Scoliosis is a curving of the spine. The spine curves away from the middle or sideways.
Spinal curvature; Kyphoscoliosis
Causes, incidence, and risk factors:
There are three general causes of scoliosis:
- Congenital (present at birth) scoliosis is due to a problem with the formation of the spine bones (vertebrae) or fused ribs during development in the womb.
- Neuromuscular scoliosis is caused by problems such as poor muscle control or muscle weakness, or paralysis due to diseases such as cerebral palsy , muscular dystrophy , spina bifida, and polio .
- Idiopathic scoliosis is scoliosis of unknown cause. It appears in a previously straight spine.
Idiopathic scoliosis in adolescents is the most common type. Some people may be prone to curving of the spine. Most cases occur in girls. Curves generally worsen during growth spurts. Scoliosis in infants and young children are less common, and commonly affect boys and girls equally.
Scoliosis may be suspected when one shoulder appears to be higher than the other, or the pelvis appears to be tilted. Untrained observers usually can't notice the curving.
Routine scoliosis screening is now done in middle and junior high schools. Many cases, which previously would have gone undetected until they were more advanced, are now being caught at an early stage.
There may be fatigue in the spine after prolonged sitting or standing. Pain will become persistent if irritation results. The greater the initial curve of the spine, the greater the chance the scoliosis will get worse after growth is complete. Severe scoliosis (curves in the spine greater than 100 degrees) can cause breathing problems.
- Backache or low-back pain
- Shoulders or hips appear uneven
- Spine curves abnormally to the side (laterally)
Note: Kyphoscoliosis also involves abnormal front to back curvature, with a "rounded back" appearance. See kyphosis .
Signs and tests:
The health care provider will perform a physical exam, which includes a forward bending test that will help the doctor define the curve. The degree of curve seen on an exam may underestimate the actual curve seen on an x-ray, so any child found with a curve is likely to be referred for an x-ray. The health care provider will perform a neurologic exam to look for any changes in strength, sensation, or reflexes.
Tests may include:
- Scoliometer measurements (a device for measuring the curvature of the spine)
- Spine x-rays (taken from the front and the side)
- MRI (if there are any neurologic changes noted on the exam or if there is something unusual in the x-ray )
Treatment depends on the cause of the scoliosis, the size and location of the curve, and how much more growing the patient is expected to do. Most cases of adolescent idiopathic scoliosis (less than 20 degrees) require no treatment, but should be checked often, about every 6 months.
As curves get worse (above 25 to 30 degrees in a child who is still growing), bracing is usually recommended to help slow the progression of the curve. There are many different kinds of braces used. The Boston Brace, Wilmington Brace, Milwaukee Brace, and Charleston Brace are named for the centers where they were developed.
Each brace looks different. There are different ways of using each type properly. The selection of a brace and the manner in which it is used depends on many factors, including the specific characteristics of the curve. The exact brace will be decided on by the patient and health care provider.
A back brace does not reverse the curve. Instead, it uses pressure to help straighten the spine. The brace can be adjusted with growth. Bracing does not work in congenital or neuromuscular scoliosis, and is less effective in infantile and juvenile idiopathic scoliosis.
Curves of 40 degrees or greater usually require surgery because curves this large have a high risk of getting worse even after bone growth stops. Surgery involves correcting the curve (although not all the way) and fusing the bones in the curve together. The bones are held in place with one or two metal rods held down with hooks and screws until the bone heals together. Sometimes surgery is done through a cut in the back, on the abdomen, or beneath the ribs. A brace may be required to stabilize the spine after surgery.
The limitations imposed by the treatments are often emotionally difficult and may threaten self-image, especially of teenagers. Emotional support is important for adjustment to the limitations of treatment.
Physical therapists and orthotists (orthopedic appliance specialists) can help explain the treatments and make sure the brace fits comfortably.
The outcome depends on the cause, location, and severity of the curve. The greater the curve, the greater the chance the curve will get worse after growth has stopped.
Mild cases treated with bracing alone do very well. People with these kinds of conditions tend not to have long-term problems, except maybe an increased rate of low back pain when they get older. People with surgically corrected idiopathic scoliosis also do very well and can lead active, healthy lives.
Patients with neuromuscular scoliosis have another serious disorder (like cerebral palsy or muscular dystrophy) so their goals are much different. Often the goal of surgery is simply to allow a child to be able to sit upright in a wheelchair.
Babies with congenital scoliosis have a wide variety of underlying birth defects. Management of this disease is difficult and often requires many surgeries.
- Emotional problems or lowered self-esteem may occur as a result of the condition or its treatment (specifically, wearing a brace)
- Failure of the bone to join together (very rare in idiopathic scoliosis)
- Low back arthritis and pain as an adult
- Respiratory problems from severe curve
- Spinal cord or nerve damage from surgery or severe, uncorrected curve
- Spine infection after surgery
Calling your health care provider:
Call your health care provider if you suspect your child may have scoliosis.
References: Hedequist DJ. Surgical treatment of congenital scoliosis. Orthop Clin North Am. 2007;38(4):497-509, vi.