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Home > Adult Spinal Deformities (ASDs) – Part IV – Conservative Treatments

Adult Spinal Deformities (ASDs) – Part IV – Conservative Treatments

Dr. Carlson

Jeffrey R. Carlson, MD, MBA, CPE, FAAOS

In this series of articles, we have covered spinal anatomy, the classifications and types of adult spinal deformities, the symptomology of ASDs and how they are diagnosed in a clinical setting.  In Part IV, I’ll review the latest conservative treatment options for ASDs and how I work with other specialists to provide the highest level of care and pain management for my patients.

Spinal deformities are by nature, structural.  As a spine surgeon, I know that my non-surgical treatment options are limited, but if the symptoms of the scoliosis can be improved, often these patients can live with the structural anomaly.

Conservative Treatments and Therapies

 Medications for Pain – Because pain is almost always present with ASDS, proper pain management will be a first concern. Pharmacological interventions, including nonsteroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, and neuropathic pain medications may provide symptomatic relief.

Depending on pain intensity and chronicity, I may also refer the patient to our Interventional Pain Management team who specialize in the management of chronic pain and working with the patient to fine tune levels of varying medications to find the specific multi-modal drug “cocktail” that will best mitigate pain but allow for highest quality of living and functionality.

Interventional Pain Procedures – Our OSC Pain Management Physicians often work closely with me to provide interventional procedures for patients who suffer from chronic pain caused by spinal problems.  Patients who have ASDs may benefit from procedures such as epidural steroid injections (ESIs) for pain relief from irritated or compressed nerves, radio frequency ablation or nerve blocks for the relief of pain. For patients who cannot undergo surgical procedures, these interventional therapies offer treatment options for patients who otherwise may only have medications to manage their painful symptoms.

Physical Therapy

After gaining some control over pain and inflammation with medication to make it tolerable, I typically refer my patients to Physical Therapy. Targeted exercises and manual therapy techniques can improve spinal flexibility, strengthen supportive muscles, and alleviate pain. OSC’s Physical Therapy team can greatly assist patients with ASDs to achieve the most function and range of motion possible, and the modalities they can apply will help with pain, inflammation, and circulation.

Bracing – Customized orthotic devices may help stabilize the spine and mitigate progression of mild to moderate deformities, particularly in individuals with idiopathic scoliosis. Bracing can greatly improve function and allow for a better quality of life and a return to activities that the patient enjoys. I recommend the use of bracing for most of my mild to moderate ASD patients, particularly for those who cannot have surgical treatment.

Durable Medical Equipment – there may also be other assistive, ambulatory, or functional equipment that can be used by the patient to increase their quality of life, whether it be in daily activities of living, work, rest, or play.  If a patient is limited by their ASD, we can explore a wide range of devices that can help them to live life more fully, many may be covered by insurance.

Multi-disciplinary team of physicians – At OSC, we believe in using a team approach to patient care whenever we feel the patient would benefit.  I already referred to working with our Interventional Pain Management physicians for their assistance with medication management and also for Interventional procedures.  I also would encourage a referral to our Pain Psychologist for education about coping skills and cognitive and behavioral support in dealing with chronic pain.

The management of adult spinal deformities is individualized based on the patient’s underlying etiology, severity of symptoms, patient preferences, and functional goals. However, progressive or symptomatic deformities often require surgical intervention to achieve correction, alleviate pain, and prevent neurological deterioration.

In the next and final article in the series, I will review the surgical options that are available for treatment of spinal deformities and discuss post-operative rehabilitation.

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