Scoliosis

In scoliosis, a lateral curvature of the spine, the vertebrae rotate into the convex part of the curve. This rotation causes rib prominence along the thoracic spine and waistline asymmetry in the lumbar spine. Scoliosis can affect the spine at any level, but right thoracic curves are most common.

Idiopathic scoliosis affects less than 1% of school-age children and is most common during the growth spurt between ages 10 and 13. It affects boys and girls equally, but spinal curve progression is more common in girls.

This disorder can be classified as nonstructural structural. In nonstructural scoliosis, the spinal curve appears flexible, straightening temporarily when the patient leans sideways. In contrast, structural scoliosis is a fixed deformity that doesn't correct itself when
the patient leans sideways.

Scoliosis is also classified by age of onset as infantile, juvenile, or adolescent. Infantile scoliosis is most common in boys ages 1 to 3. It may resolve spontaneously or it may progress and require treatment. Juvenile scoliosis equally affects boys and girls ages 3 to 10. This disorder usually requires long-term follow-up and treatment during the peak growing years. Adolescent scoliosis occurs after age 10 and during adolescence.

Causes

In approximately 65% of cases the cause of scoliosis is unknown (idiopathic). It is known that there is a genetic predisposition to adolescent idiopathic scoliosis.

 Scoliosis may also develop as a result of malformations of the spine present at birth or in association with spina bifida.

Scoliosis may also develop due to unequal leg length or as a result of injury to the spine.

Rarely Scoliosis develops as the result of neurological disease for example poliomyelitis or Friedreich's Ataxia. It may also occur in brittle bone disease (Osteogenesis Imperfecta)

Signs and Symptoms

Signs of scoliosis may include:

• Uneven shoulders
• One shoulder blade that appears more prominent than the other
• Uneven waist
• One hip higher than the other
• Leaning to one side

As scoliosis curves get worse, the spine will also rotate or twist, in addition to curving side to side. This causes the ribs on one side of the body to stick out farther than on the other side. Severe scoliosis can cause back pain and difficulty breathing.

Diagnostic tests

Spinal X-ray studies, including anterior, posterior, and lateral views taken with the patient standing upright and bending, confirm scoliosis and help determine the degree of curvature and flexibility of the spine. X-rays also help determine skeletal maturity, predict remaining bone growth, and show whether the patient has nonstructural or structural scoliosis.

Bone growth studies, though not diagnostic, may help to determine skeletal maturity.

Treatment

The severity of the deformity and potential spine growth determine appropriate treatment, which may include close observation, exercise, a brace, surgery, or a combination of these. Therapy should begin early, while spinal deformity remains subtle. A mild curve of less than 25 degrees should be monitored through X-ray studies and an examination every 3 months. If the curve progresses between 5 degrees and 10 degrees and if the patient is still growing, the doctor may recommend a brace. An exercise program that includes pelvic tilts, spine hyperextension, push-ups, and breathing exercises may strengthen torso muscles.

A 30- to 50-degree curve requires management with spinal exercises and a brace to prevent the curve from progressing. Transcutaneous electrical nerve stimulation may be used as an alternative in which the spinal muscles are stimulated while the patient sleeps. Electrodes lead to a battery pack, and the device stimulates the paraspinal muscles with a mild electrical charge. The current "pulls" muscles away from the curve, theoretically preventing the curve progression.

Usually, a brace halts progression in most patients but doesn't reverse the established curvature. Such devices passively strengthen the patient's spine by applying asymmetrical pressure to skin, muscles, and ribs. Braces can be adjusted as the patient grows and can be worn until bone growth is complete.

A curve of 40 degrees or more requires surgery (spinal fusion with instrumentation) because such a lateral curve continues to progress at the rate of 1 degree per year even after the patient reaches skeletal maturity.

Surgery is used to correct lateral curvature by posterior spinal fusion and internal stabilization with various rods and spinal hardware, depending on the patient's condition and the preferred surgery.

After spinal fusion, the patient may need to wear a brace until the spine heals and stabilizes. Periodic follow-up examinations are needed for several months.

Prevention

Scoliosis is not preventable. At this time, we do not understand what causes the condition in the majority of children.