SCOLIOSIS: THE FACTS
WHAT IS SCOLIOSIS?
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| 3d ct image of a three year olds spine, cobb angle 56 degrees |
Scoliosis is a general term used to describe a curvature of the spine. The word SCOLIOSIS is derived from the Greek word meaning "curved" or "bent". Scoliosis is a curvature of the spine, with associated rotation to the vertebral body to one side. It causes the ribs attached to the curve segment to become prominent There are two types of scoliosis:
Postural scoliosis is a simple lateral (sideways) bend of the spine without any rotation.
Structural scoliosis is a lateral curve and rotation of the spine, with associated rotation of the ribs. It most commonly occurs during the adolescent growth spurt, and is known as adolescent idiopathic scoliosis. However, structural scoliosis can occur in younger children and also in adults.
What are the symptoms of scoliosis?
Scoliosis is usually asymptomatic.
In many cases, it will be the parent/caregiver that first notices the signs of scoliosis.
There are several signs indicating a possible scoliosis. They are:
- Asymmetry of the waist
- Prominence of the ribs on one side of the back
In teenagers and adults, it is a relatively common condition, affecting at least 3% of women, and a smaller number of men.
In the vast majority of cases, the curves are small and have little or no impact on health or appearance. Treatment for this form of scoliosis is usually not necessary. However, severe scoliosis can cause problems, particularly with breathing. This is especially so in young children. Left untreated, severe curves can cause physical disfigurement, psychological distress, and can compromise the child's long term health.
The spine can curve from any point including the chest, (thoracic) the lower back (lumbar) or above and below these areas (thoracolumbar). The angle of the curve is measured on the x-ray and is called the COBB angle.
What are the different types of scoliosis?
Congenital Scoliosis
The abnormality is present at birth. Problems occur if the curve worsens. If progressive, this condition can have significant impact on health. Surgery is required for most cases of progressive congenital scoliosis.
Infantile Scoliosis
Infantile scoliosis occurs during the first three years of life. Of these cases, nine out of ten will spontaneously resolve, with no treatment needed other than simple postural positioning.
Progressive infantile scoliosis, though potentially disabling, is rare.
Juvenile Scoliosis
Refers to children from the ages of three to ten. Juvenile scoliosis can continue to progress, so continual observation is required. About half of the children with this condition will require bracing and possible surgery.
Adolescent ScoliosisAdolescent scoliosis refers to those who have reached puberty but have yet to reach adulthood. This is the most common type of scoliosis. In the vast majority of cases, the curves are small and have little or no impact on health or appearance. Treatment for this form of scoliosis is usually not necessary. When treatment is required, it is almost always to improve appearance. Like juvenile scoliosis, adolescents should be monitored until spinal maturity to prevent possible progression and future health problems.
How is scoliosis diagnosed?
Discovering your child may have scoliosis is concerning for any parent/caregiver. In many cases, it will be the parent/caregiver that first notices the signs of scoliosis, which vary with each individual child. In some cases, a scoliosis may be suspected from an x-ray taken of the child for another health issue.
Structural scoliosis can be easily diagnosed by the forward bend test. X-rays will usually be done. Further investigations, such as an MRI may be done in certain situations. In children under the age of six years, a light general anesthetic may be necessary. This is painless for your child. Procedure times vary, however, averages between one and three hours.
Once a diagnosis has been made, your child's treating specialist will be able to provide you with possible treatment options.
How is scoliosis treated?
As each child's scoliosis is different, so too are their treatment options.
Observation. Curves with a Cobb angle of 25 degrees or less are usually observed for a period of time. If the curve progresses, another treatment option may be considered.
Early Treatment with Plaster Jackets (plaster of Paris) is most effective in children under the age of two years with progressive curves. With prompt treatment, curves can be resolved. Casting in older children is often alternated with bracing, and this is called SERIAL PLASTER CASTING. Serial plaster casting differs from early treatment, with the aim of early treatment being curve resolution. (Serial casting is usually designed for curve control)
Bracing. There are many types of braces. This non-surgical technique consists of a removable brace made from a plastic substance called "poly ethylene". The aim of bracing is curve control.
Surgery. Surgery offers great hope to a child with advanced scoliosis. When surgery is being considered, it is essential the parent/caregiver speak with the surgeon so as to understand what surgical option is being offered to their child. Surgery uses instrumentation to control the scoliosis. Major advances in these surgical techniques are making surgery a safer option.