Smoking and Scoliosis

From lung cancer to cardiovascular issues, the health risks associated with smoking are well documented. One of the many reasons to quit smoking is the fact that it can cause spinal degeneration and severe back pain, which in turn can lead to a form of scoliosis known as de novo scoliosis. In a nutshell, de novo scoliosis is a spinal curvature that develops in adulthood as a result of spinal degeneration. In some cases, a curvature of the spine occurs as a result of the facet joints and discs in the lumbar (lower) spine ageing, leading to the vertebrae slipping out of place and the spine losing its shape. But if this degeneration occurs as a result of ageing, what does smoking have to do with it?

Smoking and degenerative discs

Although ageing and genetic predisposition are the main risk factors for degenerative discs, a growing number of studies indicate that smoking is another leading risk factor in the deterioration of both lumbar discs and cervical discs (found in the neck). Nicotine has been shown to deprive disc cells of vital nutrients as a result of small blood vessels becoming constricted. In addition to nicotine, through smoking, you introduce carbon monoxide into the bloodstream and your body’s tissues. These poisons begin to inhibit the disc’s ability to absorb the nutrients it needs, which can result in prematurely dehydrated and less pliable discs. As the discs in the spine become more malnourished, there is a greater risk of a rupture occurring. This happens when the disc’s contents break through the outer layer of the disc, often encroaching on nerves and causing severe pain and discomfort. These same poisons also interfere with calcium intake, leading to a compromised spinal structure and – potentially – scoliosis. Other risks related to smoking and scoliosis include:
  • Coughing – This is much more prevalent among smokers and can increase the risk of degeneration in the discs. Coughing causes increased pressure between discs, which puts added strain on both the spine and discs, resulting in a greater risk of ruptures and bulges. This is particularly common in a spine that’s already been weakened by smoking-related toxins.
  • Inactivity – This is often associated with a smoker’s lifestyle, and can result in a higher frequency of back pain. Unfortunately, pain caused as a result of degenerated discs can make an active lifestyle even more difficult to adopt and enjoy.

Smoking and failed spinal fusion

Spinal fusion surgery is often recommended for severe cases of scoliosis. The procedure involves using a bone graft to fuse vertebrae together. The long-term success of this procedure is dependent upon successful fusion; in fact, if the fusion does not heal correctly, surgery may have to be repeated. Many different factors can have an impact on the success of spinal fusion, including age, underlying medical conditions and – yes – cigarette smoking. Smoking disrupts the normal functions of basic body systems that contribute to bone formation and growth, which are imperative for a fusion to heal properly. Studies have shown that habitual cigarette smoking leads to the breakdown of the spine to such a degree that fusion is often less successful when compared to similar procedures performed on non-smokers. Smoking can also have a huge impact on the immune system and the body’s other defence mechanisms, which in turn can lead to an increased risk of post-operative infection.

Treatment at the Scoliosis SOS Clinic

If you’ve been diagnosed with de novo scoliosis and wish to avoid surgery, we at the Scoliosis SOS Clinic can provide effective exercise-based treatment that aims to correct your condition. Our ScolioGold treatment programme is designed to improve mobility, boost strength and correct abnormal posture, combining a variety of proven non-surgical techniques to achieve noticeable, lasting results.

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Whether you’re taking your child to see a GP or an orthopaedic specialist, you’re going to have a lot of questions about scoliosis and the available treatment options. In this blog post, we’ll talk you through a range of scoliosis questions that you may wish to ask your doctor.

Speaking to a doctor

If you’ve just been diagnosed with scoliosis, there are a number of questions you can ask your doctor to help you gauge whether they’re offering you the right treatment plan. It’s important to ascertain their knowledge and experience with this condition before you go any further. Not every GP will have an extensive understanding of scoliosis, particularly if they’ve never dealt with a spinal curve like yours before. If that’s the case, the GP might not be able to offer you the responses to your questions that a scoliosis specialist could.  

