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Scoliosis

scoliosisScoliosis is a side-to-side curvature of the spine. It can be caused by congenital, developmental or degenerative problems, but the vast majority of cases of scoliosis actually has no known cause.

By far the most common form of scoliosis is idiopathic scoliosis which develops in adolescents and progresses mostly during the adolescent growth spurt. The cause of idiopathic scoliosis is unknown (idiopathic literally means “cause unknown”).

Scoliosis usually develops in the thoracic spine (upper back) or the thoracolumbar area of the spine, which is between the thoracic spine and lumbar spine (lower back). It may also occur just in the lower back. The curvature of the spine from scoliosis may develop as a single curve (shaped like the letter C) or as two curves (shaped like the letter S).

It is important to note that scoliosis is not typically a cause of back pain. The condition represents a deformity of the spine but is usually not painful.

Idiopathic scoliosis is a relatively common disorder and affects approximately 1 in 1,000 adolescents. It’s categorized into three age groups, from birth to 3 years old (infant), from greater than 3 to 9 years old (juvenile), and from greater than 9 to 18 years old (adolescent). This last category accounts for 80 percent of the cases. Girls tend to be affected slightly more often than boys. More importantly, girls are eight times more likely to need treatment for scoliosis, because they tend to have curves that are much more likely to progress. For both boys and girls, the risk of curvature progression is increased during puberty, when the growth rate of the body is the fastest.

Scoliosis is a term used to describe a condition, but is not a disease, or a diagnosis. Because idiopathic scoliosis is considered a deformity, treatment is largely centered on reducing or limiting the progression of the deformity and is not focused on treatment of pain.

Diagnosis

Many cases of idiopathic scoliosis are diagnosed using the Adam’s forward bend test. Students are routinely given this examination in school to determine whether or not they may have scoliosis. A physician may also perform this test as part of a routine physical. The test involves the patient bending forward with arms stretched downward, while being observed by a healthcare professional. If a “rib hump” or asymetry is seen, or if the shoulders are different heights, scoliosis may be suspected. If so, an x-ray may be ordered to determine the degree of severity of the curve. In rare cases, especially if the scoliosis may be causing a problem for the neurological functions of the spinal cord, an MRI may be ordered so the physician can get a better look at the situation. A diagnosis of scoliosis does not mean the activity level of the individual should be restricted, since activity does not affect the degree of the curve.

Treatment for scoliosis is based on the skeletal maturity of the patient, that is, how much more the patient is expected to grow, as well as on the degree of curvature. The younger the patient and the bigger the curve, the more likely the curve is to progress. For patients with idiopathic scoliosis, there are three options for treatment. These options are observation, bracing, and surgery. Many other forms of treatment have been tested, including electrical stimulation, physical therapy, and various manual manipulation techniques, but none have been proven to be effective.

Conservative (non-surgical) treatments

The degree of curvature is measured on x-rays by what is known as the Cobb method, and this is accurate to within 3 to 5 degrees.

In cases of curves that are less than 10 degrees, there is very little chance of the condition getting any worse. In fact this isn’t even considered to be scoliosis, but instead is spinal asymmetry. Most of the time these cases won’t require any treatment, but at regular physician check-ups throughout childhood the physician should determine whether or not the curvature has progressed at all.

Curves that are 20 to 30 degrees in a growing child should be checked every 4 to 6 months to see if they are worsening. Any curves over 30 degrees in a growing child will require treatment, usually in the form of a back brace. Using a brace is intended to stop the growth of a curve, but will not correct the degree of curvature that already exists. The use of the brace is discontinued when the child stops growing.

Patients with curves of greater than 50 degrees sometimes continue to progress after the child’s growth has stopped. Therefore the objective of any treatment is to get the child into adulthood with less than a 50 degree curvature.

There are two types of commonly used braces. One is worn almost all day and night, but can be taken off for swimming or playing sports. This brace applies three-point pressure, and prevents the progression of the curvature. The other applies more pressure and bends the child against the curve. It is worn only at night while the child is sleeping.

Unfortunately, some curves continue to progress even with appropriate bracing. This may lead to the child needing more aggressive, surgical treatment. In some cases the physician will continue bracing the spine for a period of time, to allow the child to grow more before moving to the surgery option, which fuses the spine.

Surgical treatments

For patients with a 40 to 45 degree curve that is still progressing, or a curve of 50 degrees or more, surgery will likely be recommended. The objective is to fuse the spine in a more corrected position so that the curve will not continue to progress into adulthood. In addition to preventing further curvature, scoliosis surgery can also reduce the amount of deformity. Rods, cables, screws and hooks are used to move the spine back into the proper position, and when the spine fuses with the bone grafts it no longer moves out of place. Although the rods can be removed once the spine has fused, there is usually no reason to do so. Typically a correction of about 50% can be obtained with this method.

Patients should be regularly monitored for the first year or two. Once the bone is solidly fused there is no need for further treatment. In general, patients undergoing this surgery can return to a normal lifestyle and activity level.

For a full range of information and illustrations on the back and spine, see www.spine-health.com.

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