“Elsa” was a 55 year old woman who came to me two years ago with a great deal of low back pain. She had begun to have pain eight years before that, in her upper back. It had become worse and worse to the point where it was incapacitating.
Another doctor diagnosed her with scoliosis, which is an abnormal spinal curvature. In Elsa’s case it was in her upper spine, and it appeared to be the kind that had probably been present for most of her life. However, by the time she had reached middle age, the abnormal stresses inside the curvature had produced a lot of degeneration and arthritis. With Elsa, the pain became so bad that her doctor ended up performing a large operation on her called a fusion. He used steel rods, hooks and screws to straighten her spine somewhat, then he added bone around the spine so it fused into one big immobile block. This helped her pain to a significant degree, but it didn’t cure her.
Elsa was fine for about five or six years, but then her lower back began to hurt. It started as a mild pain, but by the time I saw her it had become worse. The x-rays I got showed the problem: the fusion that she had had included all of her vertebrae except the lowest two. Over the years since her fusion, these two vertebrae had to do the work and motion of all the other vertebrae that had been fused. This had worn them out prematurely. Her lowest two disks were very degenerated. At that time I told her that she would probably always have some pain, but medication and exercise could probably keep it at a manageable level for a number of years.
I saw her two years later because her low back pain had become so bad that she was again incapacitated. New x-rays showed that the lower disks had become so degenerated that her vertebra were slipping sideways on each other, like a pile of blocks that a child had erected carelessly. Her pain was so bad that she was in tears. At this point, I thought that only surgical treatment would probably help. I extended her fusion all the way down to the bottom of her spine, to immobilize the severely degenerated areas. This made her pain tolerable again.
Elsa is a good example of the reason that schoolchildren are screened for scoliosis: we can treat a child’s large curve with braces and make it smaller without surgery. Once a patient is fully grown, we can’t affect the scoliosis any more. Most people with scoliosis will have only mild to moderate pain from their curvatures as they age. The larger the curve, the more likely that pain will develop and the more likely that it will be severe. Scoliosis in an adult rarely needs surgery, but occasionally nothing else can help. If you have a child, make sure they’ve been screened for scoliosis!