What Is Scoliosis?
Scoliosis is a musculoskeletal disorder in which there is
a sideways curvature of the spine, or backbone. The bones that make up
the spine are called vertebrae. Some people who have scoliosis require
treatment. Other people, who have milder curves, may only need to visit
their doctor for periodic observation. The section, "Does
Scoliosis Have To Be Treated? What Are the Treatments for Scoliosis?" describes
how doctors decide whether or not to treat scoliosis.
Who Gets Scoliosis?
People of all ages can have scoliosis, but this booklet
focuses on children and adolescents. Of every 1,000 children, 3 to 5
develop spinal curves that are considered large enough to need
treatment. Adolescent idiopathic scoliosis (scoliosis of unknown
cause) is the most common type and occurs after the age of 10. Girls are
more likely than boys to have this type of scoliosis. Since scoliosis
can run in families, a child who has a parent, brother, or sister with
idiopathic scoliosis should be checked regularly for scoliosis by the
family physician.
Idiopathic scoliosis can also occur in children younger
than 10 years of age, but is very rare. Early onset or
infantile idiopathic scoliosis occurs in children less than 3
years old. It is more common in Europe than in the United States.
Juvenile idiopathic scoliosis occurs in children between the ages
of 3 and 10.
What Causes Scoliosis?
In 80 to 85 percent of people, the cause of scoliosis is
unknown; this is called idiopathic scoliosis. Before concluding that a
person has idiopathic scoliosis, the doctor looks for other possible
causes, such as injury or infection. Causes of curves are classified as
either nonstructural or structural.
- Nonstructural (functional) scoliosis--A structurally normal
spine that appears curved. This is a temporary, changing curve. It is
caused by an underlying condition such as a difference in leg length,
muscle spasms, or inflammatory conditions such as appendicitis.
Doctors treat this type of scoliosis by correcting the underlying
problem.
- Structural scoliosis--A fixed curve that doctors treat case
by case. Sometimes structural scoliosis is one part of a syndrome or
disease, such as Marfan's syndrome, an inherited connective tissue
disorder. In other cases, it occurs by itself. Structural scoliosis
can be caused by neuromuscular diseases (such as cerebral palsy,
poliomyelitis, or muscular dystrophy), birth defects (such as
hemivertebra, in which one side of a vertebra fails to form normally
before birth), injury, certain infections, tumors (such as those
caused by neurofibromatosis, a birth defect sometimes associated with
benign tumors on the spinal column), metabolic diseases, connective
tissue disorders, rheumatic diseases, or unknown factors (idiopathic
scoliosis).
How Does the Doctor Diagnose
Scoliosis?
The doctor takes the following steps to evaluate a patient
for scoliosis:
- Medical history--The doctor talks to the patient and the
patient's parent or parents and reviews the patient's records to look
for medical problems that might be causing the spine to curve, for
example, birth defects, trauma, or other disorders that can be
associated with scoliosis.
- Physical examination--The doctor looks at the patient's
back, chest, pelvis, legs, feet, and skin. The doctor checks if the
patient's shoulders are level, whether the head is centered, and
whether opposite sides of the body look level. The doctor also
examines the back muscles while the patient is bending forward to see
if one side of the rib cage is higher than the other. If there is a
significant asymmetry (difference between opposite sides of the body),
the doctor will refer the patient to an orthopaedic spine specialist
(a doctor who has experience treating people with scoliosis). Certain
changes in the skin, such as so-called café au lait
(coffee-with-milk-colored) spots, can suggest that the scoliosis is
caused by a birth defect.
- X-ray evaluation--Patients with significant spinal curves,
unusual back pain, or signs of involvement of the central nervous
system (brain and spinal cord) such as bowel and bladder control
problems need to have an x ray. The x ray should be done with the
patient standing with his or her back to the x-ray machine. The view
is of the entire spine on one long (36-inch) film. Occasionally,
doctors ask for more tests to see if there are other problems.
- Curve measurement--The doctor measures the curve on the
x-ray image. He or she finds the vertebrae at the beginning and end of
the curve and measures the angle of the curve (see "Curve
Patterns" diagram). Curves that are greater than 20 degrees
require treatment.
