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Transcript

When Should You Worry About Scoliosis? · Scoliosis with Dr. Chris Gubbels

• 0:00
  SPEAKER_00: A scoliosis diagnosis can sound really scary, but here's the truth.
• 0:04
  SPEAKER_00: I can show you three people with the exact same size scoliotic curve.
• 0:08
  SPEAKER_00: One may need treatment urgently now, one may be completely fine just to wait and monitor the curve to see if it gets worse, and the third could be headed towards a severe loss of function.
• 0:18
  SPEAKER_00: You see, the number doesn't tell you the whole story.
• 0:21
  SPEAKER_00: Now, when most people are diagnosed with scoliosis, the first thing they are told is the size of their curve.
• 0:26
  SPEAKER_00: Maybe it's 20 degrees, maybe it's 30, maybe even 40 degrees or larger.
• 0:31
  SPEAKER_00: And naturally, that size of the curve or that number becomes the thing most people tend to focus on.
• 0:35
  SPEAKER_00: They want to know whether a 20 degree curve is bad, whether the 30 degrees means it actually requires treatment, or whether 40 degrees means they're actually headed towards surgery.
• 0:44
  SPEAKER_00: Now, don't get me wrong, the number of the size of the curve matters, but by itself it doesn't tell me how serious the scoliosis is.
• 0:52
  SPEAKER_00: A curve measurement is a snapshot.
• 0:55
  SPEAKER_00: It's a piece of the overall puzzle, but it's not the entire puzzle.
• 0:59
  SPEAKER_00: It tells me what that spine looks like at that moment in time.
• 1:02
  SPEAKER_00: It doesn't tell me where the curve is headed, doesn't tell me how likely it is to progress.
• 1:06
  SPEAKER_00: It doesn't on its own tell how likely me a curve is to progress, or how difficult it may be to treat later on if it goes untreated now.
• 1:15
  SPEAKER_00: So let me show you what I mean by looking at three people with roughly the same size curve.
• 1:20
  SPEAKER_00: Now the first person, their curve may be safe just to monitor.
• 1:22
  SPEAKER_00: This person has a 25 degree scholotic curve.
• 1:25
  SPEAKER_00: Their curve has been shown to have been stable for years.
• 1:28
  SPEAKER_00: The spine is still relatively flexible, the person is well balanced, and there's been no meaningful loss of function, meaning the curve is not impacting the patient's ability to do normal daily activities.
• 1:40
  SPEAKER_00: They can stand, they can walk, they can work, they can exercise, and they can do all the things they normally would like to be able to do.
• 1:46
  SPEAKER_00: Maybe they have some occasional stiffness or back pain, but the scoliosis itself is clearly not changing.
• 1:53
  SPEAKER_00: And it's not beginning to negatively impact the quality of their life.
• 1:57
  SPEAKER_00: In a situation like that, it may be completely reasonable to just monitor the curve to see if it gets worse over time.
• 2:04
  SPEAKER_00: It doesn't mean ignoring it.
• 2:06
  SPEAKER_00: Monitoring means doing proactive or regularly scheduled checkups to see if the curve is stable or if it's progressing.
• 2:14
  SPEAKER_00: When we're monitoring, we do full spine standing x-rays repeated over time.
• 2:19
  SPEAKER_00: We're tracking balance, posture, pain, and function.
• 2:23
  SPEAKER_00: And we know when there are certain changes that will cause us to reassess the plan to simply monitor.
• 2:28
  SPEAKER_00: But there may be no reason to rush to more aggressive treatments because an X-ray shows a 25 degree scholiotic curve.
• 2:35
  SPEAKER_00: Now, compare that to the second patient.
• 2:38
  SPEAKER_00: Patient 2 has the same size of curve, but treatment may be required right now.
• 2:43
  SPEAKER_00: So the second person has a 25 degree curve, but the person is a 12-year-old growing girl.
• 2:49
  SPEAKER_00: They're still growing and the curve is increased from 15 degrees to 25 degrees over a short period of time.
• 2:55
  SPEAKER_00: They likely have no pain.
• 2:57
  SPEAKER_00: They're likely playing sports and they're involved in activities like fans or gymnastics or cheer.
• 3:02
  SPEAKER_00: They look pretty healthy.
• 3:04
  SPEAKER_00: They feel completely normal, but that curve is actively progressing over time.
• 3:09
  SPEAKER_00: And that's what changes everything.
• 3:11
  SPEAKER_00: You see, with a growing child, the concern may not be where the curb is today.
• 3:15
  SPEAKER_00: It's where the curve may be in six months or a year from now.
