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Scoliosis

Scoliosis, a laternl curvature of the spine may be found in the thoracic, lumbar, or thoracolumbar spinal segment. The curve may be convex to the right (more common in thoracic curves) or to the left (more common in lumbar curves). Rotation of the vertebral column around its axis occurs and may cause rib cage deformity Scoliosis is often associated with kyphosis (humpback) and lordosis (swayback).

Scoliosis runs in families, but doctors often don't know the cause. More girls get scoliosis than boys. Of every 1,000 children, three to five develop spinal curves that are severe enough to need treatment. Onset of scoliosis rarely occurs in adults. Sometimes, adult scoliosis is a worsening of a condition that began in childhood, but wasn't diagnosed or treated. In other cases, it may result from a degenerative joint condition in the spine.

Causes

Scoliosis may be functional or structural. Functional (postural) scoliosis usually results from poor posture or a discrepancy in leg lengths, not fixed deformity of the spinal column. In structural scoliosis, curvature results from a deformity of the vertebral bodies.

Structural scoliosis may be one of three types:

• Congenital scoliosis is usually related to a congenital defect, such as wedge vertebrae, fused ribs or vertebrae, or hemivertebrae.
• Paralytic or musculoskeletal scoliosis develops several months after asymmetrical paralysis of the trunk muscles from polio, cerebral palsy, or muscular dystrophy.
• Idiopathic scoliosis (the most common form) may be transmitted as an autosomal dominant or multifactoral trait. This form appears in a previously straight spine during the growing years.

Idiopathic scoliosis can be classified as infantile, which affects mostly male infants between birth and age 3 and causes left thoracic and right lumbar curves; juvenile, which affects both sexes between ages 4 and 10 and causes varying types of curvature; or adolescent, which generally affects girls between age 10 and achievement of skeletal maturity and causes varying types of curvature.

Signs and symptoms

The most common curve in functional or structural scoliosis arises in the thoracic segment, with convexity to the right, and compensatory curves (S curves) in the cervical segment above and the lumbar segment below, both with convexity to the left. As the spine curves laterally, compensatory curves develop to maintain body balance and mark the deformity.

Scoliosis rarely produces subjective symptoms until it's well established; when symptoms do occur, they include backache, fatigue, and dyspnea. Because many teenagers are shy about their bodies, their parents suspect that something is wrong only after they notice uneven hemlines, pant legs that appear unequal in length, or subtle physical signs like one hip appearing higher than the other.

Untreated scoliosis may result in pulmonary insufficiency (curvature may decrease lung capacity), back pain, degenerative arthritis of the spine, disk disease, and sciatica.

Diagnosis

The physical examination will include a forward bending test that will help the practitioner define the curve. There will also be a thorough neurologic exam to look for any changes in strength, sensation, or reflexes.

Tests may include:

• spine X-rays (taken from the front and the side)
• scoliometer measurements (a device for measuring the curvature of the spine)
• MRI (if there are any neurologic changes noted on the exam or if there is something unusual in the X-ray )

Treatment

The severity of the deformity and potential spine growth determine appropriate treatment, which may include such noninvasive measures as close observation, exercise, or a brace. For more serious deformity, surgery or a combination of methods may be needed. To be most effective, treatment should begin early, when spinal deformity is still subtle.

Noninvasive measures

A curve of less than 25 degrees is mild and can be monitored by X-rays and an examination every 3 months. An exercise program that includes sit-ups, pelvic tilts, spine hyperextension, push-ups, and breathing exercises may strengthen torso muscles and prevent curve progression. A heel lift also may help.

A curve of 30 to 50 degrees requires management with spinal exercises and a brace. (Transcutaneous electrical nerve stimulation may be used as an alternative.)

A brace halts progression in most patients but doesn't reverse the established curvature. Such devices passively strengthen the patient's spine by applying asymmetric pressure to skin, muscles, and ribs. Braces can be adjusted as the patient grows and can be worn until bone growth is complete.

Surgery

A curve of 40 degrees or more requires surgery (spinal fusion with instrumentation) because a lateral curve continues to progress at the rate of 1 degree a year even after skeletal maturity.

Other therapies

Other treatments that have been studied for treatment of scoliosis include electrical stimulation of muscles, chiropractic manipulation and exercise. There's no evidence that any of these methods prevent spinal curvature from progressing. Although exercise alone can't stop scoliosis, exercise directed or prescribed by physical medicine professionals may have the benefit of improving overall health and well-being.

Coping skills

Coping with scoliosis is difficult for a young person in an already complicated stage of life. Teens are bombarded with physical changes and emotional and social challenges. With the added diagnosis of scoliosis, anger, insecurity and fear are to be expected.

A strong supportive peer group can have a strong impact on a child's or teen's acceptance of a brace. Encourage your child to talk to his or her friends ahead of time and ask for their support.

Consider joining a support group for parents and kids with scoliosis. Support group members can provide advice, relay real life experiences and help you connect with others facing similar challenges.