Most curves and scoliosis treatment can be non-operatively if doctors detect this problem before they become too severe. However, 60 % of curvatures in rapidly growing pre-pubertal children will progress. This screening is probably not necessary until the fifth grade, and beyond that point, boys and girls should have examination every 6-9 months. However, it is important to know what to do if a patient already has scoliosis, and what treatment option are available.
What is scoliosis?
Generally, curvatures up to 30 degrees will not progress after the child becomes skeletally mature. Once this is established, doctors can freely stop scoliosis screening and monitoring. However, with greater curvatures, the curvature may progress at about 1 degree per year in adults. In this population, health care providers should continue the monitoring. If scoliosis is neglected, the curves may progress dramatically, creating significant physical deformity and even cardiopulmonary problems with especially severe curves. Currently, scoliosis treatment is successfully using special braces, electrical stimulation, surgery, or combinations of these three techniques. Off course, everyone’s spine has natural curves. These curves round our shoulders and make our lower back curve inward. However, some people have spines that also curve from side to side, so unlike poor posture, these curves cannot be corrected simply by learning to stand up straight. This condition of side-to-side spinal curves is known as scoliosis. On an X-ray, the spine of an individual with scoliosis looks more like letter S or C, than a straight line indeed. Some of the bones in a spine with scoliosis also may have rotated slightly, making the person’s waist or shoulders appear uneven.
Typical examination of the spine
Standing AP and lateral views of the entire spine demonstrate an arcuate thoracolumbar scoliosis. These views are able to show scoliosis with a rightward convexity. The normal thoracolumbar spine is relatively straight in the sagittal plane. It has a double curve in the coronal plane. The thoracic spine in convex posteriorly, or kyphosis, and the lumbar spine in convex anteriorly, or lordosis. Normally there should be no lateral curvature of the spine at all. Scoliosis is a complicated deformity with both lateral curvature and vertebral rotation. As the disease progresses, the vertebrae and spinous processes in the area of the major curve rotate toward the concavity of the spinal curve. On the concave side of the curve, the ribs are close together, but on the convex side they are widely separated. As the vertebral bodies rotate, the spinous processes deviates more and more to the concave side. Then ribs follow the rotation of the vertebrae. The posterior ribs on the convex side push posterior, causing the characteristic rib hump seen in thoracic scoliosis. The anterior ribs on the concave side push the anterior. Scoliosis also causes pathologic changes in the vertebral bodies and inter-vertebral discs.
Causes of scoliosis
Scoliosis has many causes, and many classifications. We know there are many different scoliosis, such as
- Nonstructural scoliosis
- Postural scoliosis
- Compensatory scoliosis
- Transient structural scoliosis
- Sciatic scoliosis
- Hysterical scoliosis
- Inflammatory scoliosis
- Structural scoliosis
- Cerebral palsy
- Muscular dystrophy
- Amyotonia congenita
- Friedreich's ataxia
- Mesenchymal disorders
- Rheumatoid arthritis
- Osteogenesis imperfecta
- Certain dwarves
Idiopathic genetic scoliosis accounts for about 80 % of all cases of the disorder, and has a strong female predilection. It can be sub-classified into infantile, juvenile and adolescent types, depending upon the age of patient. The most common of these is adolescent scoliosis, which by itself is by far the most common type of idiopathic scoliosis in the world. Scoliosis can also result from congenital vertebral anomalies, where a discovery of these anomalies should prompt a workup for other associated cardiac, genitourinary, or vertebral anomalies. Other causes of scoliosis are occasionally seen, especially due to trauma, neurofibromatosis, or associated with some of neuromuscular disorders.
Radiographic assessment of a scoliosis patient
One must first determine what type of curvature is present, since the curvature may be acute, such as seen with a fracture or hemivertebra. More often, it is smooth and arcuate vertebra. The doctor should report presence of any vertebral or rib anomalies. One should also describe whether the convexity of the curve points to the right or left side. If there is a double curve, the doctor must describe and measure each curve. With minor degrees of scoliosis, these two lines will probably intersect off the film somewhere. Therefore, a useful theorem from high school geometry helps measure this angle. If one constructs perpendicular lines to these first two lines, these perpendicular lines will intersect on the film and will have the same angle between them as exists between the first two lines. This information should be in the radiographic report, since it becomes part of the patient’s chart. Therefore, it lasts far longer than the radiographs, which are often recycled after 5 years or so.
Once the doctor has measured the angle of a curvature, he may then estimate the degree of rotation of the vertebra at the apex of the curve by looking at the relation of the pedicles to midline. A further goal of the radiographic examination is to determine the physiological or skeletal maturity of patient. It is valuable to remember that curvature below 30 degrees does not progress. Several methods are helpful to estimate skeletal maturity.
How do people find out they have scoliosis?
Sometimes scoliosis will be easily noticeable because a curved spine can cause a person’s body to tilt to the left or right. Many kids with scoliosis have one shoulder blade that is higher than the other shoulder. These patients also have an uneven waist with a tendency to lean to one side. These problems may be noticed when a person is trying on new clothes or similar situations. If one pant leg is shorter than the other is, the person might have scoliosis as well. It is also possible that the person does not have scoliosis, since one leg may really be slightly shorter than the other appears. You might have an exam for scoliosis at school or during a doctor visit. In the United States, about half of the states require public schools to test for scoliosis, which is an easy test, called the forward-bending test, and does not hurt at all. It involves bending over, with straight knees, and reaching fingertips toward your feet or the floor. Then, a doctor or nurse will look at patient’s back to see if the spine curves.
What should a scoliosis patient do?
If a doctor says you have scoliosis, then the doctor and your parents can talk about whether treatment is necessary or not. Sometimes the doctor will decide that the curve is not serious enough to need treatment. If you do need treatment, you will need to go to a special doctor called an orthopedist to get more information about scoliosis treatment. The orthopedist will probably start by figuring out how severe your spine’s curve is.
To do this, an orthopedist looks at X-rays and measures the spine’s curve in degrees. Someone who has a mild curve may just need regular checkups to make sure the curve is not getting worse with time. Someone with a more severe curve may need to wear a brace or have an operation as part of their scoliosis treatment.
Generally, treatment should be provided by orthopedic surgeons with special training in spinal problems. However, radiographic scoliosis examinations could be ordered by a wide variety of other physicians. Most commonly, physicians who look toward the radiologist as the local musculoskeletal expert will order this examination. Also, a physician must know how to read these films and how to dictate a coherent and helpful interpretation of them.
In planning treatment for each child, an orthopedist will carefully consider a variety of factors. He must include the history of scoliosis in the family and the age at which the curve begins. He should also consider the curve’s location and severity. Most spine curves in children with scoliosis will remain small and need only to be monitored by an orthopedist for any sign of progression. If a curve does progress, an orthopedic brace can help to prevent it from getting worse. Children undergoing treatment with orthopedic braces can continue to participate in the full range of physical and social activities during the treatment.
Electrical muscle stimulation, exercise programs, and manipulation are not effective treatments for scoliosis. If the scoliosis curve is severe when the doctor sees it for the first time, or if treatment with a brace does not control the curve, surgery may be necessary as the final treatment option. In these cases, surgery is a highly effective and safe treatment of scoliosis.