Scoliosis affects 5 to 7 million
people in the United States. More than a half million visits are made to
doctors’ offices each year for evaluation and treatment of scoliosis.
Although scoliosis can begin at any age, it most often develops in
adolescents between the ages of 10 and 15. Girls are more commonly
affected than boys. Because scoliosis can be inherited, children whose
parents or siblings are affected by it should definitely be evaluated by
a trained professional.
What is scoliosis?
Because we walk on 2 feet, the human
nervous system constantly works through reflexes and postural control to
keep our spine in a straight line from side to side. Occasionally, a
lateral (sideways) curvature develops. If the curvature is larger than
10 degrees, it is called scoliosis. Curves less than 10 degrees are
often just postural changes. Scoliosis can also be accompanied by
lordosis (abnormal curvature toward the front) or kyphosis (abnormal
curvature toward the back). In most cases, the vertebrae are also
rotated.
In more than 80% of cases, the cause of
scoliotic curvatures is unknown; we call this condition idiopathic
scoliosis. In other cases, trauma, neurological disease, tumors, and the
like are responsible. Functional scoliosis is often caused by some
postural problem, muscle spasm, or leg-length inequality, which can
often be addressed. Structural scoliosis does not reduce with postural
maneuvers. Either type can be idiopathic or have an underlying cause.
What are the symptoms of scoliosis?
Scoliosis can significantly affect the
quality of life by limiting activity, causing pain, reducing lung
function, or affecting heart function. Diminished self-esteem and other
psychological problems are also seen. Because scoliosis occurs most
commonly during adolescence, teens with extreme spinal deviations from
the norm are often teased by their peers.
Fortunately, 4 out of 5 people with
scoliosis have curves of less than 20 degrees, which are usually not
detectable to the untrained eye. These small curves are typically no
cause for great concern, provided there are no signs of further
progression. In growing children and adolescents, however, mild
curvatures can worsen quite rapidly—by 10 degrees or more—in a few
months. Therefore, frequent checkups are often necessary for this age
group.
How is scoliosis evaluated?
Evaluation begins with a thorough
history and physical examination, including postural analysis. If a
scoliotic curvature is discovered, a more in-depth evaluation is needed.
This might include a search for birth defects, trauma, and other
factors that can cause structural curves.
Patients with substantial spinal
curvatures very often require an x-ray evaluation of the spine. The
procedure helps determine the location and magnitude of the scoliosis,
along with an underlying cause not evident on physical examination,
other associated curvatures, and the health of other organ systems that
might be affected by the scoliosis. In addition, x-rays of the wrist are
often performed. These films help determine the skeletal age of the
person, to see if it matches an accepted standard, which helps the
doctor determine the likelihood of progression. Depending on the
scoliosis severity, x-rays may need to be repeated as often as every 3
to 4 months to as little as once every few years.
Other tests, including evaluation by a
Scoliometer™, might also be ordered by the doctor. This device measures
the size, by angle, of the rib hump associated with the scoliosis. It is
non-invasive, painless, and requires no special procedures. A
Scoliometer™ is best used as a guide concerning progression in a person
with a known scoliosis—not as a screening device.
Is scoliosis always progressive?
Generally, it is not. In fact, the vast
majority of scolioses remains mild, is not progressive, and requires
little treatment, if any.
In one group of patients, however,
scoliosis is often more progressive. This group is made up of young
girls who have scolioses of 25 degrees or larger, but who have not yet
had their first menstrual period. Girls generally grow quite quickly
during the 12 months before their first period and if they have
scolioses, the curvatures tend to progress rapidly. In girls who have
already had their first periods, the rate of growth is slower, so their
curves tend to progress more slowly.
What is the treatment for scoliosis?
There are generally three treatment
options for scoliosis—careful observation, bracing, and surgery. Careful
observation is the most common “treatment,” as most mild scolioses do
not progress and cause few, if any, physical problems. Bracing is
generally reserved for children who have not reached skeletal maturity
(the time when the skeleton stops growing), and who have curves between
25 and 45 degrees. Surgery is generally used in the few cases where the
curves are greater than 45 degrees and progressive, and/or when the
scoliosis may affect the function of the heart, lungs, or other vital
organs.
Spinal manipulation, therapeutic
exercise, and electrical muscle stimulation have also been advocated in
the treatment of scoliosis. None of these therapies alone has been shown
to consistently reduce scoliosis or to make the curvatures worse. For
patients with back pain along with the scoliosis, manipulation and
exercise may be of help.
Most people with scoliosis lead normal,
happy, and productive lives. Physical activity including exercise is
generally well-tolerated and should be encouraged in most cases.
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