Scoliosis is a medical condition in which a person’s spine is curved from side to side, and may also be rotated. On an x-ray, the spine of an individual with a typical scoliosis condition may look more like an “S” or a “C” than a straight line. It’s typically classified as congenital (caused by vertebral anomalies present at birth), idiopathic (sub-classified as infantile, juvenile, adolescent or adult according to when onset occurred) or as having developed as a secondary symptom of another condition, such as cerebral palsy or spinal muscular atrophy.
In the case of the most common form of scoliosis, adolescent idiopathic scoliosis, there’s a clear Mendelian inheritance but with incomplete penetration. Various causes have been implicated, but none has consensus among scientists as the cause of scoliosis. Scoliosis is more often diagnosed in females and is often seen in patients with cerebral palsy or spina bifida, although this form of scoliosis is different from that seen in children without these conditions. In some cases, scoliosis exists at birth due to a congenital vertebral anomaly. Scoliosis often presents itself, or worsens, during the adolescence growth spurt.
Treatment of Scoliosis
The treatment options depend on the severity and the age of the person. Doctors can, of course, make up a long list of treatments; only a few have actually been shown to affect the outcome of scoliosis. Numerous studies have failed to show any benefit from exercise, manipulation, meditation or drugs. While exercise is beneficial to maintaining good muscle tone and a healthier heart and lungs, there’s no evidence that it affects, one way or the other, the curve progression. Still, it may help in reducing discomfort. In any case, a patient has the following options for treatment:
- Do nothing. The decision to do nothing may be a reasonable decision depending on the age of the person and the predicted outcome. If the person is a teen or preteen and the prediction is that this curve will worsen, then doing nothing may not be appropriate.Increasing curves usually give an increase in the deformity. That is, the chest twists, throwing the shoulder blade off in back causing a rib hump, while the chest in front rotates as well, causing unevenness to the breasts. Concurrently, the hips at the waist become more uneven. As such, doing nothing in the teen years may be disastrous.
On the other hand, if the person has reached maturity ( physical at least) then if the curve is mild, below forty degrees, it may not increase any more. So not doing anything may be okay in that situation.
- Wear a brace. Bracing has been shown to be an effective method in preventing curves from getting worse. From a practical viewpointthough, this treatment is reserved for children and adolescents with whom the prediction of a rapid increase in the curve needs to be thwarted. A brace worn 16 or more hours per day has been shown to be effective in preventing 90% or more of the curves from getting worse. Unfortunately, a brace worn 23 hours per day and worn properly doesn’t guarantee that the curve will not continue to increase. Still, in curves that are mild, i.e. between 20 and 35 degrees, a brace may be quite effective.In adults, the curve may progress slowly over the years, so bracing isn’t a practical solution to prevent curves from increasing. Mild curves under 30 degrees don’t usually progress; severe curves over 60 degrees usually progress and scoliosis between 30 and 60 degrees may or may not progress. It must be remembered that a brace for a teenager isn’t an easy treatment. The brace is hot, hard, uncomfortable, ugly and while it normally can’t be seen under the clothes, it definitely makes a teenager more self-conscious.Sufferers tend to use a brace for twenty three hours per day. Using it part-time seems to create problems of when to put it on, when to take it off and for how long, whereas if it becomes part of the routine, it becomes a standard function. Additionally, logic supported by data shows that the more the brace is on, the better the chance of maintaining correction. However, take note that a brace usually doesn’t correct a curve—at best, it will stop it from worsening.
- Surgery. For those persons who already have severe scoliosis with significant deformity, surgery can reduce the arch and significantly cut down the malformation. Usually, surgery is reserved for teen and preteens who already have a curve around 40 degrees or more. In medical practice, some doctors tend to be more aggressive in doing surgery around 40 degrees while there are many excellent surgeons who defer to 45 or 50 degrees.Surgery is usually indicated for curves that have a high likelihood of progression—that is, curves that cause a significant amount of pain with some regularity, curves that would be cosmetically unacceptable as an adult, curves in patients with spina bifida and cerebral palsy that interfere with sitting and care and curves that affect physiological functions such as breathing.
Surgery for scoliosis is usually done by an orthopaedic surgeon who specializes in spine surgery. For various reasons, it’s usually impossible to completely straighten a scoliotic spine, but in most cases, very good corrections are achieved. In the adult age range, the reasons for doing surgery are less well-defined but include decreasing discomfort or pain in a curve that appears to have increased.
For many women, the deformity in the hip line and building pain combined makes surgery a reasonable option. Many persons take note of the increasing deformity in the chest coupled with an increase in the rib hump. For those persons, surgery can possibly reduce the deformity and pain.
Surgery, however, is a big deal and not to be undertaken lightly. Doctors invariably use metal rods and screws to help straighten and hold the spine in the corrected position. There are three major types of curves, each with their own method of correction. However, the particular corrective surgery may vary depending on your doctor’s judgment. Surgeons base their procedures on many different factors, including their experience with techniques and their outcomes.
- Anterior Approach. For those curves that present itself more as a distortion of the waistline or hips, going in through the front of the abdomen can reach the vertebra, so the spine can be successfully corrected using screws (though this isn’t always the case). Going in through the front can often allow doctors to fuse fewer vertebra and get better correction. So they “save a level” and get better motion remaining and usually better correction than using the posterior method.The spine is actually in the middle of the body and the larger weight bearing part of the vertebra is in the front. To correct the curve by going in front, the incision is across the chest in line with a rib and down the front of the abdomen for a short distance. It sounds like a complex approach—and it is—but the actual incision is no longer than the one in back. The chest is entered and the area of the curve is identified.The discs are removed so that the curve becomes much more mobile and screws are then placed in the vertebra and connected together with a metal rod. Bone graft is placed in the space where the discs are so that later fusion between each adjacent vertebra will occur. The screws are then compressed together, shortening the distance on the outside of the curve and, as such, straightening the curve. Usually. fusion occurs in a shorter time than the posterior method and the number of vertebra fused are ordinarily less.
Symptoms of Scoliosis
Pain is common in adulthood, especially if the scoliosis is left untreated. One of the major complaints from patients and their parents is cosmetic deformity. Pain can occur because the muscles try to conform to the way the spine is curving. However, this usually only happens in larger curves. As the curve keeps growing, there’s more pressure in some prominent areas than in others. This can cause the muscles to seize up and become sore.
The symptoms of scoliosis can include:
- Uneven musculature on one side of the spine.
- A rib “hump” and/or a prominent shoulder blade, caused by rotation of the ribcage in thoracic scoliosis.
- Uneven hip and shoulder levels.
- Asymmetric size or location of breast in females.
- Unequal distance between arms and body.
- Clothes that don’t “hang right,” e.g., with uneven hemlines.
- Slow nerve action (in some cases).
Scoliosis is a three dimensional problem. It’s easy to think of the curves from looking at the back or the front; but the side view also must be considered. Flattening of the normal roundness to the side view of the back affects the general look of the back and the person.
One of the aims of surgery is to try to restore the normal contour of the back from both the front view and the side view. Of course, at times, learning to cope, accept and live with this scoliosis is a treatment that’s far more effective than major surgery or wearing a brace, though trying the latter methods won’t hurt either.
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