• 3:18
  SPEAKER_00: A child can feel perfectly fine while the spine is changing very rapidly.
• 3:23
  SPEAKER_00: That's also why one of the reasons by judging the severity of a curve based on pain is such a bad way to monitor pediatric scoliosis.
• 3:31
  SPEAKER_00: You see, the highest risk per curved progression is what's during the peak growth phase, what's called the peak height velocity.
• 3:38
  SPEAKER_00: It's that first two years of the onset of puree where curves can go from small to severe in a very short period of time because they're growing so rapidly during that period.
• 3:48
  SPEAKER_00: And so even though the child or adolescent and the first person both have a 25-degree curve, the second situation is much more urgent and needs treatment now.
• 3:58
  SPEAKER_00: You see, one curve is stable and the other one is progressive.
• 4:01
  SPEAKER_00: And when a curve is progressive during growth, the treatment window absolutely matters.
• 4:06
  SPEAKER_00: You see, smaller curves and growing spines are easier to control than larger curves that have become more rotated, more wedged, and more rigid.
• 4:16
  SPEAKER_00: So this is someone who may need treatment right now.
• 4:18
  SPEAKER_00: And even though there's no pain and the curve number is not severe, it's where the curve is going that's most critical.
• 4:25
  SPEAKER_00: And this is one of the biggest mistakes people make with scoliosis.
• 4:29
  SPEAKER_00: They wait for the curve to get more severe or for bigger symptoms to show up before they act on it.
• 4:35
  SPEAKER_00: And by that time, the condition can be much harder to control and generally much more difficult to change or reduce the size of the curve.
• 4:42
  SPEAKER_00: Now, in person three, the curve may be actually starting to negatively take away their function.
• 4:47
  SPEAKER_00: So the third person also has a 25-degree curve.
• 4:50
  SPEAKER_00: But this person is an older adult.
• 4:52
  SPEAKER_00: Over the last several years, they've noticed things like they're starting to lose their balance, or their body's starting to lean to one side, or they're starting to hunch forward.
• 5:00
  SPEAKER_00: They can't stand as long as they used to be able to or they want to be able to.
• 5:04
  SPEAKER_00: Just being able to walk through the grocery store getting their groceries starts to require a lot of effort.
• 5:09
  SPEAKER_00: They notice things like the walk they used to go on with no difficulty now is becoming challenging or painful.
• 5:15
  SPEAKER_00: They may have back pain, leg pain, numbness, or weakness.
• 5:18
  SPEAKER_00: And every year their world becomes a little bit smaller because they're physically able to do less and less over time.
• 5:25
  SPEAKER_00: Now their curb may not be dramatically or any larger than the curve in the first person, but the effect on the body is completely different.
• 5:33
  SPEAKER_00: This is what we typically see in what's called adult degenerative scoliosis.
• 5:37
  SPEAKER_00: As we get older, the disc and the joints can start to wear down unevenly.
• 5:41
  SPEAKER_00: You see one side of the spine is losing high faster, the vertebrae begin to tilt and rotate, and then gravity places excessive pressure or more pressure on the inside of the curve where the body's already being compressed.
• 5:54
  SPEAKER_00: And that causes it to wear down unevenly faster and faster over time.
• 5:58
  SPEAKER_00: See, in a person with a generative scoliosis, the person may actually lose the ability to keep their body centered over their palace, meaning their body starts to shift or lean to the side or start to lean forward.
• 6:10
  SPEAKER_00: And when that happens, the person's muscles have to work so much harder just to hold their body in an upright position.
• 6:17
  SPEAKER_00: By the end of the day, they're exhausted.
• 6:19
  SPEAKER_00: They may be able to stand for 10 minutes, but 30 is nearly impossible or really challenging.
• 6:24
  SPEAKER_00: They may be able to walk through their house, but not through an airport or even around their block.
• 6:28
  SPEAKER_00: And they may still have a curb that's considered moderate on an X-ray, but functionally the conditions are becoming very severe.
• 6:36
  SPEAKER_00: This is why you cannot look at and judge a scoliosis by the size of the curve on its own.
• 6:40
  SPEAKER_00: You have to know what the scoliosis is actually doing to the person.
• 6:43
  SPEAKER_00: One of the first questions you have to ask, is the curve changing?
• 6:47
  SPEAKER_00: So the first thing that's going to change your level of concern is a history of curb progression.
• 6:52
  SPEAKER_00: Has the curve stayed stable or is it actually getting larger?
• 6:55
  SPEAKER_00: So a single X-ray will tell you the size of the curve, but comparable or repeated X-rays over time tells you whether the curve is actively progressing.
