SCOLIOSIS

SCOLIOSIS

Scoliosis is a disorder that causes an abnormal curve of the spine, or backbone. The spine has normal curves when looking from the side, but it should appear straight when looking from the front. Kyphosis is a curve in the spine seen from the side in which the spine is bent forward. There is a normal kyphosis in the middle (thoracic) spine. Lordosis is a curve seen from the side in which the spine is bent backward. There is a normal lordosis in the upper (cervical) spine and the lower (lumbar) spine. People with scoliosis develop additional curves to either side of the body, and the bones of the spine twist on each other, forming a "C" or an "S" shape in the spine.

Scoliosis is about two times more common in girls than boys. It can be seen at any age, but it is most common in those over about 10 years of age. Scoliosis is hereditary in that people with scoliosis are more likely to have children with scoliosis; however, there is no correlation between the severity of the curves from one generation to the next.

What causes scoliosis?

Scoliosis affects about 2% of females and 0.5% of males. In most cases, the cause of scoliosis is unknown (known as idiopathic). This type of scoliosis is described based on the age when scoliosis develops, as are other some other types of scoliosis.

• If the person is less than 3 years old, it is called infantile idiopathic scoliosis.
• Scoliosis that develops between 3-10 years of age is called juvenile idiopathic scoliosis.
• People who are over 10 years old (10-18 years old) have adolescent idiopathic scoliosis.

More than 80% of people with scoliosis have idiopathic scoliosis, and the majority of those are adolescent girls; the most common location for scoliosis is in the thoracic spine.

Medical literature often has more specific names or terms for scoliosis:

• Kyphoscoliosis: a combination of outward and lateral spine curvature
• Dextroscoliosis: curvature of the spine to the right
• Rotoscoliosis (rotatory): curvature of the vertebral column turned on its axis
• Levoconvex: curvature of the spine to the left
• Thoracolumbar: curvature related to both the thoracic and lumbar regions of the spine

What are risk factors for scoliosis?

Age is a risk factor as the symptoms often begin between 9-15 years of age. Being a female increases the risk of scoliosis, and females have a higher risk of worsening spine curvature than males. Although many individuals who develop the problem do not have family members with scoliosis, a family history of scoliosis increases the risk of the disease.

What are scoliosis symptoms and signs?

The most common symptom of scoliosis is an abnormal curve of the spine. Often this is a mild change and may be first noticed by a friend or family member or physician doing routine screening of children for school or sports. The change in the curve of the spine typically occurs very slowly so it is easy to miss until it becomes a more severe physical deformity. It can also be found on a routine school screening examination for scoliosis. Those affected may notice that their clothes do not fit as they did previously, they may notice an uneven waist, or that pant legs are longer on one side than the other.

Scoliosis may cause the head to appear off center, leaning to one side or notice one hip or shoulder to be higher than the opposite side. Someone may have a more obvious curve on one side of the rib cage on their back from twisting of the vertebrae and ribs. If the scoliosis is more severe, it can make it more difficult for the heart and lungs to work properly. This can cause shortness of breath and chest pain.

In most cases, scoliosis is not painful, but there are certain types of scoliosis than can cause back pain, rib pain, neck pain, muscle spasms, and abdominal pain. Additionally, there are other causes of these nonspecific pains, which a doctor will want to look for as well to rule out other diseases.

What is the treatment for scoliosis?

Treatment of scoliosis is based on the severity of the curve and the chances of the curve getting worse. Certain types of scoliosis have a greater chance of getting worse, so the type of scoliosis also helps to determine the proper treatment. There are three main categories of treatment: observation, bracing, and surgery. Consequently, there are treatments available that do not involve surgery, but in some individuals, surgery may be their best option.

Functional scoliosis is caused by an abnormality elsewhere in the body. This type of scoliosis is treated by treating that abnormality, such as a difference in leg length. A small wedge can be placed in the shoe to help even out the leg length and prevent the spine from curving. There is no direct treatment of the spine because the spine is normal in these people.

Neuromuscular scoliosis is caused by an abnormal development of the bones of the spine. These types of scoliosis have the greatest chance for getting worse. Observation and bracing do not normally work well for these people. The majority of these people will eventually need surgery to stop the curve from getting worse.

Treatment of idiopathic scoliosis usually is based on the age when it develops.

In many cases, infantile idiopathic scoliosis will improve without any treatment. X-rays can be obtained and measurements compared on future visits to determine if the curve is getting worse. Bracing is not normally effective in these people.

Juvenile idiopathic scoliosis has the highest risk for getting worse of all of the idiopathic types of scoliosis. Bracing can be tried early if the curve is not very severe. The goal is to prevent the curve from getting worse until the person stops growing. Since the curve starts early in these people, and they have a lot of time left to grow, there is a higher chance for needing more aggressive treatment or surgery.

Adolescent idiopathic scoliosis is the most common form of scoliosis. If the curve is small when first diagnosed, it can be observed and followed with routine X-rays and measurements. If the curve or Cobb angle stays below about 20-25 degrees (Cobb method or angle, is a measurement of the degree of curvature), no other treatment is needed. The patient may return to see the doctor every three to four months to check for any worsening of the curve. Additional X-rays may be repeated each year to obtain new measurements and check for progression of the curve. If the curve is between 25-40 degrees and the patient is still growing, a brace may be recommended. Bracing is not recommended for people who have finished growing. If the curve is greater than 40 degrees, then surgery may be recommended.

Reference

www.medicinenet.com