Dr. Charles Edwards II Discusses Study Now Underway regarding Treatment For Spinal Scoliosis
People with scoliosis suffer from an abnormal side to side (or lateral) curvature of their spine. Rather than appearing straight when viewed from the back, it may appear somewhat like an "S" or "C".
Scoliosis is a common condition, usually associated with children and adolescents. However, adults can also develop the condition, which may bring with it pain and sometimes, visible deformity.
According to Dr. Charles Edwards II, medical director of the Maryland Spine Center at Mercy, adults with scoliosis fit into two categories: those who developed the condition as adolescents and those with adult onset (degenerative) scoliosis.
"As we age, the discs in our spine degenerate, which can cause the spine to tilt, much like the Leaning Tower of Pisa, " Dr. Edwards said.
Bulging discs, tilting bones and the formation of bone spurs not only lead to the development of back pain, but also put pressure on the nerves. When spinal nerves are compressed, people feel pain, numbness or cramping in the legs.
Although paralysis is very uncommon with adult scoliosis, people tend to slow down and experience reduced quality of life due to the increased pain.
To determine which patients benefit from scoliosis treatment and what kind of treatment is most effective, The Maryland Spine Center at Mercy is participating in a 5-year, multi site trial comparing the results of surgical and non surgical treatment. Launched in 2010, the study is funded by the National Institutes of Health and is the first of its kind to examine adult-onset spinal deformities. Most of the research has historically focused on adolescents, said Edwards.
" Unlike for kids, who still have some growth potential left, for adults the treatment is mostly driven by the patient's symptoms," Dr. Edwards said. "It's about quality of life rather than concern for correction.
Two hundred patients have been studied so far; an additional 150 are being recruited at six sites around the country, including Mercy Medical Center.
For some years, doctors had recommended noninvasive treatments, such as medications, physical therapy, and steroid injections, as a first line of therapy.
"But what recent high quality research studies clearly show," said Dr. Edwards, "is that these treatments just don't help in the long run." Surgery, however, shows dramatic results, according to Dr. Edwards, who is also the associate editor of "The Textbook on Spine Surgery."
"We now consider surgery for our adult scoliosis patients sooner rather than later, not only to provide relief more quickly, but to operate before complicating factors, like osteoporosis, make surgery more difficult," he added.
A 2010 study co-authorized by Edwards and published in the journal, Spine, demonstrates that the significant improvements in pain and function achieved with surgery are maintained at follow up exams three to five years later.
Scoliosis surgery for adults- known as instrumentation and fusion- involves relieving pressure on the nerves and straightening the spine with metal implants, and fusion the bones together so they don't continue to curve.
"Our expectation is that this will be a ground breaking study that will set the standard for adult scoliosis management for the next generation," Dr. Edwards said.
People with scoliosis between the ages of 18 and 80 may volunteer for the study. Volunteers who are eligible to participate will complete a questionnaire, after which they will be assigned to one of three groups.
One group is for those who don't want to have surgery. They will be followed only by X-ray exams for five years. The second group is for those who do not want surgery, and a third for those who are undecided.
Those in the undecided group will be selected at random to either have surgery or just be observed.
The surgery usually requires a three to five day hospital stay, and is covered by Medicare or private health insurance. Some spend an additional week to 10 days in a rehabilitation facility.
"Most patients rely on a walker for the first week or two after the surgery, and then transition to a cane and then nothing over a period of a few weeks," Dr. Edwards said.
"By two or three months, most individuals are back to all normal functions, except prolonged exercise, heavy lifting or forceful bending. These functions return to normal in three-to-six month time frame."
All patients will be followed for five years with regular X-rays, doctor visits, and questionnaires.
Trial participants will receive a cash payment to compensate them for time spent completing questionnaires and follow up visits, whether or not they have surgery.
To learn more about adult scoliosis and the Maryland Spine Center study, or to see if you qualify for the study, call Lisa Ford or Ryan Andrews at 410-332-9052.
Many thanks to writer/editor Carol Sorgen for this article which may be read in its entirety in the March 2012 issue of The Senior Beacon newspaper.
Founded in 1874 in downtown Baltimore by the Sisters of Mercy, Mercy Medical Center is a 183-licensed bed acute care university-affiliated teaching hospital. Mercy has been recognized as a top Maryland hospital by U.S. News & World Report; a Top 100 hospital for Women’s Health & Orthopedics by Healthgrades; is currently A-rated for Hospital Safety (Leapfrog Group), and is recognized by the American Nurses Credentialing Center as a Magnet Hospital. Mercy Medical Center is part of Mercy Health Services (MHS), the parent of Mercy’s primary care and specialty care physician enterprise, known as Mercy Personal Physicians, which employs more than 200 providers with locations in Baltimore, Lutherville, Overlea, Glen Burnie, Columbia and Reisterstown. For more information about Mercy, visit www.mdmercy.com, MDMercyMedia on Facebook, Twitter, or call 1-800-MD-Mercy.