• 7:03
  SPEAKER_00: And this is essential and matters at any age.
• 7:06
  SPEAKER_00: Now, in a child, progression can happen really quickly during growth phases.
• 7:10
  SPEAKER_00: In an adult who's lived with scolosis for decades, a curve can be gradually changing over time as the disc and joints start to break down and wear down.
• 7:18
  SPEAKER_00: And in someone with adult degenerative de novoscoliosis, the curve may actually start to develop later in life, typically after the age of 50 in women and even at older ages in men.
• 7:30
  SPEAKER_00: The cause can be different, all those, but the principle is still the same.
• 7:34
  SPEAKER_00: A curve that is actively progressing deserves more attention than a curve that has actually remained stable over time.
• 7:40
  SPEAKER_00: But it does tell us continuing to wait without a clear plan may come with a cost.
• 7:45
  SPEAKER_00: The second question you want to know, is the body staying balanced?
• 7:49
  SPEAKER_00: What I mean by that, is the head and upper body centered over the pelvis or is it shifted to the side?
• 7:55
  SPEAKER_00: Or is the person starting to lean or fall forward?
• 7:58
  SPEAKER_00: This is frequently even more important than the actual size of the curve itself.
• 8:03
  SPEAKER_00: So you can have a relatively large curve and still be balanced.
• 8:06
  SPEAKER_00: Or you could have a small curve that creates major imbalances that force the body to fight against gravity just to maintain itself upright throughout the day.
• 8:16
  SPEAKER_00: And when the body is no longer balanced, the muscle has to work much harder, the joints become more overloaded, and standing and walking usually becomes more difficult.
• 8:25
  SPEAKER_00: The person may say, My curve is only 25 degrees, so why am I struggling so much with this?
• 8:31
  SPEAKER_00: And the answer to that problem is not only the size of the curve, it's where the curve is located, how the spine is rotated, and whether or not they can actually keep their body in an upright position without having to exert a tremendous amount of energy.
• 8:45
  SPEAKER_00: Now, if you or your child has scoliosis and you're not sure if your school is something that can be safely managed simply by monitoring, or if you need active treatment, you can get that answered by requesting a free discovery call below.
• 8:57
  SPEAKER_00: That'll give you a chance to talk to me one-on-one for 15 minutes about your case and get expert advice on what you should or should not be doing.
• 9:04
  SPEAKER_00: I can look at your case, I can tell you the severity, the risk of curve progression, and if needed, what treatments are most effective for you or your child's scoliosis.
• 9:13
  SPEAKER_00: Now, the third question you want to know is how flexible is the curve or the spine?
• 9:18
  SPEAKER_00: You see, flexibility is a major piece of the overall puzzle because a flexible curve is much easier to influence and change than a stiff or rigid curve.
• 9:27
  SPEAKER_00: Now, as scoliosis progresses, the spine becomes more and more rotated, the vertebrae get more and more wedged, and the muscles of connected tissues begin to adapt to the new spine position.
• 9:38
  SPEAKER_00: Over time, the spine becomes more and more stiff and more difficult to move or inflows.
• 9:43
  SPEAKER_00: This is why early treatment can matter so much.
• 9:46
  SPEAKER_00: We're not only trying to keep the curve from becoming larger, but we're also trying to keep the curve from becoming fixated in that position.
• 9:54
  SPEAKER_00: You see, two people could have the exact same curve measurement, but one's person's curve may be very flexible while the other person's curve is very rigid.
• 10:03
  SPEAKER_00: And because of that, they may respond differently to treatments.
• 10:06
  SPEAKER_00: And that changes what can realistically be accomplished when we're looking at scoliosis treatments.
• 10:11
  SPEAKER_00: And the fourth question is what is the person actually losing?
• 10:14
  SPEAKER_00: And this might be the most important question of all, especially when we're looking at older adults with scoliosis.
• 10:20
  SPEAKER_00: Like what is the scoliosis actually starting to take away from that person?
• 10:24
  SPEAKER_00: Can the person still stand long enough to cook their meals?
• 10:27
  SPEAKER_00: Can they walk throughout a grocery store without having to sit in one of those stroller carts?
• 10:32
  SPEAKER_00: Can they work, exercise, travel, sleep, and actually take care of themselves without someone having to assist them?
• 10:38
  SPEAKER_00: So for a child, the curve can visibly progress during growth.
• 10:42
  SPEAKER_00: But for an older adult, some of the things we look at are pain and fatigue becoming more frequent.
• 10:47
  SPEAKER_00: As an older adult, is your ability to walk shrinking from year to year?
