Scoliosis describes a condition of abnormal spine alignment that affects approximately 6 million Americans, or roughly 2-3% of the population. Although scoliosis may result from congenital, neuromuscular, developmental, neurological or other disorders, for over 80% of scoliosis patients there is no identified reason for the condition’s development, so it is termed ‘idiopathic.’ Fortunately, treatment through bracing can be highly beneficial in halting progression of the condition, thus preventing the need for surgical correction. Both the unpredictable nature of scoliosis and the benefits derived from early treatment highlight the importance of conducting regular screening tests through the end of adolescence, or until the spine has reached its full growth.
The normal alignment of the spine resembles an "S" shape. Excessive curvature of the upper outward curve is called kyphosis, while excessive curvature of the lower inward curve is termed lordosis. From the back or front view, a normal spine will appear in a straight line. In scoliosis however, there is side-to-side (lateral) deviation of the spine from its normally straight path.
For the idiopathic group, there are three designated phases during which scoliosis usually develops. Comprising approximately 80%, the adolescent phase represents the vast majority of idiopathic cases, and encompasses ages 10–18. The high proportion of idiopathic cases during the adolescent years has encouraged many school districts to institute scoliosis-screening programs. Such programs usually use a common diagnostic method, called the Adam’s forward bend test, in which the patient bends forward with their arms extended and knees straight. This position enables an assessment of spinal asymmetry from the front or back, as well as an evaluation for abnormal kyphosis or lordosis. Notably, although onset of scoliosis is equally likely for boys and girls of these ages, girls are 8 times more likely to experience further progression of the disease and accompanying spinal deformities.
The juvenile (ages 3 – 9) and infantile (birth – age 3) phases account for the remainder of the idiopathic category. In the early years idiopathic scoliosis can often go undiagnosed because there is rarely any pain experienced at this stage. Clues that scoliosis may be present include uneven shoulders, prominent shoulder blade(s), uneven waist, elevated hips, and leaning to one side. In the infantile phase, left-sided curves are rather common, but often resolve naturally as the child grows.
In addition to the idiopathic form, neuromuscular disorders or congenital defects, such as abnormal vertebrae development (including vertebrae absence, partial formation, or lack of separation), can also lead to scoliosis. A full-length radiograph of the spine is used to determine the extent of the irregularity and to identify which type of scoliosis is present. An MRI may also be used to survey for neurological impairment in the spinal cord and spinal nerves.
Fortunately, the vast majority of individuals with scoliosis do not have spinal deviation severe enough to require treatment. For those who do have a more severe misalignment, treatment options depend on both the extent of the abnormality and the patient’s physiological age (extent to which their physical growth has finished).
When onset occurs in the infantile phase, bracing and surgery are very rarely used, and the spine sometimes corrects the abnormality during growth. During the juvenile and adolescent phases however, the spine experiences periods of significant growth, so braces and surgery may need to be employed to prevent that growth from progressing abnormally and enhancing the existing irregularities.
In all cases of scoliosis, regular observations are conducted every 4-6 months. Generally, bracing is employed when the spine has curved 25-40 degrees, while surgery is suggested for any larger deviations. Both bracing and surgery aim to halt the progression of the condition. Significantly, bracing has been shown to be very effective in halting further progression of moderate curvature, often eliminating the need for future surgery. Surgery offers the added benefit of correcting physical deformities. The most common surgical method for treating scoliosis is posterior spinal fusion. Surgical outcomes are generally very successful, and post-operative casts and braces are usually not required. Patients normally remain in the hospital for one week, afterwards gradually resuming their normal routines.
Sources
·National Scoliosis Foundation. "Information and Support." http://www.scoliosis.org.info.php
·American Academy of Orthopaedic Surgeons. "Scoliosis." 2000 http://orthoinfo.aaos.org
·Scoliosis Research Society. "In Depth Review of Scoliosis." Milwaukee. 2003 http://www.srs.org
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