otherwise very well may be compensated under the influence of progesterone have progress. That is, the bands are somewhat lax, as they need for pregnancy and for the basin to develop adequately for the delivery. At the same time, the curve starts to progress, and so I will these young women who have had several children, and they will say, you know, “You, my body is changing. Something’s happened.” Some of these women are now experiencing pain.

Finally, there are women who come and say, “You know I had a small curve, and it has made further progress in the course of adulthood. Seemed not related to pregnancy, but now I am 50, 52, 55, and I I will be deformed really. The tribe has deformed. My clothes are different. I have no waist more. My ribs are actually rests on my hip bone, and it is really a dramatic change in what I look like since. But I am here not because I’m worried about my cosmetics. It’s me, because I hurt. Because I am in pain. It is to limit my ability to live effectively. ”

Have these adults require surgery?

It is serious surgery. And so I think it is extremely important that before any patient has an operation of any kind that the doctor sit down and explain that with individual and what are the risks and benefits of this procedure. So I spend much time in the preoperative interviews to discuss what are the risks, what are the advantages, what are the possibilities of what my personal experience has in the past 15 years. My goal is to make the person who decides for an operation, have a complete understanding of the risks and the desired result.

How long is an actual operation?

Scoliosis surgery is complex and there are many steps to each facility. The operation takes in children from two to three hours. In adults, it takes a little longer, about five fifty-six clock.

Two operations are necessary at all?

Adults need to do, sometimes more than procedure. That is, they need some sort of process from the front and rear done simultaneously. Sometimes this can be done in one stage together, but otherwise it is best to complete the process in two separate proceedings.

What happens after surgery?

What happens after the operation itself is done is a phase where technology and treatment options have now changed dramatically for the better.

After a routine scoliosis surgery patients in the ICU, where care is directed, is authorized. It’s very reassuring for the patient and the family to know that there is a nurse who is very attentive to their needs. One of the things that we emphasize, is the appropriate treatment of pain. For pain we put a catheter up against the spinal cord, and we pump drugs directly to the spinal cord. We treat the pain exactly there, where it exists and do not have the patient so sleepy that they can not follow, wishes or commands.

The day after surgery, some patients may actually sit in a chair and take one or two steps. On the third day they will stand and walk, and on the fourth day will often go into the halls. After the dismissal, which routinely do on the fifth day, with patients from outside the city (and many from the city) are sent to the rehab clinic to spend a further week, back their skills to all activities of daily living.

After surgery, some patients have a brace. Modern braces are thermo-plastic light, so they are easily taken on and taken off by the patient. You do not have to sleep in them. You must not bathe in them. And you wear it for about three months. It is far removed from the casts that individuals have made in years.

How long does recovery take into account?

If you talk to our patients, what you hear is that milestones of improvement. It is the first week until discharge from the hospital. And if a person can go back and eat regular food and putting on and taking off her brace, she really feel that they have made a big step forward.

Probably the second major milestone is the discharge from rehabilitation, and that is usually about one fifty-eight-and-a-half weeks total time of the operation.

The next big pushes independence. Some patients begin to drive as soon as a month.

After that, the milestones are harder to define. And yet, there comes a moment when a patient returns to me and says: “You know, the pain medication you have me really strong and I do not need it.” This is a wonderful milestone to hear a doctor.

Three months seems to be, if many people really regain control over their own lives. Many people go back to work about five weeks after the operation in a light-duty capacity. But there continue to be longer-term gains, and so we follow patients for years, and review every six months or annually.

For adults in pain, what can you do?

The main reason I work on adults to manage scoliosis or to try to prevent pain. Pain is a terribly disturbing phenomenon in the life of a man. Pain interferes with your personal emotional life. It disrupts the relationship with your spouse. It interferes with your relationship in your work. It disturbs the relationship with your children. Pain can really devastate your life. So I think the most important task I have scoliosis as a surgeon, the surgical solutions is to try to remove or alleviate pain to find.

How many doctors around the country specialize in scoliosis surgery?

There are a small number of doctors who specialize in scoliosis in the United States. What is with Consulting Orthopedists unusual is that we treat children and adults. What we have here a continuum of care from infants to adults offer, and our commitment is really to be able to care for our patients throughout their life cycle.

Why do so few doctors say adult scoliosis can be treated?

Scoliosis treatment technology is changing very fast and there are ways to treat these patients now. Unfortunately, there is a large information gap between primary care physicians and specialists around the country to treat the scoliosis. I re-educate lecture groups across the country – to pediatricians, family doctors, internists to try to – to try some of the misinformation to change that out there. The reality is that in the 21 Century, that we treat scoliosis in adults, and we can be treated very effectively.

Talk to the staff on the strength of the consulting orthopedist orthopedists consulting their staff. We have a dedicated group of individuals, including anesthesiologists, nurses, spinal cord monitoring individuals and implant specialists that work with the surgical team. Our operating time, our time for each case has decreased and the benefits for individual patients is that their results are better.

Plus, in a time when many patients report that their practices are very impersonal, we have been able not only to maintain our focus on patient care, but we’ve really built that. I am very pleased when a patient comes in and says, “You know, your staff has treated us so well.

Does scoliosis surgery covered by insurance?

This is a very common concern: “Will my insurance cover the treatment?” Scoliosis surgery is an appropriate medical treatment and it is covered by insurance. At Consulting Orthopedists we looked in the past year nationwide, with 106 different insurance companies. We have considerable skill in the management of the labyrinth that is the modern insurance company.

When you meet with scoliosis patients, what can you do to them?

Scoliosis patients do attend two things to their original office. The first is usually the physical pain of her deformity. But equally important is the emotional baggage from their previous experience with scoliosis.

While early in my career with the technical act of straightening the curve was very rewarding, as I get older I find it that most often yield the interaction with people is in the office.

As a result, just as important as the physical part of the treatment, it is to understand what the emotional problems of patients on the table: how they feel about themselves as they go about their cosmetic appearance, and things like this.

What we also created Consulting Orthopedists is a way for new patients with former patients who are in various stages of their recovery journey connected and have them communicate with each other. It is really valuable. Connecting with potential patients has successes of the past one of the most powerful tools I used to have to help my patients.

The examination room is still the most exciting part of this work. The patients come with preconceived ideas. Some are skeptical. Some are injured. Some are angry. I try, my personal enthusiasm that I transfer to aggressively address the deformity, and that I can successfully treat the pain that people bring with them in most cases.

Is there a lot of research going on scoliosis? What does the future hold?

There is a dramatic explosion in the amount of research that is done on scoliosis, both basic science and research into the cause of the scoliosis and the clinical treatment have been.

We always learn more about the basic molecular, genetic, and basic causes. The future of scoliosis treatment is the early genetic diagnosis and treatment of biopharmaceutical growth abnormalities that lead to curvature of the spine. I would hope in the future that we have the secrets of predicting which child will have a progressive characteristic unlock, and more importantly, with pharmaceutical or gene therapy that would really get the elimination of the need for implantation of metal products in the individual bodies of her curves correct.