IF SYMPTOMS PERSIST By DR. JOSE PUJALTE JR.

“The crooked be made straight and the curse be ended.”

— T.S. Eliot (1888-1965) American-born English poet, The Family Reunion (1939)

Dr. Jose Pujalte Jr. “Scoliosis” is a genuine scare word even for more millennials. Scoliosis comes from the Greek word skolios, which means “crooked.” Referring to your back or spine, scoliosis then means that the column is crooked sideways or curved as seen from behind – in some cases, resembling a snake. Normally, the spine should be straight or vertical and when seen from the side, should have three gentle curves: going inwards at the neck, outwards at the upper trunk and sloping inwards again near the lower back.  These are lost in scoliosis. Types.  Scoliosis can be present at birth (congenital).  It can be part of a larger condition such as polio or cerebral palsy.  Adult scoliosis, as a result of trauma or osteoporosis, can be painful.  Finally, there is the commonidiopathic (unknown cause) scoliosis. Signs and Symptoms.  Since scoliosis is initially painless, the following should arouse suspicion:

• One breast seems to be larger.
• The body tilts to one side.
• The shoulders are not even, one is more prominent than the other.
• The hips are not at the same height.
• On bending, the back is crooked.

Time to See the Doctor. The doctor ought to be able to screen out known causes of scoliosis, as listed above.  A common maneuver is the Adams’ forward bending test where you will be asked to clasp your hands in front then lean forward from the hips.  A positive test is the presence of trunk asymmetry – a “rib hump” appears because in scoliosis, not only does the spine curve, the individual trunk spine bones also rotate twisting the ribs with them. Confirmation.  The cheapest screening tool is an x-ray.  This first measurement, the Cobb’s angle, together with the amount of skeletal growth remaining, will help him decide what action to propose. Treatment.  The doctor may suggest observation, bracing, or surgery.  If the curve is not particularly worrisome (say 20 degrees or less in a nearly grown person), a bi-annual visit may do.  A teenager with at least two more years of growth with a 30 degree curve or more may be advised bracing.  A brace will not reverse the progression of the curve.  It is worn to prevent its worsening. The purpose of surgery, on the other hand, is to treat the curve.  Surgery consists of fusing the corrected spine using bone grafts and metal implants.  Who should get a scoliosis operation?  Growing patients with curves greater than 40 degrees, adults with curves larger than 50 degrees.  Skeletally immature girls with spinal curves between 20 and 40 degrees are also candidates for surgery. In the end, scoliosis is just a description.  It is not a diagnosis or a death sentence. See a doctor if scoliosis is apparent. And remember that it won’t get better by ignoring it. E-mail:  [email protected]