Questions to Ask Your GP

Always be respectful towards your doctor, even if you decide not to pursue treatment with them. Try not to get upset or angry if you don’t agree with their assessment of your condition.
  • Have you ever come across a scoliosis case like mine before?
Every case of scoliosis is different, so it’s possible that your GP hasn’t treated a case of scoliosis like yours before. Doctors who’ve been working with scoliosis for many years may have patient testimonials and evidence to show that the treatment approach they’re suggesting works for cases like yours.
  • Will the treatment you’re suggesting help me achieve the results I want?
Each scoliosis patient has different expectations. Some people are most concerned with their appearance while others want to improve their mobility or flexibility. The treatment option that will help you achieve your desired results might not be the one that your doctor is prescribing. For example, a scoliosis brace can help to prevent your scoliosis curvature from getting worse, but if your main concern is your appearance, you might not want to wear a scoliosis brace all the time.
  • What can I do to improve my chances of success?
With more active approaches to treatment, you might be able to improve your results by following a particular regime or plan accurately, or by doing extra activities at home to improve the effectiveness of your treatment. That’s certainly the case with our exercise-based therapy programme, which should be continued at home once you’ve left the clinic.
  • What are my other options if I decide not to try the treatment you’re recommending?
If you’re nearing the end of your consultation and you’re not happy with how it’s going, it’s completely natural to wonder what your other options are. If your doctor has no other types of treatment for you to choose from, this could be a red flag. Even if the doctor genuinely doesn’t have any other treatment options lined up for you, they should be able to refer you to another doctor who can provide additional support and advice.  

Seeking Specialist Help

If you feel like you’ve exhausted your doctor’s knowledge and haven’t got the answer you wanted, it might be time to look elsewhere. Doctors are great, but when it comes to complex conditions like scoliosis, you could be better off speaking to a specialist. Here at the Scoliosis SOS Clinic, we’ll invite you to attend an hour-long initial scoliosis assessment with one of our specialist consultants. We can even conduct your initial consultation over the phone or via Skype if you have photos and/or X-rays of your back already. Before recommending a treatment path, we take 2 measurements of your back: one to assess the rotation or kyphosis/forward bend in your spine, and a second photographic scan of your spine that analyses your back shape and profile. Then we’ll summarise our diagnosis, explain our proposed treatment plan and give you an idea of therapy timescales, plus the type of results you can expect to achieve. Even if you attend one of our consultations, you’ll be under no obligation to pursue treatment with us. We want you to be empowered to make a choice about your spinal treatment and ultimately do what’s best for you.

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Lordosis of the spine

What is lumbar lordosis?

Lumbar lordosis is the normal inward curvature of the spine, located in the lumbar (lower) region of the back. This curve helps the body to absorb shock and remain stable yet flexible. If the curve arches too far inward, however, it’s known as increased lumbar lordosis – or hyperlordosis. In extreme cases, there will be a visible C-shaped arch from the lateral view when the diagnosed individual stands, resulting in their abdomen and buttocks sticking out. This postural position can also be associated with an increased thoracic kyphosis, often resulting in excess pressure on the spine, causing pain and discomfort.  

Causes of lumbar lordosis

Lordosis of the spine can be caused by several conditions and factors, affecting people of any age. These include:
  • Spondylolisthesis – This is a spinal condition where one of the lower vertebrae slips forward onto the bone below. Learn more about spondylolisthesis here.
  • Achondroplasia – This is one of the most common types of dwarfism.
  • Osteoporosis – This is a bone disease that leads to decreased bone density, increasing the likelihood of the risk of fractures.
  • Obesity – Obesity is an epidemic in a number of countries all around the world. This condition puts people at a higher risk of developing serious diseases such as type 2 diabetes and cancer.
  • Osteosarcoma – This is a bone cancer that typically develops in the shinbone near the knee, the thighbone or the upper arm near the shoulder.

Symptoms of lumbar lordosis

The most common symptom of lumbar lordosis is muscle pain. When your spine begins to curve abnormally, your muscles get pulled in multiple directions, causing them to spasm or tighten, which can limit movement in your lower back. To check if you have hyperlordosis, simply lie on a flat surface and check to see if there is a lot of space between the curve of your back and the floor. If you can easily slide your hand through the space, you may have lumbar lordosis. Other symptoms include:
  • Weakness of the spine
  • Numbness
  • Tingling
  • Weak bladder control
  • Difficulty maintaining muscle control

Lumbar lordosis in children

Often, lumbar lordosis appears during childhood without any apparent cause. This is known as benign juvenile lordosis and occurs as a result of the muscles around the hips weakening or tightening up. Benign juvenile lordosis isn’t usually too much of a concern, however, as it tends to correct itself as children grow up. Other conditions that can cause lumbar lordosis in children are often related to the nervous system and muscle problems. Examples include:
  • Cerebral palsy
  • Spinal muscular atrophy – An inherited disorder that causes involuntary movements
  • Muscular dystrophy – A group of inherited disorders that result in muscle weakness
  • Myelomeningocele – An inherited condition where the spinal cord sticks through a gap in the bones of the back
  • Arthrogryposis – An issue that occurs at birth where the joints are limited in movement

How is excessive lumbar lordosis diagnosed?

