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Scoliosis
Overview/Definition
Symptoms
Potential Causes
Diagnosis
Treatment Options
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Overview/Definition
When viewed from the side, the spine features natural curves that form an "S"-like
shape. The cervical (neck) spine curves slightly forward; the thoracic (middle
back) spine curves backward; and the lumbar (lower back) spine curves forward
again. Viewed from the back or front, however, the spine should remain straight.
When the spine twists and develops side-to-side curves, the condition is
called scoliosis. Scoliosis can occur in either the thoracic or lumbar spine,
or both. Orthopedists measure the severity of scoliosis in degrees of curvature,
ranging from as little as 10 degrees to extreme cases of more than 100 degrees.
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Symptoms
In childhood, scoliosis seldom causes any pain. However, young patients may
notice a problem in the way their back looks--a symptom often first noticed
during a routine physical exam or during school screening. Indications of
possible scoliosis, which become more pronounced and noticeable when bending
over, include:
• One shoulder or hip that appears higher than the other
• One shoulder blade that appears higher and sticks farther out than the
other
• One arm that hangs longer than the other because of a tilt in the upper
body
• A "rib hump," a hump on the back that sticks up when the spine
bends forward, which forms because the ribs on one side tilt more than those
on the other side.
As the condition progresses, back pain can eventually develop. The deformity
caused by scoliosis may put pressure on certain nerves and possibly on the
spinal cord, which can lead to weakness, numbness, and pain in the lower
extremities. In rare and severe cases, the chest may become deformed due
to scoliosis, a deformity that may affect the lungs and heart, leading to
breathing problems, fatigue, and even heart failure.
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Potential
Causes
Sciatica most often results from general wear and tear or sudden pressure
on the discs that cushion the vertebrae of the lower spine. A herniated disc
may press directly on the nerve roots that lead into the sciatic nerve. The
damaged disc can also leak fluid, which may inflame and irritate the nerve.
Other less common causes of sciatica include: Degenerative Disc Disease,
Lumbar Spinal Stenosis, Isthmic Spondylolisthesis, Sacro-iliitis, Lumbar
Facet Joint Syndrome, Piriformis Syndrome and Iliolumbar Syndrome. In rare
cases, it can also be caused by infection or tumor.
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Diagnosis
Doctors divide scoliosis into four categories based on the age at which the
condition is diagnosed:
• Infantile scoliosis is diagnosed before age 3
• Juvenile scoliosis is diagnosed from age 3 to 10
• Adolescent scoliosis is iagnosed between ages 10 and 15
• Adult scoliosis is diagnosed after the spine has stopped growing
Infantile Scoliosis
When scoliosis appears in infants, observation is usually the best treatment
because most of the cases are relatively minor and almost 90% of them resolve
themselves without any treatment. However, it is still important for your
baby’s pediatrician to monitor the curve, because if it progresses,
surgery may be necessary.
Juvenile and Adolescent Scoliosis
Most cases of scoliosis are first discovered and treated in childhood or
adolescence, when rapid growth tends to accelerate the progression of spinal
curves. If the condition affects an otherwise healthy child and no specific
cause can be identified, it is called "idiopathic scoliosis." Idiopathic
scoliosis represents 80 to 85% of all forms of scoliosis. By far the most
common form of spinal deformity, idiopathic scoliosis affects about 3% of
the general population.
Learn more adolescent idiopathic
scoliosis in kids’ language.
Adult Scoliosis
Scoliosis that is first diagnosed in adulthood may actually represent a progression
of juvenile or adolescent scoliosis that went untreated or unrecognized during
childhood. But scoliosis can also first develop during adulthood. The causes
of adult-onset scoliosis, unlike those of most juvenile or adolescent scoliosis,
can often be identified. Degenerative adult scoliosis occurs when a combination
of age and deterioration of the spine leads to the development of a scoliotic
curve. Degenerative scoliosis usually appears after the age of 40. In older
patients, particularly women, it is often related to osteoporosis, which
weakens the bone, leading to deterioration. As the deteriorating spine "sags," a
scoliotic curve can slowly develop.
The remaining types of scoliosis are rare and can be categorized as: Congenital
Curve, Paralytic Curve, Myopathic Deformity, and Secondary Scoliosis.
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Diagnosis
Your doctor will ask a variety of questions about your family history,
dates of onset and progression, the presence of pain, bowel
or bladder dysfunction, motor function, and whether you have
had previous surgery. Your doctor will also perform a physical
exam and will order X-rays to measure the degree of curvature.
Your doctor may also order other tests to examine specific
aspects of the spine. The most common tests are: an MRI to
look at the nerves and spinal cord, a CT
scan to get a better
picture of the vertebral bones, and special nerve tests to
determine if the scoliosis has irritated or pinched any nerves.
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Treatment
Options
Your doctor will recommend a specific treatment based on your age at the
onset of scoliosis, the degree of curvature, and the presence of other symptoms.
For curves of less than 40 degrees, conservative treatment often suffices
to halt progression. Curves greater than 40 degrees, however, may require
surgery.
Conservative Treatment
Conservative treatments may include medication, bracing, physical
therapy and exercise. Bracing, often considered as a treatment option for medium
range curves, applies only in cases of juvenile or adolescent scoliosis,
when the spine is still growing. Scoliosis often affects more than one area
of the spine, and a brace can be used to support all the curved areas that
need to be protected from progression. Though the brace can help a curve
from getting worse, adolescents often feel self-conscious about having to
wear a brace, so it may take some time for the patient (and caregiver) to
get used to it.
Conservative treatment for adults begins with the treatment of osteoporosis,
if any is present. Treatment of osteoporosis may also slow the progression
of scoliosis. Current recommendations include an increase in calcium and
vitamin D intake, hormone replacement therapy, and weight-bearing exercises.
Exercise may help to relieve pain but will not affect the natural history
of the curve.
Surgical Treatment
After the completion of skeletal maturity, smaller curves tend not to progress,
seldom cause significant back pain, and therefore do not require surgery.
With medium and large curves, however, adult progression and the presence
of secondary symptoms become more likely, making surgery a treatment option
to consider. Those who would benefit most from surgery include patients with
severe pain, difficulty breathing, or progressive deformity.
Surgery for scoliosis almost always involves spinal
fusion with instrumentation.
Nearly all scoliosis surgery employs some type of rods to help straighten
the spine. The physician may use a posterior approach, which involves entering
the spine through the back, an anterior approach, which is performed from
the front or side, or a combined approach. The decision to have surgery
is a joint decision arrived at by the patient, patient’s family and
the physician. Surgery for scoliosis is never an emergency and sufficient
time is always available to make everyone comfortable with the decision.
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