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Speaking Scoliosis for Children & Adults

Online Health Chat with Dr. Thomas Kuivila & Dr. Richard Schlenk

June 26, 2012

Introduction

Cleveland_Clinic_Host: Scoliosis is an abnormal sideways curvature and rotation of the spine. About 2% to 3% of the U.S. population, or 7 million people, have this condition. Scoliosis may be detected in infancy, childhood, adolescence, or adulthood. While this condition affects both males and females, females are 10 times more likely than males to need corrective surgery for it.

ScoliScore™, a new diagnostic test, is available for children between the ages of 9 through 13 years old who have spinal curvatures greater than 10° to 25°. This convenient test, available at Cleveland Clinic, checks the saliva for the presence of certain genes that help to predict how much the curve will progress.

It is important to pay attention to whether or not scoliosis progresses. Curves that are larger have a greater chance of progressing than smaller curves. However, even mild curvatures may worsen as a child’s spine grows. Progression can lead to severe consequences in adulthood, including lung and heart problems and potential back pain. That is why it is important to detect scoliosis as early as possible, monitor its progress, and intervene when necessary.


About the Speakers

Thomas Kuivila, MD, staff physician and surgeon at Cleveland Clinic Center for Pediatric Orthopaedics, sees patients up to the age of 21 years. Dr. Kuivila’s specialty interests include congenital and developmental spinal disorders (scoliosis, kyphosis and spondylolysis, and lithesis) and pediatric orthopaedic traumatology. Dr. Kuivila completed his orthopaedic surgery residency at Cleveland Clinic, and served as an A-O international orthopaedic traumatology fellow in Graz, Austria. He was a pediatric orthopaedic surgery fellow at Brown University, Providence, RI, and Rhode Island Hospital, Providence, R.I. During his six years in the United States Air Force Medical Corps, Dr. Kuivila served as Orthopaedic Department Chairman at U.S.A.F. Medical Center Keesler, Biloxi, MS., and subsequently as the Chief of Pediatric Orthopaedic Surgery at Wilford Hall U.S.A.F. Medical Center, Lackland Air Force Base, San Antonio, TX.

Richard Schlenk, MD, staff physician and surgeon in Cleveland Clinic Center for Spine Health sees patients whose ages are 21 years and older.  Dr. Schlenk received his medical degree from New Jersey Medical School, Newark, NJ, and then went on to complete his residency at University of Medicine and Dentistry of New Jersey-University Hospital, Newark, NJ and his fellowship at Cleveland Clinic.  His specialty interests include scoliosis, complex spinal reconstruction, minimally invasive spine surgery, and spinal tumors.

For Appointments and More Information
To make an appointment with Thomas Kuivila, MD or any of the other specialists in our Center for Pediatric Orthopaedics at Cleveland Clinic, please call toll-free at 866.275.7496.  You can also visit us online at clevelandclinic.org/ortho.

To make an appointment with Richard Schlenk, MD or any other of the specialists in our Center for Spine Health in the Neurological Institute at Cleveland Clinic, please call 216.636.5860 or call toll-free at 866.588.2264.  You can also visit us online at clevelandclinic.org/spine.

A remote second opinion may also be requested from Cleveland Clinic through the secure Cleveland Clinic MyConsult® website. To request a remote second opinion, visit eclevelandclinic.org/myConsult


Let's Chat About Scoliosis

Cleveland_Clinic_Host: Welcome to our Online Health Chat with Cleveland Clinic specialists Dr. Thomas Kuivila and Dr. Richard Schlenk. We are thrilled to have them here today for this chat on scoliosis. Let’s begin with some of your questions.

Measuring Curvature

da4health: What is a minor curve?
Dr__Kuivila: One that is flexible on bending films to 25° or less.

melongail: Is there a margin of error between doctors measuring scoliosis curves? My daughter will be 13 years old, and was diagnosed with scoliosis 2 years ago. She wore a brace until this past March. At time of diagnosis her main curve was 37°. She has three curves total. From November to March her curves progressed to 36° /46° /27°. Her surgeon in Indiana is suggesting surgery. Her father does not want this surgery. He took her to a medical center in Tennessee for a second opinion, and that doctor does not recommend surgery until 50°. The Tennessee physician measured her top two curves at 40.2° and 43.2°. I am confused as to what to do. I have great confidence in the Indiana surgeon. I am afraid if we wait to do surgery, the lumbar curve may also have to be fused limiting her flexibility. She started her period 16 months ago. What do you suggest?
Dr__Kuivila: A 4° to 6° of measurement error is not uncommon. Talk to your Indiana doctor about fusion levels and his/her thoughts in this regard.

