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Know the Warning Signs of Scoliosis, as The Handmaid's Tale's Mckenna Grace Reveals Diagnosis

Surgeons explain what scoliosis is and signs that indicate you have it. 
FACT CHECKED BY Emilia Paluszek

Mckenna Grace is no longer staying silent about having scoliosis. The Handmaid's Tale actress was diagnosed with the condition four years ago when she was just 12 and recently shared she had surgery a few weeks ago. "I tried to be private about it," she tells The Hollywood Reporter. "Back when I had my back brace while filming Ghostbusters: Afterlife, there wasn't a lot of hiding a big old clunky, massive back brace. But for the most part, I kind of just kept it to myself." She added, "I like to keep my personal life a little bit more personal so that I can have a childhood and figure myself out as a teenager. So it's a little bit weird to put these deeply personal thoughts and struggles out into the world. But, hopefully, by telling my struggles with my surgery and spine and with my song, I'm hoping that maybe people who are going through the same thing will feel less alone. I guess it's important to show that it doesn't really matter how it looks on the outside, that everybody still goes through a lot of struggles in our lives."

In the interview with THR, the 16-year-old revealed how she realized she had scoliosis. "My dad is a surgeon. I'm a very affectionate person, so I hug my parents a lot, and whenever I would hug him, he would feel my back and my spine, and he would tell me my back felt weird. And then I didn't go to school, and in school, they give you scoliosis exams, and so my dad did one on me and he was like, "Oh yeah, that's you." And then it just progressively got worse."

Grace has been recovering from the surgery she had in October and explained, "I'm starting to get back to my regular activities. I want to get in shape now that I've fixed my spine because I didn't realize just how much my spine was hindering me. I would work out six days a week and make zero progress. I would do everything as hard as I could for months, and I would be like, "Why am I not seeing results?" I think it was a lot of my mind frame but also post-spine surgery I feel like I look the best I ever have in my body even though I have not worked out in months. I guess that's just how much my spine was bothering me. I feel like a new person. It's crazy."

Eat This, Not That! Health spoke with experts that have not treated Grace, who explain what to know about scoliosis and signs to look out for.  Read on—and to ensure your health and the health of others, don't miss these Sure Signs You've Already Had COVID.

1

What to Know About Scoliosis

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Jonathan J. Rasouli, MD Director, Complex and Adult Spinal Deformity Surgery for the department of Neurological Surgery at Staten Island University Hospital tells us, "Scoliosis is basically a malalignment of the spine. It's a common condition that can affect people of all ages, but most often seen in adolescents and adults with severe osteoporosis. Fortunately, most cases are asymptomatic, but sometimes people can develop pain or might be concerned with their body image. For these reasons, patients often require multi-disciplinary treatments and possibly an evaluation by a spinal surgeon. There are many support groups such as Scoliosis Warriors and Bent Not Broken on social media that are fantastic sources of information, education, support, and awareness. If you or a loved one are diagnosed with scoliosis, I would highly recommend you check them out." 

Dr. Nick Ghazarian, Director of Minimally Invasive Spine Surgery at Dignity Health Glendale Memorial Hospital and private practice explains, "Scoliosis refers to the sideways curvature of the spine.  There are different types of scoliosis, the most common being diagnosed during childhood when children go through periods of rapid growth.  Scoliosis is linked to genetics and is more common in females.  Often, scoliosis is diagnosed at school or by family members who notice differences in shoulder height."

Dr. Ali Mesiwala, Director of Neurosurgery at Dignity Health St. Bernardine says, "Scoliosis means an abnormal lateral curvature of the spine. This is often referred to as a twisted spine, rather than a bent over spine. There are three broad categories of scoliosis: early-onset, adolescent, and adult/degenerative. In early onset scoliosis, the child is between the ages of birth to eight years. It can be subdivided into infantile (birth to 3 years) and juvenile (3 to 8 years). In some cases, the cause of the scoliosis is idiopathic, or unknown, and not associated with other medical conditions. In many cases, early onset scoliosis is often accompanied by other health issues, such as chest wall deformities, neuromuscular diseases such as spina bifida or cerebral palsy, and other factors such as benign or malignant spinal tumors. In these severe cases, surgical correction or the deformity and other medical issues are required."

