Scoliosis Information: Causes, Diagnosis and Treatment Options
- Publish Date: 2010/07/24 - (Rev. 2019/05/14)
- Author: Thomas C. Weiss
- Contact : Disabled World
Outline: Information on the diagnosis and treatment of Scoliosis which involves a side to side curvature in the spine. Scoliosis is defined as a lateral (toward the side) curvature in the normally straight vertical line of the spine. If a child or person requires medical treatment for scoliosis, a doctor might refer them to an orthopedist.
Scoliosis involves a, 'C,' or, 'S,' curvature in a person's spine from side to side. The curvature may at times be severe, leading to additional health issues and potentially affect the person's heart, lungs, or joints. Should the curvature become severe, it may become visible and cause the person discomfort. Scoliosis is typically classified as either congenital (caused by vertebral anomalies present at birth), idiopathic (cause unknown, sub-classified as infantile, juvenile, adolescent, or adult, according to when onset occurred), or secondary to a primary condition. The majority of the time; however, scoliosis is mild enough that it does not affect a person's life and requires no medical treatment. In other instances, the person affected will wear a back brace, or may require surgery.
Females are more likely to experience scoliosis than males, and it may run in families. At times the curvature is temporary. A birth defect, another form of disease, or the presence of a tumor might cause the person's spine to have a curve that is not temporary. Symptoms a person can experience include leaning to one side, or having uneven hips or shoulders.
Causes of Scoliosis
Note the spinal curve to the right in the medium back and to the left in the lower back. Source: Blausen.com staff (2014). Medical gallery of Blausen Medical 2014. WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010. ISSN 2002-4436. [CC BY 3.0 (https://creativecommons.org/licenses/by/3.0)], from Wikimedia Commons.
Every person's spine can curve, a certain amount of curvature in a person's spine is needed for us to be able to move, balance, and walk. Approximately three out of every ten people have scoliosis, and medical science does not know the exact causes of the most common form of it - Idiopathic Scoliosis. The condition may be hereditary; family members of a child with scoliosis may also have it. Girls are far more prone to develop more severe spinal curvature than boys are.
Forms of scoliosis might be caused by inflammation, muscle spasms, or a person having different leg lengths. Scoliosis is something that may develop gradually; in most cases people affected by it are not diagnosed until they are between the ages of ten and fourteen years. The majority of people with scoliosis do not require treatment, and when they do they commonly continue pursuing active lives after receiving treatment.
Doctors regularly check children for scoliosis during routine physical examinations. Some schools also test for scoliosis. If a doctor suspects a person has scoliosis, they might order X-rays to measure the curvature of the person's spine. The angle of the curvature in the spine assists the doctor in deciding whether or not treatment is required, as well as how to treat it. The X-ray may be repeated at regular intervals in order to check on the curvature in the person's spine to determine whether or not it is getting bigger, and to monitor the effects of treatment.
Some children show visible signs of scoliosis; the curvature of their spine may be plain. Their ribs may protrude, or one of their shoulder blades may be noticeably higher than the other. Sometimes the curvature of the person's spine is not as obvious. Scoliosis many times does not hurt and occurs slowly, making it difficult to diagnose.
Treatment of Scoliosis
The majority of people who have scoliosis do not need medical treatment. Regular visits with a doctor to check on the person's spine are sufficient. Others may need to wear a back brace, or have surgery related to scoliosis.
If a child or person requires medical treatment for scoliosis, a doctor might refer them to an orthopedist that specializes in treatment of medical conditions involving bones. An orthopedist might mention the, 'Cobb,' angle, which measures the curvature of a person's spine in degrees. The number of degrees assists the orthopedist in deciding what form of treatment is needed. If the person has a scoliosis curve of ten to fifteen degrees, it usually means they do not need anything more than regular visits with their family doctor until they reach maturity and their growth is complete.
A scoliosis curvature of between twenty and forty degrees will commonly find an orthopedist suggesting a back brace as treatment. A scoliosis spinal curvature of greater than forty degrees may find an orthopedist suggesting that surgery is needed. Bear in mind that when an orthopedist draws the lines for the Cobb angle, or scoliosis curvature of the person's spine, there is a certain amount of leeway for measurement error. What this means is the number may change a little from one X-ray image to another, potentially up to five degrees, even though the curve in the person's spine has not changed.