To determine if you have hyperlordosis, your doctor will examine your medical history, conduct a physical assessment and ask about other symptoms. During the physical assessment, your doctor will ask you to bend forward and to the side. Here, they are checking whether the curve is flexible or not, whether your spine is aligned correctly, your range of motion and if there are any abnormalities. They may also ask several questions regarding your spine, its curve and your symptoms. After narrowing down the possible causes of your lumbar lordosis, your doctor will order tests, including X-rays, in order to determine the angle of your lordotic curve. This will help to diagnose lumbar lordosis based on the angle in comparison to other physical features like height, body mass and age.  

Lumbar lordosis treatment

Unless your case of lumbar hyperlordosis is severe, you will not require any treatment. However, if your condition is severe, there are a number of treatment options available to you. These include:
  • Medication to minimise pain and swelling
  • Physical therapy to strengthen muscles and increase range of motion
  • Wearing a brace to correct the curvature
  • Surgery for the most severe cases
  Here at the Scoliosis SOS Clinic, we provide non-surgical, therapy-based treatment programmes to help improve a variety of spinal conditions, including lumbar hyperlordosis. Our team of expert therapists help patients to perform a variety of exercises aimed at increasing the strength and range of motion of the muscles in the back. You can learn all about our award-winning ScolioGold treatment here. If you would like more information on our therapy-based treatment courses, please do not hesitate to get in touch today.

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surgical procedure

For many individuals diagnosed with severe cases of scoliosis, the only available treatment option is spinal fusion surgery. This, of course, can be quite daunting and worrying, especially if the patient is young or has never undergone any sort of surgical procedure before. The bone graft applied during spinal fusion surgery causes the bones in the spine to fuse together over a period of time. This fusion aims to stop movement between the vertebrae, providing long-term stability within the spine. Spinal fusion has just a 2-3% risk of complications; however, as with any other surgical procedure, problems do occasionally arise once the operation is complete. If you’re thinking of undergoing spinal fusion surgery for your scoliosis and would like to know more about possible long-term side effects, here are some of the things you may potentially experience.  

Failed Back Surgery Syndrome (FBSS)

One of the most common problems encountered after spinal fusion surgery – or any type of surgery involving the back – is failed back surgery syndrome. This is a misnomer; FBSS is not actually a ‘syndrome’ but a very generalised term that is often used to describe the condition of patients who have not had a successful result with spinal or back surgery and have experienced continued pain post-surgery. Surgeons are not able to physically ‘cut out’ the pain felt by patients. They are only able to alter the patient’s anatomy. In most cases, the number one reason why back and spinal surgeries are not effective (and have to be repeated) is because the area that was operated on was not actually the cause of the patient’s pain.  


Pseudarthrosis of the spine can result from a failed spinal fusion and may occur at any place where spinal fusion was attempted. It presents itself as either a pain in the neck or back (axial) area or radical (arm and leg) pain that occurs months or years after a previous spinal fusion. During spinal fusion surgery, if the bones do not fuse together properly through the bone graft, then motion may continue across that area. For some individuals, the motion can cause pain similar to that of a broken bone that never heals. Patients with metabolic disorders such as diabetes are at increased risk for the development of pseudarthrosis. Smoking is a common risk factor. Some surgeons may even refuse to operate on smokers as it poses such a great risk for failed fusion. Other factors of failure include obesity, chronic steroid use, osteoporosis and malnutrition. The choice and use of fusion material, number of fusion levels, surgical technique and instrumentation have also all been shown to influence the rate of success and impact quality of life after spinal fusion.  


Infection is another problem that can sometimes occur after spinal fusion surgery. Infections can be classified by the anatomical location involved: either the vertebral column, the spinal canal, intervertebral disc space or the adjacent soft tissues. Infection may occur as a result of bacteria or fungal organisms; most post-surgery infections occur between three days and three months after the operation. Vertebral osteomyelitis is the most common form of spinal infection, developing from direct open spinal trauma, infections in surrounding areas, and from bacteria that spreads from the blood to the vertebrae. Other common problems that can occur as a result of spinal fusion surgery are:
  • Bleeding
  • Anaesthetic complications
  • Paralysis (very rare)

Alternatives to spinal fusion surgery

Here at Scoliosis SOS, we have had success in treating patients who have been diagnosed with severe scoliosis (40-50 degrees and over) with our non-surgical, exercise-based ScolioGold programme. If you’re worried about some of the potential long-term side effects of spinal fusion surgery, and you’d like to try non-surgical treatment first, be sure to get in touch with us.  