ScoliScore™ Testing and X-rays for Scoliosis


cweibush412: I was just diagnosed with scoliosis yesterday. Four months after a fall down a flight of stairs, my back still continues to hurt, and I finally decided to see a chiropractor. He did x-Rays and said the scoliosis was there. My mom, sister, and aunt have it as well. I never realized that 2% of the population is a big number. I want to know why they don't take more time at doctors’ offices to test for it, and why schools don't require it as one of their tests. Mine could have been fixed a while ago, but was never found.

Dr__Schlenk: X-rays result in anxiety and overtreatment for patients with subtle curves.

Brad: How can I get the ScoliScore™ test done for my daughter? I live in Montana. Is there anyone here that can administer it?
Dr__Kuivila: The test is marketed by Depuy Spine. Axiomed Spine Corporation is the company that makes the test. Check their websites for providers.

 

Physician Consultation

come_on: With scoliosis, what is the best type of doctor to see? I know someone who swears by their chiropractor and another who will never see one. Do you need a specialist or can your general practitioner take care of it?
Dr__Schlenk: A pediatrician or adult internist (depending upon your age) would be the best person to start with. A very small percentage of patients with scoliosis will go onto require surgical intervention. If your doctor deems it appropriate, sending a patient with scoliosis to a spinal expert would be warranted.

 

Autism and Scoliosis

LisaP: Thanks for this opportunity. I was amazed to find the invitation for this chat in my Canadian mailbox as we struggle with a recent diagnosis for our 12 year-old daughter who is autistic and nonverbal. A recent consultation with Hospital for Sick Children in Toronto showed a curvature of 50°, and scoliosis of the apex of cervicothoracic junction of at least 25%. Monitoring will be yearly and surgery and bracing have not been recommended. I am concerned about progression and potential pain—I thought that treatment would avoid progression. Our child communicates with an advanced speaking device and signs with some fluency, but with autism I'm concerned she can't convey entirely how she feels. The leaning appears to be worsening, and I worry that treatment options being offered are limited. I wondered if I could do more to investigate? Thanks for covering the topic.
Dr__Kuivila: A 50°curve in a youngster will likely eventually be in the realm of surgical management. Bracing now may increase flexibility and may slow the progression. Bracing in the light of autism can be difficult.

 

Dizziness and Scoliosis

Tessa959: I would like to know if scoliosis, having a history of degenerative disease, and having neck fusion done at C5-C6 could cause fairly serious balance problems as well as feeling dizzy? This has caused a lot of problems for me including driving a car at times. I am also experiencing vision issues that they claim could be from a fall that I had when I was 12 years old. Do you believe that the fall could have caused any of these issues regarding my spine? Who would you recommend that I see as I feel my scoliosis is getting somewhat worse? I also have a hard time walking a straight line and at times hold my head to the side. Could this be scoliosis? Thanks for the support and look forward to the web chat.
Dr__Schlenk: I do not think that the symptoms you are describing are related to a spinal disorder.

 

Sciatica and Scoliosis

Curly: I am a 54-year-old female. Could the mild scoliosis that I have be playing a part in the sciatic pain I am experiencing in my right buttock and leg?
Dr__Schlenk: Sometimes that indeed can be the case. Patients with mild scoliosis can have spinal stenosis, which can cause nerves to be pinched in the spine.

Curly: I am having a lot of sciatica pain and was told I have mild scoliosis. Could this be part of my problem? I was also told I have a slightly bulging disc.
Dr__Schlenk: Spinal stenosis and scoliosis can occur together as both are degenerative conditions in adults.

 

Progression and Prognosis of Scoliosis

katherineananda: I'm 20 years old, with a 38°, well-balanced curve. I often run into older people with scoliosis like mine. What should I do to prepare as I age? What do I do when I am 80 years old? Will going to activities like water aerobics help? Is there a good chance I'll be bedridden? Do you know anything from dealing with elderly patients?
Dr__Kuivila: Maintain aerobic fitness, good muscle strength, and bone health through vitamin D and calcium supplements. 38° curves usually do not progress when primarily thoracic in location. Bedridden? Not from your curve!

