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Scoliosis Causes and Risks:
Scoliosis may occur by itself, or in combination with kyphosis (the condition is then called kyphoscoliosis).
Scoliosis may occur in 3 ways: as a congenital condition noticed at birth usually related to a defect in the vertebrae or fused ribs; as a paralytic or musculoskeletal disorder resulting from paralysis of the muscles due to polio , cerebral palsy , or muscular dystrophy ; or idiopathic (of unknown cause) that appears in a previously straight spine.
An idiopathic disorder is the most common form and may have a genetic cause. Most cases occur in girls and become apparent during the rapid growth phase of puberty (there are infantile and juvenile forms). Scoliosis may be suspected when one shoulder appears to be higher than the other, or parents and friends may notice nothing. Routine scoliosis screening is now done in junior high school/middle school and many very early cases are detected that previously would have gone unnoticed until they were more advanced.
There may be fatigue in the spine after prolonged sitting or standing. Pain will become persistent if irritation of ligaments results. As the spine curves laterally, a compensatory curve may develop to maintain balance. The greater the initial curve of the spine, the greater the chance for progression of the condition after growth is complete. Severe scoliosis (curves in the spine greater than 60 degrees) may cause respiratory problems.
Prevention:
There is no known prevention.
Symptoms:
Note: Kyphoscoliosis also involves abnormal front-to-back curvature, with a "rounded back" appearance. See kyphosis .
Signs and Tests:
In a physical examination , the curvature is usually more pronounced when bending forward.
Tests may include - spine X-rays taken in several positions
- scoliosometer measurements (a device for measuring the curvature of the spine)
Treatment:
The treatment is determined by the extent of the deformity and the stage of bone growth (how near the growth centers are to closure). Many scoliotic curves require no treatment (less than 30 degrees) but should be followed in 6-month intervals. Alternatives include observation, exercise , a back brace, surgery, or a combination of alternatives. The treatment is most successful when it is started early.
Exercises to strengthen torso muscles may prevent curve progression in mild cases (a curve of less than 30 degrees).
The Milwaukee brace or body shells are effective in controlling progression of the scoliosis but must be worn for long periods of time. A back brace does not reverse the curve. The spine is strengthened by the brace from asymmetric pressure, and can be adjusted with growth. The brace is usually worn until bone growth has stopped in late adolescence. A spinal curve of 30 to 50 degrees can be managed with a brace and exercises.
A spinal curvature of 40 degrees or greater usually requires surgery to correct the curvature since curvature to this degree progresses even after bone growth stops. Surgical procedures include placement of a metal rod (Harrington rod) that prevents progression of the curvature but restricts spinal mobility. A brace may be required after surgery to stabilize the spine.
The limitations imposed by the treatments are often emotionally difficult and may threaten self-image, especially of teenagers. Emotional support is important for adjustment to the limitations of treatment. Physical therapists and orthotists (orthopedic appliance specialists) can be helpful in explaining the treatments and ensuring a comfortable fit of the brace to increase the compliance with the treatment plan.
Support Groups:
The stress of illness can often be helped by joining a support group where members share common experiences and problems. See scoliosis - support group .
Prognosis:
The outcome depends on the location and severity of the curve. The greater the curve, the greater the chance of progression after growth has stopped. Untreated scoliosis may result in heart and lung problems due to decreased lung capacity, back pain , physical deformity, degenerative arthritis of the spine, and sciatica .
Complications:
Emotional problems or lowered self-esteem may occur as a result of the condition or its treatment.
Call Your Healthcare Provider:
Call for an appointment with your child's health care provider if you suspect that he or she may have scoliosis.
Abnormal curvature in the spine is known as scoliosis, and generally begins just at the onset of puberty and progresses during the period of rapid growth. Most junior high schools routinely screen for scoliosis because, if caught early, progressive spine curvature can be prevented. Scoliosis affects girls much more frequently than boys.
The spine is divided into several sections. The cervical vertebrae make up the neck. The thoracic vertebrae comprise the chest section and have ribs attached. The lumbar vertebrae are the remaining vertebrae below the last thoracic bone and the top of the sacrum. The sacral vertebrae are caged within the bones of the pelvis, and the coccyx represents the terminal vertebrae or vestigial tail.
Lateral curvature of the spine, scoliosis, is a relatively common condition. The majority of individuals with scoliosis do not require surgery or braces because their condition is self-limiting. Progressive scoliosis, however, requires therapy. The "S" shaped curve is usually more apparent on an X-ray.
Lateral curvature of the spine, scoliosis, is a relatively common condition. The majority of individuals with scoliosis do not require surgery or braces because their condition is self-limiting. Progressive scoliosis, however, requires therapy. The "S" shaped curve is usually more apparent on an X-ray.
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