What
is scoliosis?
Scoliosis is a lateral (toward the side) curvature in
the normally straight vertical line of the spine. The normal spine curves
gently backward (kyphosis) in the upper back and gently inward in the
lower back (lordosis). When a person with a normal spine is viewed from
the side, a mild roundness is normally present in the upper back and a
degree of swayback is present in the lower back. When a person with a
normal spine is viewed from the front or back, the spine appears to be
straight. When a person with scoliosis is viewed from the front or back,
the spine appears to be curved.
Is
scoliosis a recently discovered condition?
No,
scoliotic spinal deformities have been depicted in the cave art of the
Stone Age. Hippocrates, the father of medicine who lived in Greece around
400 B.C., is credited with coining the term "skoliosis" to describe this
spinal abnormality. While the condition has been around for thousands of
years, it was not until this century that effective surgery (1914) and
effective bracing (1946) were first performed. Our ability to treat the
condition has made dramatic advances even in the last 10 years.
What
causes scoliosis?
There
are many types of scoliosis and many causes for curvature. Congenital
scoliosis is a result of a bone abnormality which is present at birth.
Neuromuscular scoliosis is a result of abnormal muscles and/or nerves and
is frequently seen in patients with spina bifida, cerebral palsy or those
with various paralytic-type conditions. Degenerative scoliosis may result
from traumatic bony collapse, previous major back surgery or osteoporosis.
Certain types of spinal cord abnormalities can also cause scoliosis. The
most common type of scoliosis, called idiopathic scoliosis, has no
specific identifiable cause. Many theories have been formulated but none
have found to be all-encompassing. There is, however, definitely a strong
genetic link in idiopathic scoliosis.
Many signs of
scoliosis can be physically noticed in a person and may include the
following:
·Difference in shoulder height when
standing
·Prominence in one part of the back
of the chest (thorax)
·Prominence in the lower back when
standing or bent over
·Appearance of an S-shaped curve in
the back while standing
Who is
affected by scoliosis?
The
prevalence of scoliosis in the American population at age 16 is 2 to 3%.
Less than 0.1% have curves measuring greater than 40 degrees, which is the
magnitude of curvature when surgery becomes a consideration. Girls are
affected overall 3.6 times more commonly than boys. Girls with curves over
30 degrees outnumber boys ten to one. Idiopathic scoliosis is most
commonly a condition of adolescence affecting ages 10 through 16.
Idiopathic scoliosis may progress during the "growth spurt" years, but
usually will not progress in adulthood in most cases.
How is
scoliosis diagnosed?
Most
curves are initially detected on school scoliosis screening exams, by a
child's pediatrician or family doctor, or by a parent when summer swim
season (bathing suit time) starts. The diagnosis of scoliosis and the
determination of the type of scoliosis is then made by a careful
orthopaedic exam and an x-ray to evaluate the magnitude of the curve.
What is
the treatment for scoliosis?
The
majority of adolescents with idiopathic scoliosis are observed at regular
intervals (usually every 4 to 6 months) by a physical exam and a low
radiation x-ray. Bracing is the usual treatment choice for adolescents who
have a spinal curve over 25 to 30 degrees - particularly if their bones
are still maturing and if they have at least two years of growth
remaining. Those who have or develop curves beyond 45 to 50 degrees are
often candidates for surgery.
What do
bracing and surgery do for the curvature?
The
purpose of bracing is to halt progression of the curve. It may provide a
temporary correction but usually the curve will assume its original
magnitude when bracing is eliminated. Surgery utilizes metallic implants
to correct some of the curvature and hold it in the correct position until
bone graft placed at the time of surgery consolidates and creates a rigid
fusion in the area of the curve.
In recent
years, effective minimally invasive surgery has also been used to treat
scoliosis. This surgery eliminates painful, abnormal motion, reduces nerve
irritation and increases function in most patients. A thin, telescope-like
instrument called a laparoscope, and spinal cages (hollow, metal
cylinders) are placed between the vertebrae through puncture incisions in
the abdomen to fuse the spine. Most patients having this surgery can leave
the hospital in 2-3 days.
Do
electrical stimulation, exercise programs or manipulation help?
Many
studies have shown that electrical stimulation, exercise programs and
manipulation are of no benefit in preventing the progression or "curing"
scoliosis. Patients should be encouraged to be active and stay fit,
however. Like many other disorders, understanding and education about
scoliosis is the most important tool with which to manage and prevent
complications
