Scoliosis

Scoliosis is an abnormal curvature of the spine. Everyone has a natural S-shaped curve of the spine that can be seen from the side. When looking at a person from behind, the spine should appear as a straight line from the base of the neck to the tailbone. Side-to-side curvature, characteristic of scoliosis, is usually painless and does not get worse. But, sometimes the curvature worsens over time and requires intervention. Most small curves do not require any surgery or special care. They are usually painless, but may require treatment if they worsen, cause back pain or make breathing difficult.

Scoliosis is usually first diagnosed just before or during adolescence. It affects about 2 percent of the population, runs in families and is more common in girls than in boys. When it occurs in adolescents, most cases are idiopathic (no known cause). In most cases, children will develop a small curve that never progresses. Some childhood cases, however, do have a known cause. These can include tumor, congenital disorders or diseases of early childhood.

The second group affected by scoliosis is older adults who develop what is called degenerative scoliosis. It can occur in someone who had idiopathic scoliosis that did not progress until later in life. Other cases occur in adults with degenerative diseases of the spine.

Scoliosis is diagnosed through a physical exam and confirmed using X-rays of the spine. MRI or CAT scans may be required to look at the nerves, muscles or associated structures being affected by the curve.

Signs of scoliosis include:

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

Severe curves may also cause the spine to twist, causing the ribs of one side of the body to stick out farther than on the other side.

Doctors use X-rays to confirm the diagnosis, determine the angle of the curve and to monitor it over time. They describe a curve based on its shape, location, direction and angle. Doctors use a measure called the Cobb Angle to measure the degree of the curve. Scoliosis is defined as a spinal curvature that has an angle of greater than 10 degrees.

Treatment for scoliosis varies, depending on the severity of the curve at diagnosis and the likelihood that the curve will worsen. Curves that are in the upper spine, have greater curve angles, or those diagnosed in newborns, younger children and girls are more likely to worsen over time.

Typically, curves that are less than 20 degrees are considered mild and usually only require monitoring for any changes. For growing children, your spine center physician will want to evaluate your child and have X-rays of his or her spine taken every six to 12 months until the child stops growing.

Braces
Curves of between 25 and 40 degrees often require the use of a brace to keep the curve from worsening. It will not, however, cure scoliosis or improve the curve. Children who wear braces can usually lead normal, active lives. Wearing a brace will take some getting used to, both physically and emotionally. Your spine center team will help you help your child build and maintain a positive attitude toward wearing a brace.

Surgery
Doctors usually recommend surgery to correct a curve of greater than 40 to 50 degrees or for curves that rapidly progress despite bracing. In order to correct a curve, vertebrae in the back must be fused together. This involves connecting the vertebrae in the curve together, using bone taken from the pelvis. The bone is held in place by metal hooks, screws, wires or rods. These metal implants remain in the body after surgery and help provide additional stability to the spine. The bones and vertebrae fuse together over a period of months, when activity is restricted. The fused area will no longer grow, nor will it curve. The surgery takes several hours and requires a hospital stay of several days. Your spine center doctor will discuss the complications that may result from this delicate procedure.

Scoliosis can sometimes lead to other pain syndromes that need individualized treatment. This may include the use of physical therapy, medications or evaluation by other specialist physicians.