Doctors group curves of the spine by their location,
shape, pattern, and cause. They use this information to decide how best
to treat the scoliosis.
- Location--To identify a curve's location, doctors find the
apex of the curve (the vertebra within the curve that is the most
off-center); the location of the apex is the "location" of the curve.
A thoracic curve has its apex in the thoracic area (the part of the
spine to which the ribs attach). A lumbar curve has its apex in the
lower back. A thoracolumbar curve has its apex where the thoracic and
lumbar vertebrae join (see "Normal
Spine" diagram).
- Shape--The curve usually is S- or C-shaped.
- Pattern--Curves frequently follow patterns that have been
studied in previous patients (see "Curve Patterns" diagram). The
larger the curve is, the more likely it will progress (depending on
the amount of growth remaining).
Pictures of Scoliosis
Does Scoliosis Have To Be Treated?
What Are the Treatments?
Many children who are sent to the doctor by a school
scoliosis screening program have very mild spinal curves that do not
need treatment. When a child does need treatment, the doctor may send
him or her to an orthopaedic spine specialist.
The doctor will suggest the best treatment for each
patient based on the patient's age, how much more he or she is likely to
grow, the degree and pattern of the curve, and the type of scoliosis.
The doctor may recommend observation, bracing, or surgery.
- Observation--Doctors follow patients without treatment and
re-examine them every 4 to 6 months when the patient is still growing
(is skeletally immature) and has an idiopathic curve of less than 25
degrees.
- Bracing--Doctors advise patients to wear a brace to stop a
curve from getting any worse when the patient:
- is still growing and has an idiopathic curve that is more than
25 to 30 degrees;
- has at least 2 years of growth remaining, has an idiopathic
curve that is between 20 and 29 degrees, and, if a girl, has not had
her first menstrual period; or
- is still growing and has an idiopathic curve between 20 and 29
degrees that is getting worse.
As a child nears the
end of growth, the indications for bracing will depend on how the
curve affects the child's appearance, whether the curve is getting
worse, and the size of the curve.
- Surgery--Doctors advise patients to have surgery to correct
a curve or stop it from worsening when the patient is still growing,
has a curve that is more than 45 degrees, and has a curve that is
getting worse.
Are There Other Ways To Treat
Scoliosis?
Some people have tried other ways to treat scoliosis,
including manipulation by a chiropractor, electrical stimulation,
dietary supplements, and corrective exercises. So far, studies of the
following treatments have not been shown to prevent curve progression,
or worsening:
- Chiropractic manipulation
- Electrical stimulation
- Nutritional supplementation
- Exercise--Studies have shown that exercise alone will not
stop progressive curves. However, patients may wish to exercise for
the effects on their general health and well-being.
Which Brace Is Best?
The decision about which brace to wear depends on the type
of curve and whether the patient will follow the doctor's directions
about how many hours a day to wear the brace.
There are two main types of braces. Braces can be
custom-made or can be made from a prefabricated mold. All must be
selected for the specific curve problem and fitted to each patient. To
have their intended effect (to keep a curve from getting worse), braces
must be worn every day for the full number of hours prescribed by the
doctor until the child stops growing.
- Milwaukee brace--Patients can wear this brace to correct
any curve in the spine. This brace has a neck ring.
- Thoracolumbosacral orthosis (TLSO)--Patients can wear this
brace to correct curves whose apex is at or below the eighth thoracic
vertebra (see "Normal Spine" diagram). The TLSO is an underarm brace,
which means that it fits under the arm and around the rib cage, lower
back, and hips.
If the Doctor Recommends Surgery,
Which Procedure Is Best?
Many surgical techniques can be used to correct the curves
of scoliosis. The main surgical procedure is correction, stabilization,
and fusion of the curve. Fusion is the joining of two or more vertebrae.
Surgeons can choose different ways to straighten the spine and also
different implants to keep the spine stable after surgery. (Implants are
devices that remain in the patient after surgery to keep the spine
aligned.) The decision about the type of implant will depend on the
cost; the size of the implant, which depends on the size of the patient;
the shape of the implant; its safety; and the experience of the surgeon.