2

This is Who is at Risk

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Dr. Rasouli explains, "We most often see scoliosis in adolescents (adolescent idiopathic scoliosis) and older adults with osteoporosis (adult spinal deformity). We do not quite yet know the cause, but it is likely due to a combination of genetics and external environmental factors. We do tend to see scoliosis more commonly in women. Adolescent scoliosis is generally diagnosed in individuals between the ages of 10-18. If recognized early enough, non-surgical treatments such as bracing can be very effective and stop curve progression. Therefore, mandatory scoliosis screening is performed in many elementary schools across the United States so we can catch it early and get patients treated."

Dr. Ghazarian says, "McKenna Grace likely was diagnosed with adolescent idiopathic scoliosis, which is generally diagnosed in children between 10 and 18 years of age and tends to favor females. The cause of this type of scoliosis is multifactorial, which means many factors, including genetics, may cause it. The size of the curve is measured in degrees, and the patient's skeletal maturity, or how much growth they have left, determines the treatment.  Scoliosis tends to worsen with time, so patients need to be monitored by a specialist."

Dr. Mesiwala adds, "Adolescent idiopathic scoliosis occurs in children during the adolescent growth spurt, a time when growth is fairly rapid. It affects approximately 2-3 % of children in the US. In many cases the abnormal curvature of the spine is stable, and does not progress substantially. And in some children the curve progresses and becomes more severe over time. Severe and progressive curvature, for unknown reasons, occur more frequently in girls than boys." 

3

Adult or Degenerative Scoliosis

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Dr. Mesiwala explains, "In adult or degenerative scoliosis, patients typically develop a twisted spine as a result of age-related wear and tear in the spine, trauma, previous spine surgery, or progression of untreated idiopathic scoliosis as an adolescent. Its prevalence increases with age. Many adults do not have symptoms until age-related degeneration causes additional stress and strain on the spine. In these cases, early symptoms include low back pain and stiffness. Progression of wear and tear can result in numbness, cramping and shooting pain in the legs due to pinched nerves. Fatigue often results from strain of the muscles of the lower back and legs, and the constant attempt to achieve a correct posture when the spine is twisted in such a way to not allow normal functioning. 

Medical evaluation in adults includes a comprehensive physical examination, standing x-rays of the entire spine, as well as CT and MRI imaging to further define anatomy. Treatment options include over-the-counter pain relievers, physical therapy, and injections such as epidurals or nerve blocks. Operative treatment can range from simple operations designed to relieve a pinched nerve, to major operations designed to correct the deformity and achieve a normal alignment of the spine. Deformity correction operations in adults are generally more invasive and lengthy than those performed on adolescents, and post operative recovery can be more variable, complicated, and unpredictable."

4

How Scoliosis Can Affect Daily Life

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According to Dr. Rasouli, "In most cases, scoliosis does not have major symptoms and does not create a significant impact in a person's daily life. However, some patients can develop back pain and might be unhappy about their body appearance as a result of the scoliosis. In severe cases, patients can develop limb-length discrepancies, short stature, or difficulty walking due to spinal cord compression. As if being a teenager was tough enough, scoliosis only makes it harder. In some cases, it can be nearly impossible to work and do normal activities. This is why we try to diagnose it early and start treatment to prevent it from getting really bad."

Dr. Ghazarian explains, "A majority of the time, scoliosis does not significantly limit one's ability to work or stay active.  However, for patients with large degrees of scoliosis, it may substantially affect their quality of life.  Patients diagnosed with scoliosis are more likely to complain of back pain than patients without scoliosis."

Dr. Mesiwala says, "The extent to which scoliosis affects daily life depends on the severity of the curvature, whether it causes substantial pain, postural and walking difficulties, breathing problems, or neurological issues such as weakness and sensory loss. Rarely, loss of bladder and bowel control can occur."