Back Braces and Scoliosis
Approximately twenty-percent of children with scoliosis require treatment using a back brace, something that acts as a holding device, preventing their spine from developing more curvature. The brace will not make their spine straight, but it will ensure their spine does not curve by more than an addition five or ten degrees and potentially help them to avoid surgery. There are different types of back braces that are commonly made of lightweight materials. Some back braces are meant to be worn from between eighteen and twenty hours per day, while others are designed to be worn only at night.
The particular back brace an orthopedist chooses to treat a person's scoliosis with depends upon the person, the severity of the curvature of their spine, as well as its location. The most common type of back brace is a thoracic-lumbar-sacral-orthosis or, 'TLSO,' brace. The brace is, 'low-profile,' meaning it comes up under the person's arms and fits beneath their clothing. TLSO braces include the following.
- The Wilmington Jacket: The Wilmington Jacket brace was developed at the Alfred I. duPont Hospital for Children in Wilmington, Delaware. It is constructed of custom-fit lightweight plastic and can be worn under a person's clothes so it isn't visible. It's designed to be worn as much as possible, at least 18-20 hours per day.
- The Charleston Brace: The Charleston Brace is also a low-profile brace. It bends the spine in an effort to straighten the curve as much as possible to prevent the curve from worsening. The brace places the child's body in an awkward position - it can only be worn while they are sleeping.
Surgery and Scoliosis
The use of a back brace prevents the need for surgery approximately sixty to seventy-percent of the time. There are times when, despite the use of a back brace, surgical intervention becomes necessary to correct the curvature of a person's spine. If surgery does become necessary, an orthopedic surgeon will perform a procedure that causes the separate bones in the person's spine where the curve is to grow into one solid piece of bone.
The procedure is referred to as a, 'spine fusion,' and assists in preventing additional side-to-side curvature of the person's spine. The orthopedic surgeon may also use screws and metal rods to correct the person's spine, helping to keep it straight until the portions of bone join together with the person's vertebrae. The surgery usually takes between four and six hours and the child is home within a week. They should be able to pursue regular activities promptly, such as walking, climbing stairs, dressing and so forth.
The person may need to take around a month off from school to recover from the soreness they experience due to the surgery, as well as to recover their strength. In approximately three to four months, they may pursue the majority of their usual activities, and after six months to a year, they can return to nearly all of their activities. Six months after the surgery is completed, the fusion of the person's bone is commonly complete. The areas where the rods are located are usually stiffer than before, but do not limit the person's movement to a great degree. The rods remain in the person's back, only because removing them would require another surgery.
Facts and Statistics
- Generally, the prognosis of scoliosis depends on the likelihood of progression. The general rules of progression are larger curves carry a higher risk of progression than smaller curves, and thoracic and double primary curves carry a higher risk of progression than single lumbar or thoracolumbar curves.
- Secondary scoliosis can be the result of a neuromuscular condition (e.g., spina bifida, cerebral palsy, spinal muscular atrophy, or physical trauma) or syndromes such as Chiari malformation.
- The incidence of idiopathic scoliosis (IS) stops after puberty when skeletal maturity is reached, however, further curvature may proceed during late adulthood due to vertebral osteoporosis and weakened musculature.
- Overall, girls are more likely to be affected by scoliosis than boys.
- Approximately 2% to 3% of Americans at age 16 have scoliosis. Less than 0.1% have spinal curves measuring greater than 40 degrees, which is the point at which surgery becomes a consideration.
- An estimated 65% of scoliosis cases are idiopathic, about 15% are congenital and about 10% are secondary to a neuromuscular disease.
- A scoliosis spinal column's curve of 10 degree or more affects 1.5% to 3% of individuals.
- The likelihood of progression among adolescents with a Cobb angle of less than 20 degree is about 10% to 20%.
- Idiopathic scoliosis is most commonly a condition of adolescence affecting those ages 10 through 16. Idiopathic scoliosis may progress during the "growth spurt" years.
- Curves over 50 degrees when reaching adulthood have a 70-90% progression rate during adulthood.
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