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Scoliosis & Spine Deformity - Detection and Treatment

Author: Francis, R.M., Plumb, J.C.

While a slight curvature of the spine is normal and healthy, there are some cases where it is over-pronounced and can cause both cosmetic deformity and health risks. When the spine curves inward too much in the low back, it is called lordosis. When the spine in mid-spine area has too much forward curve, or too much of a hump, it is called kyphosis. Scoliosis, a major type of spine deformity, is a lateral curvature in the normally straight vertical line of the spine. Scoliosis is a common condition that, in most cases, only needs to be observed carefully through growth years. Early detection is key to ensuring that the degree of the curve does not progress. Advances in orthopedic techniques have made the relatively few cases that require medical intervention extremely manageable.

WHO GETS SCOLIOSIS?

*Children
The majority of scoliosis is "idiopathic," meaning its cause is unknown. It usually develops in middle or late childhood, before puberty, and is seen more often in girls than boys. Although scoliosis can occur in children with cerebral palsy, muscular dystrophy, spina bifida and other miscellaneous conditions, most
scoliosis is found in otherwise healthy adolescents.

*Adults
Scoliosis usually develops during childhood, but can also occur in adults. Adult scoliosis may represent the progression of a condition that actually began in childhood, and was not diagnosed or treated while the person was still growing. What might have started out as a slight curvature has progressed in the absence
of treatment. Adult scoliosis can also be caused by the degenerative changes of the spine. Other spine deformities such as kyphosis or round back are linked with the common problem of osteoporosis involving the elderly. If allowed to progress, adult scoliosis can lead to chronic severe pain, deformity, and difficulty
breathing.

EARLY DETECTION: WHAT TO LOOK FOR

Scoliosis is not preventable, but early detection and treatment during a child's growing years is important in order to control the progression of the curve and prevent complications such as heart and lung failure. Idiopathic scoliosis can go unnoticed in a child because it's rarely painful in their growing years. Therefore,
parents should watch for the following signs of scoliosis starting when a child is about eight years of age:

• One shoulder or hip higher than the other
• One shoulder blade sticks out
• Rib hump at the back of the waist or on the back at the ribs
• One arm hangs lower than the other

Although only a physician can accurately diagnose the condition, many schools screen students for scoliosis. School nurses are often the first to discover symptoms and will alert parents to the presence of its warning signs in their child.

TREATMENT OPTIONS

The management of scoliosis is individualized for each person depending on his/her age, degree of curvature, and amount of time remaining for skeletal growth. The most critical time for observation and treatment are before and during adolescence – a time of rapid skeletal growth when curves can worsen quickly. Appropriate intervention at this time can easily prevent curve progression and surgery later in life.

Observation

Curves measuring less than 20° on an x-ray usually do not require treatment. However, observation and repeated examinations may be necessary to determine if the spine is continuing to curve. Progression of the curve depends upon the amount of skeletal growth, or the skeletal maturity of the child.

Bracing

Curves between 30° and 45°, or curves showing rapid progression, may require a brace. The brace is used to prevent the curve from getting worse until adolescent skeletal growth is complete. Curve progression typically slows down or stops after the child reaches puberty.

Surgery

Surgery may be recommended when the curve measures 50° or more and bracing is not successful in slowing down its progression. In these instances, surgery has been found to be a highly effective and safe treatment for scoliosis.

 

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