Each patient should discuss his or her options with at least two
experienced surgeons.
Patients and parents who are thinking about surgery may
want to ask the following questions:
- What are the benefits from surgery for scoliosis?
- What are the risks from surgery for scoliosis?
- What techniques will be used for the surgery?
- What devices will be used to keep the spine stable after
surgery?
- Where will the incisions be made?
- How straight will the patient's spine be after surgery?
- How long will the hospital stay be?
- How long will it take to recover from surgery?
- Is there chronic back pain after surgery for scoliosis?
- Will the patient's growth be limited?
- How flexible will the spine remain?
- Can the curve worsen or progress after surgery?
- Will additional surgery be likely?
- Will the patient be able to do all the things he or she wants to
do following surgery?
Can People with Scoliosis
Exercise?
Although exercise programs have not been shown to
affect the natural history of scoliosis, exercise is encouraged in
patients with scoliosis to minimize any potential decrease in functional
ability over time. It is very important for all people, including those
with scoliosis, to exercise and remain physically fit. Girls have a
higher risk than boys of developing osteoporosis (a disorder that
results in weak bones that can break easily) later in life. The risk of
osteoporosis is reduced in women who exercise regularly all their lives;
and weight-bearing exercise, such as walking, running, soccer, and
gymnastics, increases bone density and helps prevent osteoporosis. For
both boys and girls, exercising and participating in sports also
improves their general sense of well-being.
What Are Researchers Trying To Find
Out About Scoliosis?
Researchers are looking for the cause of idiopathic
scoliosis. They have studied genetics, growth, structural and
biochemical alterations in the discs and muscles, and central nervous
system changes. The changes in the discs and muscles seem to be a result
of scoliosis and not the cause. Scientists are still hopeful that
studying changes in the central nervous system in people with idiopathic
scoliosis may reveal a cause of this disorder.
Researchers continue to examine how a variety of braces,
surgical procedures, and surgical instruments can be used to straighten
the spine or to prevent further curvature. They are also studying the
long-term effects of a scoliosis fusion and the long-term effects of
untreated scoliosis.
Keeping on Top of Your Condition
Keeping in tune with your disease or condition not only makes treatment less intimidating but also increases its chance of success, and has been shown to lower a patients risk of complications. As well, as an informed patient, you are better able to discuss your condition and treatment options with your physician.
A new service available to patients provides a convenient means of staying informed, and ensures that the information is both reliable and accurate. If you wish to find out more about HealthNewsflash's innovative service, take the tour.
Where Can People Get More
Information About Scoliosis?
National Scoliosis Foundation
5 Cabot
Place
Stoughton, MA 02072
Phone: 617-341-6333 or 800-NSF-MYBACK
(673-6922) (free of charge)
Fax: 617-341-8333
E-mail: scoliosis@aol.com
This is a nonprofit voluntary organization that provides
pamphlets, a newsletter, and other information materials on childhood
and adult scoliosis. The foundation also provides support group
information and lists of physicians in each state who specialize in
scoliosis.
The Scoliosis Association, Inc.
P.O. Box
811705
Boca Raton, FL 33481-1705
Phone: 561-991-4435 or
800-800-0669 (free of charge)
Fax: 561-994-2455
E-mail: normlipin@aol.com
www.scoliosis-assoc.org
This association publishes a quarterly newsletter and
pamphlets. A single copy of their fact sheet is available free by
sending a self-addressed, stamped envelope. The association also
provides information about local chapters and support groups.
Scoliosis Research Society
611 East Wells
Street
Milwaukee, WI 53202
Phone: 414-289-9107
Fax:
414-276-3349
E-mail: goulding@aaos.org
www.srs.org
This is a professional organization for orthopaedic
surgeons interested in scoliosis. It provides pamphlets about the
diagnosis and treatment of scoliosis. Their free pamphlet is offered on
their Web site as well as through the mail. The society also can provide
referrals to physicians.
American Physical Therapy Association
Scoliosis
1111 North Fairfax Street
Arlington, VA
22314-1488
E-mail: svcctr@apta.org
www.apta.org
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