Adult Idiopathic Scoliosis: Essentials of Diagnosis and Treatment (Podcast)

Idiopathic scoliosis is a form of the spine deformity that develops during adolescence without a known cause and can progress into adulthood if not treated early. It’s characterized by a main thoracic curve, typically to the right, that may be accompanied by additional curves depending on how the spine compensates.

“One of the first symptoms is pain,” says William Clifton, MD, a dually trained spine orthopaedic surgeon and neurosurgeon with Cleveland Clinic’s Center for Spine Health. “We often see idiopathic scoliosis in teenagers who are very active, and it occurs more often in females. They start to experience shoulder pain or midthoracic pain or even some low back pain. They often notice that their clothes aren’t fitting the way they used to, or they start to notice some breast asymmetry they didn’t have before. When an adolescent or young adult reports changes like these, idiopathic scoliosis is one of the first diagnoses we consider.”

In the latest episode of Cleveland Clinic’s Neuro Pathways podcast, Dr. Clifton shares the essentials of diagnosis and treatment of idiopathic scoliosis and when to refer for specialist evaluation. He touches on the following topics, among others:

• How idiopathic scoliosis differs from the other three major types of scoliosis
• The workup for idiopathic scoliosis, including the role of the Adams forward bend test
• The importance of early intervention, as well as treatment of older adults with the condition
• Nonsurgical and surgical treatment options and prognosis
• The importance of subspecialty training for surgical success
• Future directions in scoliosis management

Click the podcast player above to listen to the 28-minute episode now, or read on for a short edited excerpt. Check out more Neuro Pathways episodes at clevelandclinic.org/neuropodcast or wherever you get your podcasts.

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Excerpt from the podcast

Podcast host Glen Stevens, DO, PhD: Tell us about some of the surgical procedures you offer for idiopathic scoliosis.

William Clifton, MD: There’s a procedure called selective thoracic fusion that we can offer to a patient who has two or more curves but only one or two of the curves is what we call structural, or the main curve. With this approach we surgically correct only the structural curve or curves, after which the remaining curve can be addressed with postoperative physical therapy. This allows us to avoid fusing a large portion of the patient’s entire spine. If we can catch patients early, many of them are candidates for this selective fusion, which involves less surgery, less operative time and less blood loss than with a massive spinal reconstruction if you wait until the patient is far into adulthood.

There is another procedure called vertebral body tethering that is not a fusion but can reduce the degree of scoliosis. It’s a minimally invasive surgery that uses anchors and a flexible cord to guide the spine into alignment. It’s a great option for kids who are on the border of being skeletally mature, when you want to reduce their curve to keep it from progressing but the spine is not yet mature enough to undergo a fusion.