Spinal fusion recovery

If, however, you have already undergone surgery but are still experiencing some pain, our physical therapy programme can still help you.

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Spine segment

What is a spinal osteotomy?

A spinal osteotomy is a surgical procedure used to correct deformities in the spine. Here, bone is removed from the back of the vertebral arch to correct long, gradual curves of kyphosis like those produced by Scheuermann’s kyphosis or ankylosing spondylitis. The majority of procedures that treat spinal deformities are types of osteotomy. These include posterior column osteotomy (PCO), pedicle subtraction osteotomy (PSO) and vertebral column resection (VCR).  

When is a spinal osteotomy performed?

Proper spinal alignment is important for pain-free functioning of the spine. The slight lordosis of the neck and lumbar (lower) spine are balanced by a slight kyphosis of the thoracic (upper) spine. These curves work in harmony to keep the body’s centre of gravity aligned over the pelvis. A reduction in lordosis in the lower region of the spine (also known as flatback syndrome) or an excess in kyphosis in the upper region of the spine (known as hyperkyphosis) results in spinal misalignment. This is called sagittal imbalance and can cause fatigue, pain and compression of organs such as the heart and lungs. During a spinal osteotomy, the surgeon removes a wedge-shaped section of bone from the back of the spine. Closing this wedge either adds lordosis or reduces kyphosis. This disc in front of the removed bone must accommodate the new position of the bones, so a spinal osteotomy requires a flexible disc between the target vertebrae. A surgeon assesses spinal flexibility during the creation of a treatment plan. If the discs cannot support a spinal osteotomy, other surgical options may be considered instead. A PCO usually provides a patient with 10-20 degrees of correction, but this procedure is often performed at multiple spinal levels. Depending on where and how much correction is needed, a series of PCOs can ‘add up’ to the desired correction.  

How is a spinal osteotomy performed?

A spinal osteotomy is conducted under general anaesthetic, meaning the patient is unconscious. They are placed face-down on the operating table, where the surgeon makes an incision over the spine to expose the bones in the spinal column. The surgeon then places screws into the vertebrae above and below the area from which the bone is to be removed. The heads of the screws are designed to hold rods. At the end of the surgery, the surgeon will insert rods that immobilise the spine while it heals in its new position. Next, the surgeon removes bony projections that extend from the back of the vertebrae. The surgeon then removes sections of bone called the lamina at the back of the vertebrae and portions of facet joints between the vertebrae that will be realigned. It is then time to realign the vertebrae. Here, the surgeon manipulates the patient’s spine into a new position, using implants to obtain the desired correction. Once alignment has been achieved, the surgeon inserts rods into the screws that were placed at the beginning of the surgery. The role of the rods is to hold the bones of the spine in the position achieved during the surgery while they heal. After this, the surgeon will apply bone graft or transplanted bone over the vertebrae. The bone graft will fuse with the vertebrae, forming one solid bone. Achieving good bone fusion is vital for long-term stability.  

What to expect after a spinal osteotomy

Once the spinal osteotomy procedure has been successfully completed, you may have a number of questions. Let’s answer several common post-osteotomy questions right now:

How long will I have to stay in the hospital?

Patients typically stay in the hospital for 5-7 days after their spinal osteotomy procedure.

Will I need to wear a brace or collar?

Sometimes surgeons may prescribe a brace or collar if the osteotomy was performed in the neck. If performed on the spine, this is less common.

Will I have to take any medication?

If any discomfort is experienced after the spinal osteotomy, pain relief medication may be prescribed.

How long before I can exercise again?

You can begin to walk as soon as you’re comfortable to do so. More rigorous forms of exercise will have to wait until later on in the healing process.

Will I require any form of rehab or physical therapy?

Yes, physical therapy will be a part of your recovery process.

Will spinal osteotomy cause any long-term limitations?

As a result of your fusion, you may experience some decreased mobility; however, this all depends on your particular procedure.  

How can Scoliosis SOS help?

If you have undergone a spinal osteotomy procedure and your doctor recommends participating in physical therapy as part of your recovery plan, we at the Scoliosis SOS Clinic can help! We offer world-renowned physical therapy that helps to increase the spine’s range of motion and strengthen the muscles in your back, helping you to resume regular activities as soon as possible. Our ScolioGold method combines the well-known Schroth method with other proven therapy techniques to help speed up your spinal osteotomy recovery.

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