• Scoliosis

    Definition

    Scoliosis is an abnormal curvature of the spine, or backbone. Instead of a straight vertical line from the neck to the buttocks, the spine has a C- or S-shape. This can result in uneven shoulders and hips.
    Scoliosis
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    Causes

    In most cases, the cause of scoliosis is unknown. Sometimes it is related to a congenital birth defect, disease, or infection. It usually develops in childhood before puberty, though it may not be diagnosed until the teen years. Scoliosis is classified by the age at diagnosis:
    • Infantile scoliosis: younger than three years old This form may result from:
    • Juvenile scoliosis: 3-10 years old
    • Adolescent scoliosis: from age 10 to end of growing period
    Occasionally, the spine curvature of scoliosis is due to a muscle imbalance rather than a spinal deformity.

    Risk Factors

    A risk factor is something that increases your chance of getting a disease or condition.
    Risk factors include:
    • Age: Adolescent years (age 10 and older)
    • Family members who have had scoliosis
    • Delayed puberty and first menstrual period in girls

    Symptoms

    Symptoms include:
    • Uneven shoulders
    • Prominent shoulder blade or ribs
    • Uneven waist
    • An elevated hip
    • Leaning to one side
    • Chronic back pain (usually only if left untreated for several years)
    More severe cases of scoliosis can lead to:
    • Breathing difficulties due to pressure on the lungs and heart
    • Body image issues

    Diagnosis

    Scoliosis is often screened routinely in well-child visits and schools. At an office visit your doctor will ask about your symptoms and medical history, and perform a physical exam. The doctor will examine the following:
    • Back
    • Shoulders
    • Chest
    • Pelvis
    • Legs
    • Feet
    • Skin
    Other tests and diagnostic methods may include:

    X-ray or MRI

    The doctor may recommend an x-ray if you have significant spinal curves, unusual back pain, or signs of brain and spinal cord problems. Occasionally, more tests are needed. You may also have an MRI.

    Curve Measurement

    The doctor measures the angle of the curve on x-rays. In general, curves that are greater than 20° require observation and treatment. Doctors classify curves of the spine by their location, shape, pattern, and cause. They use this information to decide how to treat the scoliosis.

    Referral to a Spine Doctor

    Your doctor may refer you to an orthopedic spine specialist, a doctor who has experience treating people with scoliosis.

    Treatment

    Children with mild spinal curves generally do not need treatment. The type of treatment depends on:
    • Your age
    • How much more you are likely to grow
    • The degree and pattern of the curve
    • If you have back pain
    Treatment options include:

    Observation

    Your doctor will probably just monitor the curve by examining you every 3-6 months if your curve is less than 20° or if you are almost done growing.

    Bracing

    The goal of bracing is to prevent curves from getting worse. Your doctor may recommend that you wear a back brace if you are still growing and your curve is more than 20°. Once you stop growing, the need for more treatment will depend on the size of the curve and how it affects your appearance and function. Braces are not typically used beyond the ages of 15-16 for girls and 17-18 for boys.
    Bracing will feel uncomfortable at first. Children will need lots of support to wear the brace as prescribed, as well as encouragement to foster a positive body image.

    Surgery

    In severe cases where the curvature is greater than 40°-50°, your doctor may recommend surgery to correct a curve or stop it from worsening if you are still growing. Surgery typically involves fusing the vertebrae of the spine together or the use of internal rods to decrease the curvature. Hospitalization can last 5-7 days. Recovery can take several months. Surgical techniques using stapling methods or implants, as well as other surgical techniques are also available, but some are still experimental.
    If your child is diagnosed with scoliosis, follow your doctor's instructions.

    Prevention

    There are no guidelines for preventing scoliosis because the cause is usually unknown. Some schools have scoliosis screening programs to detect scoliosis, usually in the fifth or sixth grade. If scoliosis is detected in school, you will be advised to follow-up with your doctor.

    RESOURCES

    American Academy of Orthopedic Surgeons http://www.aaos.org

    Scoliosis Research Society http://www.srs.org

    CANADIAN RESOURCES

    Caring for Kids http://www.caringforkids.cps.ca

    Health Canada http://www.hc-sc.gc.ca

    References

    American Academy of Orthopedic Surgeons website. Available at: http://www.aaos.org. Accessed July 9, 2009.

    National Institute of Arthritis and Musculoskeletal and Skin Diseases website. Available at: http://www.niams.nih.gov/. Accessed July 9, 2009.

    Rosenberg JJ. Scoliosis. Pediatr Rev. 2011;32(9):397-398.

    Scoliosis. EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com/about/about-us. Updated July 2009. Accessed July 9, 2009.

    Scoliosis. Mayo Clinic website. Available at: http://www.mayoclinic.com/health/scoliosis/DS00194. Accessed July 9, 2009.

    Vertebral body stapling for idiopathic scoliosis. Department of Health and Aging (Australia) website. Available at: http://www.horizonscanning.gov.au/. Accessed July 9, 2009.

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