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Article written by Elliot Carlisle, MD
Scoliosis is a disease that often occurs in childhood and adolescence. It causes the spine to curve abnormally to one side or the other and it resembles the letter S or C, whereas a normal spine is straight. When the spine curves the vertebral bones rotate and this may result in a rib prominence if the curve is in the thoracic part of the spine. If left untreated, the spine may become severely deformed and in extreme cases the heart and lungs may become affected.
In children, scoliosis may be congenital or idiopathic. Congenital curves are caused by a vertebral defect in the early development of the spine when in utero, whereas idiopathic scoliosis occurs without a known cause. Idiopathic scoliosis is classified as infantile, juvenile and adolescent. Infantile scoliosis occurs before three years of age and is more common in boys. Many cases resolve on their own without treatment, while some may progress to severe deformity. Juvenile scoliosis occurs between the ages of three and ten, and is more common in girls. These curves often require surgical intervention because they are at high risk for progression. Adolescent Idiopathic Scoliosis (AIS) more commonly occurs in females between the age of ten to maturity and may become apparent during puberty. It often progresses during periods of the adolescent growth spurt.
Early diagnosis of scoliosis may help to prevent the progression of curvature and deformity. A thorough history of any underlying personal or family medical conditions that may be associated with scoliosis should be reviewed by a physician. The patient’s age, onset of puberty and in females, the first menstrual period is important to determine the remaining spinal growth and risk for progression. Patients should then be assessed for any other neurological symptoms including pain, numbness or tingling, weakness and any loss of control of bowel and bladder functions.
A thorough physical exam provides information about the health of the patient and their spine. The exam includes observing the patient for any abnormalities including overall balance of the spine, relative shoulder and pelvis height, as well as spinal curvature and rib cage deformity. The Adam’s Forward Bending Test allows the clinician to view, from behind, any prominences the patient may have while the patient bends forward at the waist. A significant rib hump can be measured in degrees by a Scoliometer. A careful neurologic exam is performed to ensure that the spinal cord and nerves are functioning properly. This includes strength and sensation testing, as well as an examination for abnormal reflexes.
Radiographs of the entire length of the spine are taken from both the front and the side to determine the magnitude, in degrees, of the spinal curve (known as the Cobb angle), overall alignment and future growth potential. Abnormalities of the vertebrae may be noticed in congenital curves. Bending X-rays may be taken to help determine flexibility of curves.
A plan of treatment is determined by the overall analysis of the patients age, history, physical exam, remaining growth, curve type and magnitude, expected progression of the curve and overall appearance. Small curves that are not expected to progress may not require treatment and may be followed by interval X-rays. Often, a brace is recommended for children with curves in the 20 – 40 degree range. The braces are usually worn in the range of 16-23 hours a day. Braces are used to help prevent progression of curves, but do not cure scoliosis. Curves in the 45-50 degree range and higher are often treated surgically. The goal of surgery is to correct deformity and prevent progression. Metal rods with screws and/or hooks and wires may be used to correct the curvature while the process of spinal fusion occurs. Excellent results can be expected with this type of procedure. Whether treatment is with serial X-rays, careful observation, bracing or surgery, close and careful follow-up with a physician is essential to achieving desired results.