Scoliosis

 

Scoliosis is a common condition that is a curvature of the spine.  Scoliosis can be congenital (idiopathic) and may run in your family.  Other types are neuromuscular or can also be the result of degeneration of the spinal bones and discs.  Neuromuscular scoliosis is associated with certain conditions like muscular dystrophy, spinal cord injury, spina bifida or cerebral palsy where there is an inability to control the muscles that support the spine resulting in scoliosis.

 

Who is Affected by Scoliosis?

The National Scoliosis Foundation estimates that 2-3% of the population is affected by scoliosis.  The diagnosis is often made at the time of adolescence during screenings in school. Most commonly, scoliosis is mild and does not cause any symptoms.  If the curve is greater than 25 degrees in adolescence, since you are still growing, it is followed closely to monitor progression.  Severe curvatures can ultimately impact cardiovascular or pulmonary function and for curvatures greater than 50 degrees surgery may be indicated.

 

Symptoms of Scoliosis?

Adults who have scoliosis often will suffer from more mechanical spine pain than the general population.  This is because of the extra forces placed on the facet joints and discs as a result of the rotation and curvature of the spine.  As scoliosis worsens throughout the aging process, the curve may progress and there may also be a compensatory S-shape of the spine where there are two locations of the curvature.  This changes the mechanics of the spine causing the shoulders to be uneven and the rotation is evident with a rib hump, shift at the pelvis and one hip may appear higher than the other.

 

What Can Be Done For Scoliosis-Associated Spine Pain?

Treatment is focused toward the painful facet joints and musculoskeletal imbalances. There are good non-surgical long-term treatment options that can be effective to help minimize the impact of the chronic pain associated with the rotational forces placed on the spine. Similar to the usual treatment for painful facet arthritis, medial branch blocks are precise nerve blocks (numbing) that are performed to identify the painful joints.  If the results of the nerve block provide significant relief, radiofrequency ablation can then provide long-term relief. Most insurance companies will cover this treatment at least once a year.

 

Radiofrequency Ablation is the treatment of choice for many painful areas of spine whether it is a result of arthritis or a painful nerve. In the case of arthritis pain, the nerve (medial branch nerve) that provides the painful sensation from the facet joints to the brain is interrupted.  Radiofrequency can offer more long term relief of the cervical or lumbar region, and even other peripheral nerves.

 

What is Radiofrequency Ablation? 

Radiofrequency neurotomy is a safe, minimally-invasive procedure using a specialized machine and insulated needles with a probe to deliver high-frequency, low voltage radio waves that convert to heat that interrupts and eliminates the sensation of the pain from the target nerves.  Thermal radiofrequency interrupts the painful stimuli.

 

How is Radiofrequency Ablation Performed? 

The procedure is performed in a special fluoroscopy room utilized only for xray-guided injections.  The needle is positioned using bony landmarks seen on the x-ray that identify the nerve location. The needle is precisely placed within 1mm of the nerve to create an effective lesion. Therefore, pinpoint accuracy is important in achieving the best results. Depending on the area treated, the procedure may take 30-45 minutes.

 

Is Radiofrequency Neurotomy Painful? 

Patients typically tolerate the procedure very well. Occasionally, if very nervous, we'll provide the patients with oral xanax to relax them during the procedure.  I utilize lots of numbing medicine in order to minimize any pain from the needle movement (much like a dentist does).  

 

How Long Does The Relief Last from Radiofrequency Ablation? 

The results with radiofrequency may vary depending on the severity of arthritis, progression of arthritis between treatments, and lifestyle choices.  Results are also dependent on an accurate diagnosis made with nerve blocks that would indicate concordant pain relief.  Typically, we expect an average of 12 months of pain relief, however we've seen as short as 6-9 months or as long as 18+ months.

 

Is Radiofrequency Ablation Safe? 

Radiofrequency ablation is a standard pain management technique that has been used for over 50 years in various regions of the body. Radiofrequency has full FDA clearance. However there are some insurance companies that claim it is “experimental” and not covered despite efforts to provide documentation with multiple peer-reviewed scientific studies.