What is Scoliosis?
WHAT IS SCOLIOSIS?
Scoliosis is the most common deformity of the spine. The condition causes the spine to abnormally curve sideways, into an “S” or “C” shape and to rotate. Most curves are not severe and require only that patients are monitored by doctors, but high-degree curvatures may impact lung and heart function and self-esteem, and can require treatment with bracing or surgery.
HOW MANY PEOPLE HAVE SCOLIOSIS?
One out of every 40 people, or about 7 million people in the U.S, have scoliosis. The condition can affect people of any age, but the most common age of onset is between 10 and 15 years of age. Each year, an estimated 30,000 children are fitted for braces and more than 100,000 children and adults diagnosed with scoliosis undergo surgery.
WHO IS AT A HIGH RISK OF GETTING SCOLIOSIS?
Anyone, at any age, can get scoliosis. Most of the time the person may be the only one in the family with scoliosis, but people who have a family member with scoliosis are much more likely to develop the condition. Girls are more likely to be treated for scoliosis; although girls and boys are diagnosed in equal numbers, girls are eight times more likely to have a curvature that progresses and becomes severe.
WHAT ARE THE SIGNS AND SYMPTOMS OF SCOLIOSIS?
Common signs and symptoms include: uneven shoulders, ribs, hips or waist, back pain, one shoulder blade sticking out, a rib hump at the back of the waist or ribs, one arm hanging lower than the other, discoloration or change in texture in the skin that covers the spine. Idiopathic scoliosis is generally not painful at the onset.
WHAT CAUSES SCOLIOSIS?
In 85 percent of cases, the cause of scoliosis is unknown; this is called idiopathic scoliosis. Before diagnosing a patient with idiopathic scoliosis, a doctor will look for other causes, such as injury, infection, birth defect or underlying syndrome or disease.
HOW DOES A DOCTOR DIAGNOSE SCOLIOSIS?
A doctor will take the following steps to diagnose scoliosis: take a medical history, perform a physical exam, order and review an x-ray and/or MRI and take measurements of the curve.
HOW IS SCOLIOSIS TREATED?
One quarter of children with spinal curves require medical attention. Most scoliosis patients have their spinal curvatures monitored by doctors, on a regular basis, to determine whether the curve is progressing. Some patients may choose a variety of alternative methods for more active treatment of smaller curves or for ongoing management. For children who are still growing and have spinal curves more than 20 degrees, bracing may be recommended as a treatment. Surgery may be advised in severe cases, in which a spinal curve has progressed rapidly, or has progressed to more than 50 degrees.
SYMPTOMS AND CAUSES
By Mayo Clinic Staff
Symptoms
Signs and symptoms of scoliosis may include:
•Uneven shoulders
•One shoulder blade that appears more prominent than the other
•Uneven waist
•One hip higher than the other
If a scoliosis curve gets worse, the spine will also rotate or twist, in addition to curving side to side. This causes the ribs on one side of the body to stick out farther than on the other side.
When to see a doctor
Go to your doctor if you notice signs or symptoms of scoliosis in your child. Mild curves, however, can develop without the parent or child knowing it because they appear gradually and usually don't cause pain. Occasionally, teachers, friends and sports teammates are the first to notice a child's scoliosis.
Causes
Doctors don't know what causes the most common type of scoliosis — although it appears to involve hereditary factors, because the disorder tends to run in families. Less common types of scoliosis may be caused by:
•Neuromuscular conditions, such as cerebral palsy or muscular dystrophy
•Birth defects affecting the development of the bones of the spine
•Injuries to or infections of the spine
Risk factors
Risk factors for developing the most common type of scoliosis include:
•Age. Signs and symptoms typically begin during the growth spurt that occurs just prior to puberty.
•Sex. Although both boys and girls develop mild scoliosis at about the same rate, girls have a much higher risk of the curve worsening and requiring treatment.
•Family history. Scoliosis can run in families, but most children with scoliosis don't have a family history of the disease.
Complications
While most people with scoliosis have a mild form of the disorder, scoliosis may sometimes cause complications, including:
•Lung and heart damage. In severe scoliosis, the rib cage may press against the lungs and heart, making it more difficult to breathe and harder for the heart to pump.
•Back problems. Adults who had scoliosis as children are more likely to have chronic back pain than are people in the general population.
•Appearance. As scoliosis worsens, it can cause more noticeable changes — including unlevel shoulders, prominent ribs, uneven hips, and a shift of the waist and trunk to the side. Individuals with scoliosis often become self-conscious about their appearance.
Mayo Foundation for Medical Education and Research
From Diagnosis to Treatment
Written by Christopher I. Shaffrey, MD
Treatments for Scoliosis in Children
A treatment plan is determined by the child's age, remaining growth potential, curve pattern and magnitude, anticipated rate of progression, and appearance.
Spinal Bracing for Scoliosis
In the past, plaster casting was routinely used to treat scoliosis. Today plaster jackets are used to treat some cases of infantile scoliosis. Casting is generally not used today except in countries where bracing is not available.
Bracing is the standard treatment today used to prevent curve progression and improve deformity.
Typically bracing is prescribed for children with smaller curves ranging from 20 to 40 degrees. Bracing may temporarily correct the scoliosis but does not cure the disease.
Children and teenagers may find bracing difficult because the brace can be uncomfortable, hot, rigid, unattractive, and must be worn 16 to 23 hours a day. Although well disguised under clothing, it can make a child self-conscious.
Bracing is usually not prescribed when the curve is greater than 40 degrees. Certain types of curves do not respond to bracing, such as high thoracic curves. In those situations, surgical intervention may be warranted.
Surgery to Correct Scoliosis
Scoliotic curves greater than 45-50 degrees are usually treated surgically. Rods, bars, wires, screws, and other types of medically designed hardware are used to surgically control and correct scoliosis. These procedures may enable the child to sit upright, thereby reducing the risk for cardiopulmonary complication. Furthermore, instrumentation (hardware) may increase the child's ability to be mobile. These devices are meant to hold the spine straight while the process of fusion occurs.
In infantile and juvenile scoliosis, rods may be implanted without bone grafts. Bone grafts facilitate fusion. Later in life, spinal instrumentation and fusion provide a more permanent treatment.
Adolescent scoliosis may be treated surgically using spinal instrumentation and fusion, when necessary.
The goals of spinal instrumentation include:
•stabilization of spinal segments
•deformity correction within safe parameters
•enchancing spinal fusion
Recovery from Scoliosis Treatment
Whether the treatment course is conservative or surgical, it is important to closely follow the physician and/or physical therapist's instructions. Discuss any concerns about activity restrictions with your child's doctor. He or she will be able to suggest safe alternatives.
Physical therapy may be incorporated into the treatment plan to build strength, flexibility, and increase range of motion. The therapist may provide the patient a customized home exercise program.
If the patient undergoes surgery, written instructions and prescriptions for necessary medication are given prior to release from the hospital. The patient's care continues during follow-up visits with his or her surgeon.
Childhood scoliosis is complex, but the doctor will develop a treatment plan that addresses the curve and any other symptoms.