CMB: I was told I had scoliosis as a child. Now that I'm an adult, what other spine problems do I need to be concerned with?
Dr__Schlenk: It is best to have x-rays done every few years to assess the degree of curvature progression. Curves that are balanced and are not becoming greater in their degree of measurement can continue to be treated conservatively. It is not uncommon for patients with adolescent scoliosis to have degenerative (arthritic) changes seen as an adult, but earlier in life than would be expected otherwise. Having a firm understanding of the natural progression of one's own unique scoliosis condition as an adult is important in strategizing ways to compensate for problems that may arise and for surgical avoidance if possible.

 

Treatment Options for Minor Curvature

lauraandken: My daughter was diagnosed late with scoliosis (at age 15 years), with a 23° curve. What are her options for treatment?
Dr__Kuivila: Curves under 25° to 30° generally are not treated. She should be followed until skeletal maturity though. She may be skeletally mature at this point.

 

Exercise and Nutritional Supplementation

Barnegat: Thank you for having this chat. I am 54 years old with about a 65° S curve. I also have osteoporosis. Other than some pain at times, I am doing well. I walk an hour each day and do floor exercises for an hour. My question is, should I be doing anything other than I already am to help stay mobile? I am on 1000 IU of calcium daily in addition to three servings of dairy (1 cup each), 10,0000 IU of vitamin D, and 800 IU of magnesium. How much longer do I have to stay mobile if I continue with this? I would not like my life much if I was not able to walk and do all of the things I currently do as a busy person.
Dr__Schlenk: You need to stay as active as possible given your condition. I would have a discussion with your primary care doctor on osteoporosis medication therapies if indeed you have not done such.

 

Exercise and Scoliosis

katherineananda: I'm 20 years old. I have a 38° curve. It's quite balanced. I do yoga every morning and it reduces the pain a lot. I want to do tai, kickboxing, aikido, and parkour. Can I do these things?
Dr__Schlenk: I’d say you can probably do those things, but you may be at increased risk for an exacerbation of back pain. It is not likely to affect your scoliosis. Basically, if you can do those activities comfortably, it is o.k. from my standpoint.

katherineananda: Is running barefoot okay with scoliosis?
Dr__Schlenk: Fine.

juphilli: I have about a 15° curve, and I am a female 60 years old. I do yoga, Zumba®, Pilates (exercise), ballet, massage, reflexology, and acupuncture. I am able to manage my pain without medications. I also see a chiropractor. Is there anything else I can do to help my condition without medications or surgery? I am also at a healthy weight. Do you recommend chiropractors for helping with scoliosis pain? With my spine twisted my chiropractor rotates my spine to straighten it and alleviates the pain. Isn't that a good thing?
Dr__Schlenk: I think you are doing most of what you need to do. Being healthy and active is best. Chiropractic treatments are optional, but of unproven benefit. If they help then keep going.

 

Physical Therapy (P.T.) Exercises

lauraandken_1: Will any type of chiropracty or other physiotherapy help alleviate pain symptoms?
Dr__Schlenk: Pain that is musculoskeletal in nature for patients should be treated with physical therapy modalities to help with core strengthening and increasing range of motion.

lauraandken_1: What kind of exercises can my 16.5-year-old daughter do to help alleviate her scoliosis? She is about 23°, and was diagnosed too late for bracing.
Dr__Kuivila: Nothing will correct the curve. 23° curves are usually below the threshold for bracing. She should do well with a 23° curve. Exercise can improve flexibility and can help with muscle aches.

lauraandken_1: My daughter walks with a pronounced concave posture. What exercises  can she do to help her posture and rotation?
Dr__Kuivila: She should be assessed by a physical therapist.

SATURN9: I would like to download the correct exercises for adult scoliosis, in a diagram form, but can’t find them. I’m also wondering if extreme groin pain is common?
Dr__Schlenk: I am sorry but am not aware of an online site for exercises. Groin pain can be seen in patients with pinched nerves in the upper lumber region.
 
SATURN9: I am 69 years old and was just diagnosed one year ago with scoliosis. I am doing exercise only. Is that enough to straighten the curves?
 Dr__Schlenk: Often exercises are all that are needed to address symptoms related to minor scoliosis curves.

heatherann0033: What are some good exercises you would recommend? Also, is there a best way to sleep?
Dr__Schlenk: Core stabilization exercises are best. Your doctor can refer you to a physical therapist who can teach you proper exercises. There is no best way to sleep. Do what works best for you.

js1960: I am 51 years old and have a heart condition, and also have had scoliosis my whole life. Physical therapy (PT) does help my back feel better and it does straighten my back a little. I am limited in walking and cannot swim. I was told your outpatient centers may be able to help with physical therapy. Do I need a physician's order or can I go them on my own? Not sure how to start.
Dr__Schlenk: You will need an order in most states from a physician for P.T. I would start with your primary doctor.

