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Scoliosis is a three-dimensional curvature of the spine
that is most commonly found in adolescent girls, although
both sexes and people of any age can develop the condition.
Unlike a straight spine, where the vertebrae face forward,
with scoliosis some of the vertebrae are twisted in
a curved spine. Scoliosis generally has either a single
C-shaped curve or a double S-shaped curve.
Adolescent Idiopathic Scoliosis:
About one in every 10 adolescents has scoliosis to some
degree, according to the Scoliosis Research Society.
Many of these cases are mild; others require wearing
an orthotic brace or having corrective surgery. Girls
are more likely than boys to develop severe scoliosis.
Doctors believe there is a correlation between puberty
and scoliosis: Spinal curvatures often do not appear
until a child enters the teen years, and it is not uncommon
for curves to significantly progress during his or her
last major growth spurt. Once a child has stopped growing
and reached skeletal maturity, it is unlikely that curvatures
will become larger.
Adult Idiopathic Scoliosis:
Adults 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.
In adult idiopathic scoliosis, curves less than 30 degrees
rarely progress, while curves greater than 50 degrees
are frequently problematic. Surgery is usually reserved
for patients with large (greater than 50 degrees) curves,
progressing curves, or who have chronic back pain.
Other Types of Scoliosis:
About 20 percent of scoliosis cases are associated with
other conditions (neuromuscular, connective tissue disorders,
chromosomal abnormalities). The approach to treatment
is often different in these cases than it would be for
idiopathic scoliosis. The curve patterns tend to be
different, and there are other factors to consider.
For example, one of the goals of scoliosis surgery is
to preserve the maximum amount of spinal mobility, and
thus, the shorter the length of rod placed alongside
the backbone, the better. But for a muscular dystrophy
patient with poor muscular control, the supporting rods
may run the entire length of the spine.
Other Spinal Deformities:
Two other types of spinal curvature are lordosis
(swayback) and kyphosis (roundback). Sometimes people
generalize and refer to these conditions as scoliosis,
but they have unique characteristics. Scoliosis is a
sideways curve of the spine; lordosis is a forward curve
of the spine; and kyphosis is a hump-like, backward
curve of the spine. With physical examination, medical
history, X-ray, and curve measurement, a doctor can
determine what type of curvature a person has and how
to proceed with treatment.
Diagnosing Scoliosis
Fortunately, most cases of scoliosis-a three-dimensional
curvature of the spine-are not painful and, when diagnosed
at early stages, require minimal treatment. While a
pediatrician or family doctor may make an initial diagnosis,
scoliosis patients frequently are referred to an orthopedic
spine specialist or a neurosurgeon for specialized care.
Some patients need only to be observed at regular
intervals by a physician; for others, wearing a brace
can slow the progression of the condition. When the
curvature is severe, surgery is often the recommended
treatment plan.
The earlier scoliosis is detected, the better. That
is why many schools include scoliosis screenings as
part of the physical examinations they provide to students.
The American Academy of Pediatrics recommends scoliosis
screenings at ages 10, 12, 14, and 16.
Physical clues that healthcare practitioners look
for include: an uneven waistline; a prominent shoulder
blade; one shoulder appearing higher than the other;
a rib "hump", elevated hips; leaning to one
side; rounded shoulders; and an excessive "swayback."
Ultimately, an image must be made of the spine for
a specific diagnosis. Usually X-rays suffice, but sometimes
computerized tomography (CT) scan or magnetic resonance
imaging (MRI) are used to capture the image.
The doctor can determine the degree of curvature from
the X-rays. People with straight spines have a 0 degree
curvature; at the other end of the spectrum are people
with severe scoliosis, indicated by a curvature of 60
degrees or more.
Determining the Course of Treatment
It is extremely important for patients to consult
with a trained physician to determine the course of
treatment that is best for their individual needs. The
degree of curvature is an important factor when it comes
to scoliosis treatment options, and may be a consideration
when developing a treatment plan.
- Curvature of 10 degrees or less: This slight curvature
is considered to be within a normal range, making
treatment unnecessary.
- Curvature between 10 degrees and 20 degrees: These
curvatures may warrant monitoring by a physician.
If the patient is in his or her growing years, the
curvature could become more severe over time. No additional
follow-up is need for patients in this range when
skeletal growth is complete.
- Curvature between 20 degrees and 45 degrees: Wearing
an orthotic brace can stop the progression of the
curvature, but not cure it.
- Curvature exceeding 45 degrees: Surgery is the recommended
treatment for curvature of this severity.
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Scoliosis
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