Scoliosis

Introduction

Normal spine and scoliosis spine

Scoliosis is a common spinal deformity which affects about 3% of adolescent, young children, and some babies. Scoliosis is a sideways (towards the lateral side) curvature of the spine that occurs most often during the growth spurt just before puberty. In most of the cases, it is related to the rotation of the vertebrae. In the majority of the patients with scoliosis, the mobility of the vertebrae is decreased significantly, interfering the active strengthening of the spine. A normal spine looks straight when it is viewed from the front or back whereas scoliosis spine looks curved if it is viewed from the front or back. Scoliosis spine looks like the letter ā€˜Cā€™ or ā€˜Sā€™.

Most of the cases of scoliosis are mild, but in some children, it becomes severe with spinal deformities with increased age and causes some complications. For example, A severe spinal curve can decrease the space within the chest, affecting the lungs to function properly.

Children who have mild scoliosis are monitored closely with X-rays to see if the curve is getting worse. In many cases, no treatment is required. Some children will have to wear a brace to stop the curve from getting worse. Others might need surgery to keep scoliosis from getting worse, and to straighten in severe cases of scoliosis.

Causes of scoliosis

Scoliosis spine signs

Following are the possible causes of scoliosis:

Idiopathic scoliosis (unknown cause):

This type of scoliosis commonly seen 80% of cases without any specific cause.

Neuromuscular scoliosis:

It is a spinal deformity which occurs due to the improper functioning of the nervous system or the muscles. The patients with neuromuscular scoliosis are more likely to have rapid progression of the spinal deformity throughout their lives. Cerebral palsy, muscular dystrophy, neurofibromatosis, etc. are the example of some neuromuscular disease that can affect the spine, and increases the risk of scoliosis.

Congenital scoliosis (present at birth):

Paediatric or congenital scoliosis is a rare condition, which is typically noticed due to the change in the stature, or during the routine screenings. This type of scoliosis occurs during the intrauterine developmental period of the foetus.

Heredity:

Commonly involved gene - GPR126.

Leg length:

If someone's leg is longer than the other, the individual may develop scoliosis.

Other:

Poor posture, using backpacks or briefcases, and exercise can also cause scoliosis.

Signs and symptoms

Signs and symptoms of scoliosis may include:
  • Uneven shoulders
  • Uneven waist
  • Shoulder blade that appears more prominent than the other
  • A hip higher than the other
  • If scoliosis curve worsens, the spine will also rotate or twist, in addition to curvature side to side. This makes the ribs on one side of the body to protrude farther than the other side. Severe scoliosis can cause pain and difficulty breathing back.

    Risk factors

    Risk factors for developing the most common type of scoliosis include:

    Age:

    Signs and symptoms usually begin during the growth stage that occurs just before puberty. This is usually between the ages of 9 to 15 years.

    Sex:

    Girls have a much higher risk of developing scoliosis.

    Family history:

    Scoliosis can be hereditary, but most children with scoliosis have no family history of the disease.

    The doctor initially reviews a detailed medical history and might ask questions about the recent growth. During the physical examination, your doctor might make your child stand and then bend forward from the waist, arms hanging freely, to see if one side of the chest is more prominent than the other.

    x-ray of scoliosis spine

    Your doctor may also perform a neurological exam to check:

  • Muscle weakness
  • Numbness
  • Abnormal reflexes
  • A plain radiograph can confirm the diagnosis of scoliosis and reveal the severity of the curvature of the spine. If the doctor suspects an underlying disease - like a tumor - is causing scoliosis, he or she may recommend additional imaging tests, including:

    MRI (magnetic resonance imaging): MRI uses radio waves and a powerful magnetic field to produce detailed images of bones and soft tissues.

    CT (computed tomography): CT combines X-rays taken from many different directions to produce images in more detail than do plain radiographs.

    Bone scan: Bone scans involve injecting a radioactive material that travels to the parts of the bones that are injured or healing.

    Most children with scoliosis have smooth curves and probably will not need treatment with a brace or surgery. Children who have mild scoliosis may require examinations every 4 to 6 months to see if there have been changes in the curvature of their spines.

    What are the treatments available for scoliosis?

    There are some guidelines for mild, moderate and severe curves; the decision to start treatment is always done individually.

    Factors to consider include:

    Sex

    Girls have a much higher risk of progression than boys do.

    The severity of the curve:

    Larger curves are more likely to get worse over time.

    The pattern of the curve:

    Double curved or S-shaped curves, tend to worsen more often than do C-shaped curves.

    Location of the curve:

    Curves located in the (rib) center section of the spine worse more often than do curves in the upper or lower sections of the spine.

    Age

    If a child's bones have stopped growing, the risk of curve progression is low. That also means that the braces have the greatest effect on children whose bones are still growing.

    Braces

    If your child's bones are still growing, and he or she has moderate scoliosis, the doctor may suggest a brace. Wearing a brace will not cure scoliosis or reverse the curve, but usually prevents progression of the curve.

    Most braces are worn day and night. The effectiveness of a brace increases with the number of hours per day that is worn. Children who wear braces can usually participate in most activities and have few restrictions. If necessary, children can take off the corset to participate in sports or other physical activities.

    The supports are discontinued after the bones stop growing. This usually happens:

  • Nearly two years after girls start menstruating
  • When there are no more changes in height
  • Different options of braces to treat scoliosis

    Surgery:

    Diagram of corrected spine pre and post surgery

    Severe scoliosis typically progresses over time, so your doctor may suggest surgery to reduce the severity of scoliosis curve of the spine and to prevent worsen further. The most common type of scoliosis surgery is called spinal fusion.

    In spinal fusion operation, surgeons connect two or more bones of the spine (vertebrae) together, so they cannot move independently. A piece of bone or bone-like material is placed between the vertebrae. Metal rods, hooks, screws or wires may be used to hold a part of the spine straight while the bone heals.

    Surgery is usually delayed until after a child's bones have stopped growing. If scoliosis is rapidly progressing at an early age, surgeons can install a bar that can be adjusted in length as the child grows. This growth rod joins the upper and lower sections of the curvature of the spine, and usually increase the length of rod every six months.

    Complications of spinal surgery can include bleeding, infection, and pain or nerve damage. In rare cases, the bone does not heal, and another surgery may be necessary.