Mehta Casting

kl: What are the benefits of Mehta casting versus non-Mehta casting for early intervention of infant scoliosis?
Dr__Kuivila: Mehta casting is successful in treating many infantile curves. Other types of bracing and casting can be successful if they are demonstrating improvement of the curve by x-ray measurement while in the cast or brace.

Traction

RIE: Is traction a viable option for treatment of pain from degenerative arthritic scoliosis in the lower lumbar region of an 83-year-old woman?
Dr__Schlenk: Traction is not very effective in treating arthritic symptoms related to scoliosis.

Effectiveness of Bracing

klblunk: My 15-year-old son was just diagnosed with idiopathic scoliosis with a curvature of more than 25°. His orthopaedic doctor suggests a brace, but I heard that recent research indicates that bracing doesn’t always benefit the child. What is your opinion on this new research and should I get a second opinion? Thanks for your time!
Dr__Kuivila: Boys progress their curves longer than do girls. Bracing is thought to keep a curve from progressing 85% of the time. How many curves that would not have progressed anyway is not clear. Most kids do well in braces, if they don't have to wear it to school and social functions.

da4health: Is there good evidence to suggest reasonable improvement in scoliosis with exercise, physical therapy, chiropractic, or other means of conservative care other than bracing? At what degree of scoliosis should bracing be considered? At what age is bracing no longer a feasible option? What is/are the most effective means of correcting a scoliosis short of surgical intervention?
Dr__Kuivila: There really isn't anything overwhelmingly positive. Bracing should be considered at 25° to 30° curvature, up to 40° Age for bracing depends on physical maturity. A rough guideline is 14 years old for a girl, and 16 years old for a boy. Only surgery will correct scoliosis. Most curves don't need surgery!

TLSO Bracing vs Surgery (Vertebral Body Stapling, Rods, Tethering)

Brad: I have a daughter with 35° of curvature uncorrected, and about 15° corrected by a TLSO (thoraco-lumbo-sacral-orthosis) Boston Brace. She is a 9-year-old Tanner II female. Is vertebral body stapling a reasonable option? Should we simply continue the TLSO bracing despite the indications that no juvenile idiopathic scoliosis patients avoid surgery? I can send films—what do you recommend? Thanks!
Dr__Kuivila: It is an option. The Philadelphia Shriners Hospitals for Children is a leader in this new technique. We are not doing this procedure at Cleveland Clinic.

Brad: My daughter is a 9-year-old, Tanner II, with a 37° uncorrected curvature, and about 15°  corrected by TLSO Boston brace. Mayo Clinic says to continue brace therapy. What do you folks think of growth rods, vertebral body stapling, brace, etc.?
Dr__Kuivila: No, to growth rods at her age. An evaluation at a major center that is facile with stapling would be an excellent option.

kyparents: What medical studies have been done on the effectiveness of vertebral body stapling? Our daughter is a prime candidate.
Dr__Kuivila: Yes, there are several centers, notably The Philadelphia Shriners Hospitals for Children that have published their early results. Very few centers are doing this. More will likely do so in the future.

Brad: Is surgery likely to be the only option for a 9-year-old with a 35° curve already?
Dr__Kuivila: Not necessarily. It should be treated with bracing at this time.

Brad: Quoting, "38° curves usually do not progress when primarily thoracic in location." is that true of juvenile as well as adolescent?
Dr__Kuivila: No, I was referring to curve magnitude at skeletal maturity.

kyparents: What minimally invasive procedures do you recommend for scoliosis?
Dr__Kuivila: The types of minimally invasive procedures—anterior (front) stapling or rod and posterior percutaneous rods depend upon the age of the patient, type of curve, and its flexibility. Many curves are not good candidates for a fully minimally invasive approach.

kyparents: Our daughter is 12 years old with a 20°curve. Her doctor has stated that she may be a good candidate for vertebral stapling, if her curve progresses during her puberty growth spurt. It is difficult to find research information about this procedure. How do you feel about this technique? We would also like your input on vertebral tethering. Thank you.
Dr__Kuivila: Both of these techniques have promise, but both are in their relative infancy. I would not consider anything interventional unless she progresses to 30°.

