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Scoliosis
When to seek medical adviceThe onset of scoliosis is gradual and almost always painless, and a significant curvature can develop without the parent or child knowing it. Early detection is important to prevent the curve from progressing. Unfortunately, the condition usually progresses during the same time that children become more self-conscious (ages 10 to 16) and avoid exposure, so parents and others are not likely to see the problem. Have your child examined if you notice any of the signs of scoliosis. Scoliosis has the potential to lead to serious health problems, such as severe back pain, difficulty breathing, physical deformity, and injury to the lungs and heart. Be sure to have your child see your doctor if you have a family history of scoliosis.
Screening and diagnosisYour child may be checked during routine health visits. Screening programs for scoliosis also are conducted at schools in some states. If your child receives a positive screen for scoliosis at school, see your doctor to confirm the condition. Your doctor will want to ask about your child's personal and family medical history, and may take these diagnostic steps: Physical examination. Your doctor observes the spine. Scoliosis is defined as a spinal curvature of greater than 10 degrees. A normal spine, viewed from the back, is at 0 degrees. A curve that is horizontal, or parallel to the floor, would be 90 degrees. Most doctors can detect a 10-degree curve during a physical exam. Some curve patterns are easier to see than others are. In almost all cases, larger curves, which are uncommon, are easier to recognize than smaller curves, which are quite common. As the spine bends to the side, it rotates as well. X-rays. Your doctor may use X-rays to confirm the diagnosis. Looking at the X-ray also allows your doctor to determine the curve degree, which is necessary to make treatment decisions.
ComplicationsIn some cases, scoliosis may result in complications: Lung and heart damage. In severe scoliosis — a curve greater than 70 degrees — the rib cage may press against the lungs, making it more difficult to breathe. In very severe scoliosis — a curve greater than 100 degrees — injury to the lungs and the heart can occur. The risk of lung infections and pneumonia increases. Bone loss. Scoliosis puts you at a higher risk of loss of bone density (osteopenia). Especially for women who had scoliosis in their youth, the risk of osteoporosis increases with age. Back problems. Adults who had scoliosis as children are more likely to have chronic back pain than the general population. Also, people with untreated scoliosis may develop inflammation and arthritis of the spine (spondylosis). Emotional effects. Having to wear a brace during childhood and teenage years may result in feelings of social isolation and lowered self-esteem.
TreatmentMost children who have an abnormal spine curve have it to a relatively small degree, and treatment involves observation to make sure the curve doesn't progress. Doctors usually recommend observation for people with curves of less than 20 degrees. People whose skeletons are still growing need checkups at 3- to 6-month intervals to see if there have been changes in the curvature of their spine. If the curve progresses to a more serious degree, treatment may involve using an orthopedic brace and, in some cases, surgery. Braces Doctors recommend the use of braces for growing children with adolescent idiopathic scoliosis who have curves of 25 to 40 degrees. Bracing doesn't cure the scoliosis, or even improve the curve. Bracing is used to prevent further progression of a curve. Bracing is an option only during years of active growth. Treatment with bracing ends if the curve progresses into the surgical range (40 to 50 degrees) or if it's successful and the child has reached skeletal maturity. The person wearing a brace usually may participate in all normal activities without restrictions. Long-term problems are unusual. Braces are of two main types: Milwaukee brace. This is a full-torso brace with a neck ring that has rests for the chin and for the back of the head. The brace has a flat bar in the front and two flat bars in the back. A Milwaukee brace may be used to stabilize a curve anywhere in the spine. Thoracolumbosacral orthosis (TLSO). This closer-fitting brace is less visible under the clothes. A TLSO fits under the arms and around the rib cage, lower back and hips. This type of brace is used primarily to stop the progression of curves that occur below the midpoint of the spine. Surgery Doctors typically recommend surgical treatment for people whose curves are greater than 40 to 50 degrees. Scoliosis surgery is generally successful in improving posture and the function of the back. Surgical procedures include the following: Posterior spinal fusion and instrumentation. The most common surgical procedure for scoliosis is posterior spinal fusion and instrumentation. The fusion involves placing pieces of bone taken from the pelvis between two or more vertebrae. Eventually, the vertebrae and the pieces of bone grow together. The instrumentation is the insertion of metal rods, hooks, screws and wires to hold the curve from moving for the 3 to 12 months that it takes for the fusion to become solid. Instrumentation also applies forces to the spine to correct the deformity and may make the curve smaller by as much as 50 percent. Anterior spinal fusion. Occasionally, surgery involves the front of the spine. A surgeon performs this procedure, called anterior spinal fusion, through the chest cavity. Some techniques involve performing surgery through several half-inch incisions. Scoliosis surgery is one of the longest and most complicated orthopedic surgical procedures performed on children. The operation takes several hours. Hospitalization can last several days, and activities are restricted for several months. Other approaches Some people have tried electrical stimulation of muscles, chiropractic manipulation and exercise as ways to treat scoliosis. 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.
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