Scoliosis: Treatment Options for a 32-Degree Curve

Scoliosis of 32 degrees?

I am 31 years old and have congenital torticollis.
While studying at university in Australia, I suffered a spinal injury and underwent surgery for L5-S1 disc herniation in 2008, without any implants.
It wasn't until about two years ago (in 2011) that I returned to Taiwan for the first time, and during my military service examination, it was confirmed that I have severe scoliosis with a curvature of 32 degrees, which allowed me to be exempted from service.
I then returned to work in Australia, but recently I have been experiencing persistent discomfort in my back.
I noticed that my left shoulder is lower than my right, although not by much.
I have also been undergoing rehabilitation for my L5-S1 condition.
At the end of the year, I will be transitioning back to Taiwan, and I would like to know whether I should see an orthopedic surgeon or a neurosurgeon.
Should I consider wearing a brace or opt for surgical treatment for my scoliosis? I've heard from many people who have worn braces that they were ineffective and ultimately required surgery.
If surgery is necessary, which type of procedure would you recommend, considering I have already undergone L5-S1 surgery? Thank you for your advice, Doctor.

Xiao Yu, 30~39 year old female. Ask Date: 2013/09/30

Dr. Shi Guozheng reply Orthopedics

A 32-degree scoliosis angle is not considered significant.
If there are no symptoms of lower back pain or nerve compression, surgery is not necessary.
Since you are already 31 years old, the growth plates in your bones have fused, meaning it will not worsen.
You can consult an orthopedic specialist.

Reply Date: 2013/09/30

More Info

Understanding scoliosis, particularly in the context of a 32-degree curve, involves a multifaceted approach that considers both the physical implications of the curvature and the potential treatment options available. Scoliosis is defined as a lateral curvature of the spine that can occur in various degrees and can be classified as either idiopathic (of unknown origin) or secondary to other conditions, such as congenital anomalies or neuromuscular disorders.
In your case, having a history of congenital torticollis and a previous L5-S1 disc herniation surgery adds complexity to your situation. The fact that you have been diagnosed with a 32-degree curve indicates that your scoliosis is likely significant enough to warrant consideration for treatment, especially since you are experiencing discomfort and asymmetry in your shoulders.

Treatment Options
1. Observation: For curves that are less than 20 degrees and not causing significant symptoms, observation may be sufficient. However, given your 32-degree curve and associated symptoms, this may not be the best option for you.

2. Bracing: Bracing is often recommended for adolescents whose bones are still growing. However, in adults, especially those who have completed their growth, bracing is less effective. Many adults report that braces do not alleviate pain or correct the curvature, which aligns with what you have heard from others.
3. Physical Therapy: Engaging in a structured physical therapy program can help strengthen the muscles surrounding the spine, improve posture, and potentially alleviate some discomfort. Specific exercises targeting the core, back, and shoulder muscles can be beneficial.
4. Surgical Options: Given your degree of curvature and the history of back surgery, surgical intervention may be a consideration. The most common surgical procedure for scoliosis is spinal fusion, which involves fusing the vertebrae to correct the curvature and stabilize the spine. There are various techniques, including posterior spinal fusion and anterior spinal fusion, and the choice of procedure often depends on the specifics of the curvature and the surgeon's expertise.
5. Minimally Invasive Techniques: Some surgeons may offer minimally invasive options that can reduce recovery time and postoperative pain. These techniques may involve smaller incisions and less disruption to the surrounding muscles.

Next Steps
Given your situation, it would be advisable to consult with an orthopedic surgeon who specializes in spinal disorders. They can assess your specific curvature, review your medical history, and discuss the potential benefits and risks of surgery versus conservative management. It may also be beneficial to consult with a neurosurgeon, especially considering your previous disc surgery, as they can provide insights into how your current condition may interact with your past surgical history.

Conclusion
In summary, while bracing may not be effective for adults, physical therapy can provide symptomatic relief and improve function. Surgical options, particularly spinal fusion, may be appropriate given your degree of curvature and associated symptoms. It is crucial to have a thorough evaluation by a specialist who can tailor a treatment plan to your individual needs, taking into account your previous surgeries and current symptoms. Engaging in this dialogue with your healthcare provider will help you make an informed decision about the best course of action for your scoliosis.

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