Scott Webb (Host): Scoliosis is a spinal deformity characterized by an abnormal sideways curvature of the spine and though it's most commonly diagnosed in children and adolescents, it can affect adults as well. My guest today, Dr. Wajeeh Bakhsh, Board Certified Physician in both Spine and Orthopedic Surgery at Franciscan Health, is here to discuss the diagnosis and treatment of scoliosis and discuss the emotional support that Franciscan Health offers to patients during the treatment process. 

This is the Franciscan Health Doc Pod. I'm Scott Webb. Doctor, it's great to have you back again. Last time we talked about spinal stenosis. Today, we're going to talk scoliosis. And I remember being checked for scoliosis, you know, like in junior high school, we would all line up in the gym and go behind the curtain. And I'm sure there's been some advancements in screening and diagnosing.

And as I mentioned last time, you know, you're Board Certified in Orthopedics, advanced training, spine, orthopedic surgery, all that good stuff. So today, we're going to talk about the advancements in the care of scoliosis, perhaps the screening and diagnosis. Let's just start out with the most basic one. You know, what is scoliosis? What does that mean?

Wajeeh Bakhsh, MD: So in terms of scoliosis, scoliosis is a frightening term. But what it generally is, is a curvature to the spine that deviates from the normal curve.

And the normal curve is kind of an S shape that we all have. Our spines are not actually straight. Even though we like to think of having a straight posture, our spines aren't straight, which allows us to stand up straight. And a scoliosis is when there's a change to that. It's not only a curve, but it also includes a twist or rotational component as well.

Host: Yeah. And I mentioned there, it was a sort of traumatic experience. I don't know if you're old enough to remember being screened or diagnosed the way they used to with scoliosis in the gym, long lines, you know, a PE class kind of diagnosis. I'm assuming though it's changed a little bit, but essentially how is scoliosis diagnosed and is it predominantly children, adults, I'm guessing mostly kids, but from you.

Wajeeh Bakhsh, MD: Yeah, you would think that we've come far with all these technological advancements, but still the best screening is to just have the patient, a lot of times it's, it's these adolescents or these young kids. When you lean forward, what can happen with the twisting part of scoliosis is it changes the way your rib cage looks, and an easy way, we call it a scoliometer, is to literally just look at the back and make sure that it's symmetric.

So the easiest way to kind of screen is for the same exact thing that we used to kind of go through in school when we were younger is we'll have the school nurse or someone out there just kind of use this thing and make sure that there's not an abnormal rotation or curve to the spine. The earlier we catch it the better.

So that's very good way to kind of get some early screening. The more technical diagnosis to look at the curve and say hey, you know it's X degrees and this is what we need to do; that's done through x-ray imaging. And we can kind of take a look at the whole spine from the side and from the front, and get the information that we need to do.

While we screen in children, there are multiple variations of scoliosis. The one that has been popularized is called idiopathic scoliosis, and that is more typically found in children, although adults are kind of at risk of their own versions.

Host: Yeah, so children, adults, talked about my sort of, you know, traumatic experience, if you will, of being screened. It was just more that there were so many of us and, you know, it was just the anticipation of waiting in line, you know, be, to be screened. It was a whole thing, but are there different stages or degrees of scoliosis?

Wajeeh Bakhsh, MD: Absolutely, so we literally just measure the angle of the between the bones as the spine kind of constitutes its curve. So the degrees of scoliosis are actually just the degrees of what we call the COB angle. And the angle of the spine kind of tells us how bad the spine is kind of mal rotated or how bad the curvature is, how different it is than normal.

I mean, that kind of helps guide our decision making. The degree of the curvature is what helps us classify scoliosis patients.

Host: Okay, yeah, and I think I have this right as I've done some other scoliosis podcasts, that you don't necessarily know you have scoliosis in terms of symptoms, unless somebody tells you, right, someone sees you who might have a sense of what it is, and they might mention it to you. But does anyone know that they have scoliosis? Are there actual symptoms?

Wajeeh Bakhsh, MD: So the symptoms are really dependent on the location of the curve and how severe it is. So if it's a small curve and it's in a part of the spine where you can kind of compensate and it doesn't make too much of a difference in terms of your function, you might never notice.

 It might only be picked up if like a school nurse does that little screening test. But generally speaking, the more mild it is, the less symptomatic it is. If it is a severe curve, then it can cause some significant deformity where you notice like hey, you know, my one shoulder is always riding higher than the other, I have I can feel I have a twist in my spine or even if it's severe enough to change the position of the ribcage, it can affect breathing and whatnot.

 So the initial symptoms kind of are always dependent on how severe the curve is. Generally speaking, down the line, as scoliosis patients get older, what we've found through several studies is that in general, patients with a spine that's not straight or not, like, normally curved or with patients that has scoliosis is just going to be at risk of a higher degree of back pain in general than someone else their age that doesn't have the curve.

Host: Gotcha. Yeah, when we think about causes or risk factors, I mean it feels sort of congenital, it feels more like family history and genetics. Are there any other causes though besides just kind of being born with it for scoliosis?

Wajeeh Bakhsh, MD: Yeah, there are a lot of potential causes that all contribute because there are so many different versions of scoliosis. So the most common one that we call idiopathic, means it's the fancy term for us doctors saying we don't exactly know. So idiopathic scoliosis, it's multifactorial. There is a familial component.

You know, if it runs in the family, you are at risk at a higher risk than the normal population. There's a version of it that happens with age we call it degenerative scoliosis because as the spines wear out, sometimes it can wear out more to one side than the other and that kind of pulls you into a tilt going that way and that can kind of result In a curve and then there's also some what we call them neuromuscular disorders where the spinal cord and the body's nerves aren't developing the right way and that can lead to a curve to the spine if there's say, a component of a vertebrae that doesn't develop, so there are some congenital or neuromuscular scoliosis conditions that are out there.