5

Treatment Options

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Dr. Rasouli states, "Fortunately, there are many treatment options available for individuals with scoliosis. In adolescents, the gold standard treatments are close follow-up with a scoliosis specialist and dedicated physical therapy. In patients who are candidates, bracing is also an option as well. When symptoms and scoliosis progression are severe, or patients are concerned about cosmesis, surgical correction may be necessary. The most common surgical treatments are spinal fusion, vertebral body tethering, and placement of growing rods. These help to realign and stabilize the spine to facilitate normal growth and posture. Many  treatment options exist and should be discussed with a scoliosis surgeon."

According to Dr. Ghazarian  "A common misconception is that a back brace is always required for patients with scoliosis.  In fact, bracing is generally only recommended in a small group of young patients who are still growing. Physical therapy is the most prescribed treatment and focuses on muscular balance, strengthening weak muscles, and loosening tight ones.  Physical therapy is an important factor in the lives of patients with scoliosis.  Also, maintaining a healthy weight may help avoid symptoms. Many factors influence whether someone with scoliosis needs surgery.  Surgery is generally recommended to straighten large spinal curves and halt the worsening, which tends to occur over time.  There are various techniques surgeons use to straighten the spine, the most common being a spinal fusion.  This is a procedure where surgeons attempt to realign the vertebrae using metal rods and screws, allowing the bones of the spine to fuse together in a straighter alignment.  Most patients can return to noncontact sports by about 4-6 months after surgery. Spine surgery continues to advance with technological advances allowing us to treat patients with less invasive procedures."

Dr. Mesiwala says, "Once a child is identified as having scoliosis, routine x-rays performed every six months can be used to assess the curvature, and in most cases, if the curve does not progress substantially, does not require surgical treatment. As long as the curvature is well balanced, is less than 45°, does not cause substantial asymmetry or postural problems, and does not result in physical limitations, surgery is not required. In most cases, kids with scoliosis have no symptoms, lead a normal life, and never undergo any treatment. Some children benefit from physical therapy and bracing, although a brace must be used for more than 20 hours a day and be fit appropriately in order to make a substantial difference in the progression of the curvature. Any child with severe pain, substantial postural and mobility issues, difficulty breathing, or loss of neurological function should have medical evaluation of their scoliosis. Surgical correction of the abnormal curvature is often performed once the scoliosis has progressed substantially, oftentimes beyond 45°, or causes severe pain, neurologic problems, pulmonary issues, or other physical limitations, or impairment in function. In addition, even if the child is asymptomatic but has a substantial deformity, surgery is performed in order to prevent further problems in adulthood. The outcomes of adolescent scoliosis surgery are generally quite good, and full recovery is the norm."

6

A Doctor's Personal Experience with Scoliosis

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Dr. Mesiwala shares, "While many people in the community are familiar with scoliosis, and screening is common in school, having a child diagnosed with scoliosis can be quite alarming. It can be terrifying learning that your child has a twisted spine, especially when they seem perfect, healthy, and have no complaints. In most cases, regular doctor appointments and monitoring is all that is needed. In cases where the curvature progresses, and the child remains healthy without symptoms, the dilemma is whether to surgically intervene or not. 

As a neurosurgeon, who routinely performs these operations on adolescents and adults, I am very familiar with the goals, benefits, and risks of surgery, and the alternatives. Nonetheless, when my daughter was diagnosed with scoliosis as an 11-year-old, and her curve rapidly progressed over a year, our family had a tough decision to make. Our daughter's curve was nearly 45°, and consisted of both a thoracic and lumbar component. Fortunately, we felt that by correcting her thoracic curvature her lumbar component would realign itself and her long-term outcome would be excellent. She underwent surgery before the age of 13, had her operation performed at the end of her summer break, and was able to return to school on the first day of school. 

She recovered quite quickly, as most adolescents do, and returned to full functioning within six months on an unrestricted basis. She was able to have a successful high school career in competitive athletics, went to college without any difficulties, pursued all of her interests without restriction, and has no long-term effects from her operation. The only evidence that she had surgery is a faint midline scar along her back, and x-rays which prove that she has instrumentation in her spine. With proper counseling and guidance, most children who undergo treatment for scoliosis will be totally normal and have no long term consequences from their scoliosis."

Heather Newgen
Heather Newgen has two decades of experience reporting and writing about health, fitness, entertainment and travel. Heather currently freelances for several publications. Read more about Heather
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