• 10:52
  SPEAKER_00: You see, a scoliotic curve becomes more and more concerning when it's actually changing the way the person lives their life.
• 10:57
  SPEAKER_00: It doesn't mean every single ache and pain is directly coming from someone's scoliosis.
• 11:01
  SPEAKER_00: A person can have arthritis, degenerative discs, stenosis, or even irritated nerves.
• 11:07
  SPEAKER_00: But if the curve and the imbalances are helping create the pressure that keeps irritating those areas, then the scoliosis is the overall problem that's driving everything they're experiencing.
• 11:18
  SPEAKER_00: Now there are some definite warning signs I would highly recommend not ignoring.
• 11:23
  SPEAKER_00: These are a few things that should make you take your scoliosis more seriously, regardless of your age.
• 11:29
  SPEAKER_00: So that first one, as I already mentioned, is documented curve progression.
• 11:33
  SPEAKER_00: If a comparable standing x-rays shows a curve that's increasing, you definitely want to know why and what the risk of continued progression are.
• 11:41
  SPEAKER_00: The second is loss of spinal balance.
• 11:44
  SPEAKER_00: Is the person starting to lean further to the side or starting to lean or hunch forward?
• 11:48
  SPEAKER_00: When that happens, the body is losing its ability to compensate for the curve.
• 11:52
  SPEAKER_00: The third is declining function.
• 11:54
  SPEAKER_00: If walking, standing, work, exercise, travel, or just normal activities are become harder and harder over time, that matters.
• 12:02
  SPEAKER_00: And the fourth is new or worsening neurological symptoms, especially leg pain, weakness, or numbness.
• 12:10
  SPEAKER_00: Now, those symptoms can come from several different problems, but in an adult with scoliosis, they may be related to how the spine is degenerating, causing a narrowing of the opening around those nerves.
• 12:20
  SPEAKER_00: And in a child, the biggest warning side is rapid curve progression during growth.
• 12:25
  SPEAKER_00: That's the period where curves can change very quickly.
• 12:28
  SPEAKER_00: And it's when early treatment may have the best chance of controlling what happens next.
• 12:32
  SPEAKER_00: Now, lastly, when is it reasonable to just monitor the curve?
• 12:36
  SPEAKER_00: It may be reasonable to just monitor when we know a curve is stable.
• 12:40
  SPEAKER_00: The person is well balanced, there are no signs of spinal instability, and there's been no meaningful decline in overall function.
• 12:46
  SPEAKER_00: But monitoring needs to be very specific.
• 12:49
  SPEAKER_00: You should know when the next evaluation or next x-ray is scheduled for.
• 12:53
  SPEAKER_00: You should know what changes you're actually looking for or what you're watching for.
• 12:57
  SPEAKER_00: You should know what kind of changes would cause your plan to change.
• 13:00
  SPEAKER_00: Simply being told coming back if it gets worse is not enough.
• 13:03
  SPEAKER_00: Somebody needs to explain what worse actually looks like and how do we measure or define that.
• 13:08
  SPEAKER_00: For a parent, worse would mean visible body changes or progression of curves during growth.
• 13:14
  SPEAKER_00: For an adult, it may mean increasing pain, imbalances, or loss of physical stamina.
• 13:19
  SPEAKER_00: For an older adult, it may mean being able to walk less, leaning more to the side or forward, or having more severe neurological symptoms.
• 13:26
  SPEAKER_00: But any real monitoring plan is really clear about what we're looking for and how we're monitoring.
• 13:31
  SPEAKER_00: So a lot of doctors can tell you the size of the curve.
• 13:33
  SPEAKER_00: That's actually the easy part.
• 13:35
  SPEAKER_00: What you really need is someone who can actually tell you what the curve is likely to do next and what needs to happen before some of your treatment options start to disappear.
• 13:44
  SPEAKER_00: So if all you're hearing is it's only 25 or it's only 30 degrees, or come back if it gets worse, you need to get a different opinion.
• 13:51
  SPEAKER_00: At Scholar Care Denver, we have people that reach out to us from all over the world to understand exactly that.
• 13:56
  SPEAKER_00: So if you're ready for a specialist opinion, you can click on the link below to contact our team.
• 14:01
  SPEAKER_00: And if your curve is progressing and you've actually been recommended for surgery, before you accept that recommendation, watch my video.
• 14:09
  SPEAKER_00: Before you get scoliosis surgery, watch this.
• 14:12
  SPEAKER_00: I'm going to explain exactly what you need to understand about the decision to get scoliosis surgery, the risk, and the questions to ask before committing to something that's permanent.
• 14:22
  SPEAKER_00: You can watch that video right here.