The most common one is the idiopathic version, which again is kind of a combination, multifactorial.

Host: Yeah. Wondering, you know, you mentioned that the most common symptom for folks, if they even know or realize that they have something going on, is probably just some back pain, and then maybe gets progressively worse over time. Are there any other physical complications? You mentioned that, you know, one shoulder might be riding higher than the other one. Does that manifest with any sort of pain or symptoms?

Wajeeh Bakhsh, MD: So yeah, physical complications with scoliosis, it's really a matter of how bad the curve is and where the curve is. So if it's a small curve, kind of in the lower part of your back, you won't notice all that much. You'll be able to do what you need to do. And there's not really any cosmetic kind of changes.

So those are a lot of what we call the degenerative curves sit in the lower part of the spine and don't really cause too much of a problem. But when you're younger, you're growing and you've got a curve, let's say it's pretty advanced at the thoracic or the middle part of your spine; that's when you start noticing these cosmetic issues and we call them cosmetic, not because it's makeup related, but it's something that you notice just from the outside, from looking, you can see uneven shoulders, you can see a hump in the upper back, while it's not a complication; back pain is the most common complaint. And like we talked about earlier with more advanced scoliosis; physical complications can go as far as, affecting the ability of the lungs to expand if the rib cage becomes kind of constricted. And that's when we really kind of have to get involved surgically to help straighten out the spine to make sure that you can address some of these complications.

Host: Right. And as we talked about earlier, it's often diagnosed, especially the idiopathic in children, adolescents, and it's good to diagnose this early. And that kind of leads me to my next question. Cause I remember kids wearing braces at school, and I want to talk to you a little bit about the emotional effects of scoliosis because wearing those braces and you know how let's say unkind some other children can be when you're the different one and you're wearing the brace and it can be stressful and all of that. So maybe encourage folks to make sure that they're screened and diagnosed early.

Wajeeh Bakhsh, MD: Yeah, absolutely. So just in general, we should always get screened. I know it's frightening. Cause you're always worried about what if, what if, but the earlier we catch it, the better our options are. And, you know, emotionally, like an unsightly spine curve can really affect body image.

And the younger you are kind of, the more, at risk we are. Part of it's being teased and then, you know, it can affect your confidence growing up and all that. When we're treating these patients, there's a lot of coaching that goes in, especially with younger patients to get them to embrace their condition, but not let it define them.

Right, so the emotional battle is sometimes that it's sometimes more important than the physical one. Bracing, for example, is such a challenge because kids can be mean and no one wants to be the kid wearing a brace, like a funky brace that goes all the way up your body and gets in the way when you're changing for gym class and all that kind of stuff.

So, the important thing is, you know, with a good family support system; we have counseling available for these patients and understanding from the patient themselves, bracing and like treatment of these scoliosis conditions can be successfully accomplished. It just requires a little bit more of a kind of holistic touch than just saying, hey, here's a brace, wear it.

Host: Right. Yeah. I love the way you said that embrace, but not define, right? That's just so perfect, especially for kids in those tough years, you know, junior high, high school. Want to have you talk about some of the latest advancements in care for scoliosis.

Wajeeh Bakhsh, MD: It's been a growing field. There've been quite a few advancements in treatment options. So we have gotten better with our bracing technology to help prevent these curves from getting bad enough where we need to operate on them. So that's something that we've encouraged folks to consider.

When there are curves that will need surgery, sometimes if we catch them early enough, in order to avoid doing the big surgery, which is fusion with screws and rods, sometimes we can use tethering to help anchor the spine and guide it to grow back into the right shape. When curves are smaller, we can kind of better predict how they'll behave, so that's why we try to get involved as soon as possible.

The gold standard of treatment is still a big surgery, and that's the way to kind of correct the spine and hold it in place. It's the most definitive way to treat it, but we have kind of been exploring and developing new ways to address especially the smaller curves.

Host: Yeah, for sure. Well, it's been great to have you on both of these times. We're getting close to wrapping up here on this one and just want to find out, you know, final thoughts, takeaways, sure, but maybe you could share some success stories, you know, how patients can manage the healthy lifestyle with a diagnosis.

Just, final thoughts, put a smile on everybody's face, Doc.

Wajeeh Bakhsh, MD: Yeah, absolutely. So patients with mild scoliosis, in general, they do very well. They won't have any long term restrictions or not be able to play football or anything like that. If it's a bad enough scoliosis where we need to get involved with bracing early on and some activity modification later, patients can lead totally full lives.

The most essential thing, especially with these scoliosis curves, if they start having a little bit of a cosmetic change, is we coach and really reinforce self-love and self- confidence. To be happy with your body. Some of the more serious cases in scoliosis that require surgery, you know, as long as patients are partnered with their surgeons, they'll end up doing well.

It can just take a year or so to really complete their recovery. So overall, it's not a condition to be afraid of depending on the curve. There are some more invasive things that might need to happen. But don't be afraid of the diagnosis, kind of treat it early. And it's always worth having a conversation with your spine surgeon.

Host: Yeah, that's perfect. Mission accomplished. I had a smile on my face throughout that entire answer. I'm sure listeners did as well. So again, great to have you back on again. Thanks so much.

Wajeeh Bakhsh, MD: All right. I appreciate it.

Host: And for more information, visit franciscanhealth.org and search scoliosis.

 And if you found this podcast helpful, please share it on your social channels, and be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.