 

Corrective Surgery

katherineananda: What are your viewpoints on getting corrective surgery?
Dr__Schlenk: It depends upon the age of the patient and the type of problem that the patient presents with. In the pediatric population (less than 21 years of age), the most common indication for surgery is deformity progression and cosmetic concerns surrounding scoliosis. In the adult population with scoliosis, patients may present with pain as their primary complaint. Surgery should be one's last option.

KLB: My 13 year old has been wearing a back brace for several years. She has just gone into her third brace. Her curve has progressed to 40°, and is now termed kyphoscoliosis. We are having difficulty getting her to wear the new brace. We have briefly discussed surgery, but she is still growing. Her biggest fear about surgery is scarring. How bad is this, and what recovery is expected if this route is recommended?
Dr__Kuivila: Growth need not, nor necessarily should be, complete prior to surgery.
The scar is long, but most heal quite nicely. Following surgery, the patient is in the hospital 6 to 7 days, and back to school in 4 to 6 weeks. Full activity is attained in most cases at 6 months.

MrsBear: A 12-year-old female was diagnosed with idiopathic scoliosis at age 11 years as an  incidental finding status post-fall with arm fracture. Per x-ray in October 2011, 47° angle of right thoracic with lumbar curve to the left was found. Parents elect observation with physical therapy in lieu of brace. Follow-up study in May 2012 shows greater than 65° thoracic apex. During 7-month observation, the patient had onset of menarche with irregular cycle. Second opinion recommends spinal fusion. On June 14, 2012, 6 wks after diagnosis of greater than 65° degree angle, the patient now has visible shoulder asymmetry with pronounced hip deformity and back tenderness on palpation. The patient is tall at approximately 5 ft, 9 inches height, The mother is 6 ft tall and the maternal grandfather is 6 ft, 2 inches. No known history of scoliosis on the maternal side, but prevalent on the paternal, with the child's father requiring a brace as a teenager. Per parents this child is “clumsy” with balance problems and frequent falls since a very young age. Considering history of present illness, rapid progression of diagnosis, and personal and family history, is there a possible differential diagnosis for the type of scoliosis this child suffers from?
Dr__Kuivila: I would agree with the recommendation for surgery. Also, she needs a neurology consult and a screening MRI of the cervical, thoracic, and lumber spine to rule out any other underlying disorder or pathology.

MrsBear: Is a neurology consult and MRI to rule out underlying pathology common?
Dr__Kuivila: It’s fairly common in my practice, but not necessarily routine.

MrsBear: I have read that Harrington rods have a high rate of displacement and revision. For a 12-year-old girl with a greater-than-65° degree thoracic curve accompanied by an increasingly severe lumbar curve, is there a better fixation option?
Dr__Kuivila: True. Harrington rods are 20 years obsolete. Newer technologies have resulted in a very low rate of displacement and need for revision surgery.

natsmom: Our daughter is a patient of yours and has a greater than 70° curve. At her last appointment, we were told that surgery should be done soon. We have been making a list of questions and concerns to ask at her appointment, but some of our biggest questions are: How long will she be in the hospital? How long until she will be at home? What risks are there? Is the full recovery time 6 months or a year?
Dr__Kuivila: She would be in the hospital about a week. She would need to be out of school about 4 to 6 weeks. Usually, patients are back to full activity in 6 months. Risks include infection, hardware failure, and neurologic injury, but all are very rare. We are exceedingly attentive to all these issues before, during, and after surgery.

natsmom: Prior to surgery, will the procedure be described to the patient and her parents and will they be given the opportunity to see what will be used on the patient? How long post-surgery should we expect our daughter to be monitored? Are there any concerns in adulthood after surgery if it is done at age 11 years?
Dr__Kuivila: Parents and the patient can see the representative hardware if they are interested!

natsmom: What kind of pain management is to be expected post-surgery?
Dr__Kuivila: Epidural catheter and IV (intravenous) PCA (patient-controlled analgesia) are the standard modalities we employ.

natsmom: If surgery is a final option, what is the recovery time?
Dr__Kuivila: We usually see the patient at 1, 3, and 6 months after surgery, and every other year for 5 years. Adult concerns are minimal, but it depends on the levels of fusion.

Cage Correction

Nonda: I'm 54 years old with a severe S curvature. A neurosurgeon I recently saw mentioned a new treatment to stabilize the spine utilizing cages. Can you give me more detail?
Dr__Schlenk: Sometimes cages (which are spacers) can be placed through side incisions either with a standard opening or with minimally invasive techniques. It can assist with deformity correction and with bone healing, but is not required. Unfortunately, these techniques require a separate back incision (usually lengthy) to place screws and rods and achieve final correction if needed.


