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What is scoliosis?
Scoliosis is a three-dimensional
curvature of the spine. Idiopathic scoliosis, which
means there is no known cause for the condition, applies
to about 80 percent of all cases. The other 20 percent
are caused by disorders such as cerebral palsy, muscular
dystrophy, and Down syndrome or even tumors along the
spine. Scoliosis tends to run in families, and its most
common form-adolescent idiopathic scoliosis-becomes
apparent at puberty. However, scoliosis can affect people
of all ages.
Can
anything be done to prevent scoliosis?
While scoliosis is believed to have
a genetic base-that is, it tends to run in families-it
does not occur because of something the mother did or
did not do during the pregnancy. Also, scoliosis is
not caused by carrying heavy backpacks or by poor posture.
At this time, there are no preventive measures that
can be taken. Early detection of scoliosis, however,
is important.
What
are the symptoms of scoliosis?
Scoliosis is usually a painless
condition, but there may be back pain or headache. More
often, there are visual "clues": uneven shoulders
or waistline; a prominent shoulder blade; a hump at
the rib area; uneven hem line on dresses and pants;
and leaning to one side.
How
is scoliosis diagnosed?
The earlier scoliosis is diagnosed,
the better, and that is why many schools conduct scoliosis
screenings. A screening is not a definitive diagnosis,
but an indicator as to whether the child needs further
examination by a physician. The American Academy of
Pediatrics recommends scoliosis screenings be performed
at ages 10, 12, 14, and 16.
Medical history, physical examination,
X-ray imaging, and measurement of the spine's curvature
all factor into a diagnosis. The diagnosis indicates
the type of scoliosis a patient has, how large the curvature
is, and the angle of trunk rotation. From there, the
doctor will recommend a treatment plan of observation,
orthotic bracing, or surgery.
What
are the treatment options for scoliosis?
Mild cases of scoliosis (curvature
of less than 20 degrees) can be followed over time with
X-rays and physical examination by a doctor. In more
advanced cases, where the curvature is between 25 and
40 degrees, an orthotic brace can be worn by to stop
a curve from getting worse. Bracing is most commonly
used for patients with adolescent idiopathic scoliosis
who still are actively growing.
Surgery may be recommended for a
variety of reasons. Sometimes a child's scoliosis is
not detected until the curvature is past 40 degrees.
It may be that bracing has not successfully contained
a curve, whether because a patient did not wear the
brace as instructed or because of other factors. An
adult with scoliosis may be treated surgically because
of chronic back pain or compromised lung or heart function.
What
does surgery to correct scoliosis involve, and what
are some of the risks?
Bone is taken from another part
of the patient's body and then grafted onto vertebrae.
The bone graft literally acts as cement that may take
months to fuse or "harden." To stabilize the
fusion and hold the vertebrae in place during this time
period, two stainless steel rods are attached to the
spine with hooks and wires or pedicle screws.
Some of the risks of surgery include
blood loss, infection, complications associated with
anesthesia; and damage to the spinal cord. The risk
for nerve damage is low, at about 1 percent, and more
commonly occurs in adult scoliosis surgery. In the months
and years after surgery, there is the possibility of
dislodged hooks; disc degeneration resulting in back
and leg pain; and pseudoarthrosis, when a fusion doesn't
heal properly and a false joint develops at that site.
What
is adult idiopathic scoliosis?
Much attention is focused
on teenagers with scoliosis because the growth of curves
tends to coincide with puberty. Once a person's skeletal
growth is complete, most spinal curvatures stop growing,
also. However, people past their growing years still
can be affected by scoliosis. It may be that a mild
scoliosis went untreated when the adult was younger,
or that osteoporosis (thinning of the bone) has caused
a curve to become worse.
Unlike scoliosis in children, adult
scoliosis is often painful. In severe cases, it can
affect breathing and the way the heart functions. Treatment
includes non-invasive techniques to control pain, such
as medication, physical therapy, and exercise, as well
as surgery. However, surgery usually is reserved for
patients with large (greater than 50 degrees) or progressing
curves or those with chronic back pain.
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About
Scoliosis
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