Scoliosis

Adolescent Idiopathic Scoliosis

Scoliosis is an abnormal lateral (side-to-side) curvature of the spine with rotation (twisting) of the vertebrae within the curve.

The cause of scoliosis is unknown in 80 percent of cases – meaning that the person is otherwise healthy. This is called Idiopathic scoliosis. (In the other 20 percent it is caused by other disorders, e.g. muscular dystrophy, cerebral palsy, degeneration of the spine in older adults). Idiopathic scoliosis often runs in families.

Curve Patterns

Though the cause of Idiopathic Scoliosis remains unknown, it is interesting to note that the majority (90%)of curves of the upper spine are on the right side, while the majority (70%)of curves of the lower spine are on the left side. Curves that affect both the upper and lower spine are called double major curves – S shaped curves. Single curves are C shaped.

In some cases a curve in the lower spine may be compensatory – the body’s way of balancing the curve in the upper spine – rather than structural. A structural curve of the upper spine with a compensatory curve of the lower spine is not considered a double curve.

The upper back (thoracic spine) or area between the upper and lower back are affected more often than the lower back (lumbar spine).

How common is Adolescent Idiopathic Scoliosis?

Although about two to three out of every hundred adolescents have scoliosis (a curve over ten degrees on x-ray), only two to three out of every thousand curvatures are severe enough to need treatment. Treatment consists of wearing a back brace in the majority and surgery in a minority of these cases.

*About ten percent of people have a slight lateral curvature of the spine, but not enough to cause a problem or to be considered scoliosis.

Will Adolescent Scoliosis keep progressing?

When growth is complete, curves under 30 degrees usually don’t get any worse. Bracing for curves that reach 30 degrees to prevent them from getting worse during the growing years is essential. Bracing is usually ineffective for curves over 45 degrees. Curves over 45 - 50 degrees almost always keep progressing and usually require surgery. Spinal fusion surgery halts the progression of the curve and greatly reduces existing deformity. Spinal fusion involves fusing two or more vertebrae of the spine together by surgery.

The Emotional Consequences of Scoliosis

Scoliosis has psychological consequences as well as physical consequence. Self-esteem can be negatively impacted, especially in the formative adolescent years. Counseling may help a child deal with emotional issues arising out of having this disorder.

Scoliosis can be so mild that an untrained eye cannot see the curve, or it can be severe enough to cause deformity

Diagnosing Scoliosis

A mild curvature often goes unnoticed. A scoliosis curvature becomes more visible when the person is bending over. Each side of the back may appear to be a different height when bending over. Besides a curve to the spine, Scoliosis can cause one hip or shoulder to be higher than the other. One shoulder blade may protrude more than the other. The rib cage may be uneven. The head may not be centered. One may lean to one side, with one arm hanging lower than the other.

Monitoring Mild Curves (up to 20 degrees)

Mild curves must be Monitored but do not require treatment. A mild curvature (under 20 degrees) does not usually produce back pain or cause any problems. Fortunately, most adolescents with scoliosis fall into this category.

Though mild Adolescent Scoliosis does not require treatment, a mild curvature may progress quickly in a growing child and must be monitored by a physician. The progression of scoliosis is unpredictable. The more growing left, the more likely a curve is to worsen. Double curves are more likely to progress than single curves. Regular checkups are important.

Back Braces for Moderate Curves (25 – 40 degrees)

Orthopedic surgeons often recommend fitting a young patient with a back brace when a curvature reaches about 25 degrees to 30 degrees. Whether or not a back brace is recommended not only depends on how severe the curve is but how much growing a child has left and the rate of progression. An orthopedic back brace (orthosis) is usually worn for a couple of years during the main growth spurt until growth is completed. A curve under 30 degrees upon completion of growth is unlikely to get worse.

In growing children, orthopedic braces usually prevent the curve from getting worse but do not correct the curve that is already present; therefore, it is important catch scoliosis early. Wearing a brace will temporarily correct an existing curve but when the brace is taken off, the existing curve will return.

Some braces only have to be worn at night, some 16 hours per day, some all the time. Braces can be taken off for activities requiring bending and twisting such as exercising and sports.

Does Exercise Help?
Exercises do not prevent the abnormal curvature of the spine from progressing. However, exercise is still important. Though Idiopathic scoliosis does not usually cause back pain, an abnormal curve of the spine places extra stress on the back muscles. If back pain develops, doing back exercises to increase strength and flexibility may help. Consult your physician before starting an exercise program.

Surgery for Severe Curves (over 45 degrees)

Rarely, the curve still progresses despite the use of bracing. Spinal curves over 45 to 50 degrees almost always progress and an orthopedic surgeon will usually recommend surgery in these cases. Fusing the section of vertebrae where the spine curves stops it from progressing and significantly reduces existing deformities.

Spinal Fusion Surgery

A section of vertebrae are fused together (forming a single bone). Steel rods may be implanted, one on each side of a segment of vertebrae, and attached to vertebrae (by hooks or other means). Bone grafts (usually small pieces of bone, usually taken from hip) are then placed between and alongside the vertebrae and slowly fuse to the vertebrae as a part of the healing process. The fused vertebrae will hold this section of the spine straight. The rods hold the spine in position until the fusion is complete (3 months to a year). The rods are not needed once the fusion is complete but are usually left in place to avoid more surgery.

Spinal fusion surgery totally stops the curve from progressing any further. The existing curve is reduced considerably but it usually isn’t completely eliminated. The results vary but there is generally significant improvement in appearance

Spinal fusion limits overall range of motion by totally eliminating any range of motion between the fused vertebrae- the extent of the limitation of movement is dependent upon the number of vertebrae involved in the fusion. This is preferable to the deformity of severe scoliosis, especially if the lungs and heart are being compressed

Is Spinal Fusion Surgery Done Before Growth is Complete?

In growing children or adolescents, the part of the spine that has been fused can no longer grow, however the rest of the spine will continue to grow. Many people end up a couple of inches taller after the surgery anyway, as the curve in their spine is reduced significantly. Surgery is sometimes done before growth is complete, depending on the severity of the curve.

An orthopedic surgeon’s recommendation to perform surgery now or wait until later is based upon many factors. Sometimes surgery is put off until full growth is reached, even if the curve is getting worse.

Spinal fusion is often more successful in children and teenagers than adults because spine is more flexible in younger patients and complications are fewer.

Surgery for scoliosis is major surgery that comes with risks but the benefits usually outweigh the risks for those with severe curvatures. Scoliosis, left untreated, can lead to deformity, physical problems (crowed lungs, back pain), and low self esteem which can affect every aspects of one’s life.

Are there Other Treatments for Scoliosis besides Back Braces and Surgery?

Studies have shown that exercises and chiropractic treatment will not help scoliosis. Back bracing and surgery are the only treatments shown to be the only effective treatment for Idiopathic Scoliosis. The use of a back brace usually prevents scoliosis from progressing any further. If the curve becomes severe spinal fusion surgery is usually recommended.