Pain Management in Adolescents

dlash1: When you have an adolescent who presents with scoliosis and back pain, how do you approach the treatment for the pain?
Dr__Kuivila: A full examination will evaluate the source of pain. Most commonly musculoskeletal and mechanical back pain is well managed with exercise, weight loss (if overweight), aerobic fitness, and/or NSAIDs (nonsteroidal anti-inflammatory drugs).

Scoliosis Options in Adult and Geriatric Patients

grandma20: I am 71 yrs old. Is it possible that I can get a brace that would be of any help to me at this late stage of my life? Is surgery an option at all?
Dr__Schlenk: Bracing can be done for scoliosis in children. In adults it has no proven benefit, and in my opinion leads to weakened musculature around the spine.

charl: What can you suggest for addressing chronic back pain from scoliosis in a 78-year-old woman (me!) whose curve has worsened with age, and even protrudes as well as curves? I assume at this age, surgery is not a valid option. Thank you.
Dr__Schlenk: It depends upon the degree and progression of the scoliosis in conjunction with the type of symptoms you may be experiencing. Surgery is one last option, and not usually successful in treatment of back pain.

charl: What are the best exercises for older adult with 35° curve?
Dr__Schlenk: Core stabilization exercises are best. Your doctor can refer you to a physical therapist who can teach you proper exercises.

SATURN9: I have thoracolumbar 41° curve. What concern is there for a ridge hump, and decreased lung and chest area for a person more than 60 years old?
Dr__Schlenk: As curves get greater than 40° there is some increased chance of progression of deformity. Your doctor should monitor your back with x-rays on a yearly basis.

Stem Cells and Back pain

kriskull: Do you know of any work with stem cells in this area for the back pain?
Dr__Kuivila: No, I do not.

Alternative Therapies: Clear Institute and Chiropractic

crackedjar: What do you think of the CLEAR™ Institute protocol for scoliosis correction and reduction?
Dr__Kuivila: I have had three patients do the protocol prior to surgery. It has increased their flexibility. I have not seen anything in peer-reviewed medical journals showing any actual improvement or reversal of curves.

Cleveland Clinic MyConsult® Online Medical Second Opinion

kriskull: What is next? My main problem is my lumbar at the belt level and nerve pain in my right hip. I have had epidural injections, therapy, surgery to clean around the nerves, and spinal stimulator trial that did not work. I am going to try to send a copy of my last MRI (magnetic resonance imaging).
Dr__Schlenk: Your question is quite specific and renders itself to Cleveland Clinic MyConsult® Online Medical Second Opinion. This is a program which connects patients with the diagnostic expertise of Cleveland Clinic physicians who will review the patient's individual situation, answer their questions, and provide a comprehensive report that they can share and discuss with their family and physician. Based on the medical second opinion patients receive from Cleveland Clinic, they can decide to travel to Cleveland Clinic for their treatment, or if they would like, stay in their hometown and receive treatment locally.

Niiemi: I am a 52-year-old male with an S-curve in my back. What is standard procedure on an adult my age with the two curves that combine together summing to a 54° curve in my back? I had a second opinion from an orthopaedic doctor and he said," I could put the rods down your back, but you would lose all the spinal flexibility that you have now.” One bigger problem is I am a lifelong Coumadin® (warfarin) patient. I also have two bulging discs, one at C-6 and the other at the apex of the curve in the thoracic area?
Dr__Schlenk: Your question is quite specific and renders itself to Cleveland Clinic MyConsult® Online Medical Second Opinion. This is a program which connects patients with the diagnostic expertise of Cleveland Clinic physicians who will review the patient's individual situation, answer their questions, and provide a comprehensive report that they can share and discuss with their family and physician. Based on the medical second opinion patients receive from Cleveland Clinic, they can decide to travel to Cleveland Clinic for their treatment, or if they would like, stay in their hometown and receive treatment locally.


Closing

Cleveland_Clinic_Host: I'm sorry to say that our time with Cleveland Clinic specialists Thomas Kuivila, MD and Richard Schlenk, MD is now over. Thank you both for taking the time to answer our questions today about Scoliosis.

Dr__Schlenk: It has been a pleasure to field your great questions. Thank you.

Dr__Kuivila: Thanks for the opportunity to answer your questions. Your questions reflect an excellent understanding of the condition!


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