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Scoliosis

What is scoliosis?

A normal spine, when viewed from behind, appears straight. However, a spine affected by scoliosis shows evidence of a lateral, or sideways, curvature, and a rotation of the back bones (vertebrae), giving the appearance that the person is leaning to one side. Scoliosis is defined as a curvature of the spine measuring 20 degrees or greater on X-ray.

Scoliosis is a type of spinal deformity and should not be confused with poor posture.

Spinal curvature from scoliosis may occur on the right or left side of the spine, or on both sides in different sections. Both the thoracic (mid) and lumbar (lower) spine may be affected by scoliosis.

What causes scoliosis?

In most cases, the cause of scoliosis is unknown - a condition called idiopathic scoliosis. Scoliosis is more common in females than males.

The American Academy of Orthopaedic Surgeons, in cooperation with the Scoliosis Research Society, describe three different types of scoliosis that can occur in children - congenital (present at birth), neuromuscular, or idiopathic.

• congenital
  This type of scoliosis occurs during fetal development. It is often caused by one of the following:
  • failure of the vertebrae to form normally
  • absence of vertebrae
  • partially formed vertebrae
  • lack of separation of the vertebrae
• neuromuscular
  This type of scoliosis is associated with many neurological conditions, especially in those children who do not walk, such as the following:
  • cerebral palsy
  • spina bifida
  • muscular dystrophy
  • paralytic conditions
  • spinal cord tumors
  • neurofibromatosis - a genetic condition that affects the peripheral nerves that causes changes to occur in the skin, called café-au-lait spots.
• idiopathic
  The cause of this type of scoliosis is unknown. There are three types of idiopathic scoliosis:
  • infantile - occurs from birth to 3 years of age. The curve of the vertebrae is to the left and it is more commonly seen in boys. Typically, the curve resolves as the child grows.
  • juvenile - occurs in children from 3 to 9 years of age.
  • adolescent - occurs in children from 10 to 18 years of age. This is the most common type of scoliosis and is more commonly seen in girls.

Other causes of scoliosis may include:

• hereditary conditions that tend to run in families
• differences in leg lengths
• injury
• infection
• tumors

What are the symptoms of scoliosis?

The following are the most common symptoms of scoliosis. However, each child may experience symptoms differently. Symptoms may include:

• difference in shoulder height
• the head is not centered with the rest of the body
• difference in hip height or position
• difference in shoulder blade height or position
• when standing straight, difference in the way the arms hang beside the body
• when bending forward, the sides of the back appear different in height

Back pain, leg pain, and changes in bowel and bladder habits are not commonly associated with idiopathic scoliosis. A child experiencing these types of symptoms requires further medical evaluation by a physician.

The symptoms of scoliosis may resemble other spinal conditions or deformities, or may be a result of an injury or infection. Always consult your child's physician for a diagnosis.

How is scoliosis diagnosed?

In addition to a complete medical history and physical examination, x-rays (a diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film) are the primary diagnostic tool for scoliosis. In establishing a diagnosis of scoliosis, the physician measures the degree of spinal curvature on the x-ray.

The following other diagnostic procedures may be performed for non idiopathic curvatures, atypical curve patterns, or congenital scoliosis:

• magnetic resonance imaging (MRI) - a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.
• computed tomography scan (Also called a CT or CAT scan.) - a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.

Early detection of scoliosis is most important for successful treatment. Pediatricians or family physicians, and even some school programs, routinely look for signs that scoliosis may be present.

Treatment of scoliosis:

Most patients with scoliosis do well without treatment. Only 10 percent of those diagnosed with idiopathic scoliosis develop a curve that is large enough to consider treatment. The rest require only advice and observation.

When a progressive curve does need attention, orthopaedic specialists at The Children's Hospital of Philadelphia only consider treatment after a careful examination of the patient and diagnostic tests. We individualize treatment for every child or adolescent and explain options through the use of models and other teaching aids. Treatment options are based on:

•  X-rays
• Demographics
• Magnetic resonance imaging (MRI)
• Computerized tomography (CAT scan)
• Radioisotope bone scan or Dexacen (which determines the health and strength of the bone in the spine.)

A bracing program used for a period of time may be all that is necessary for a progressive but moderate-sized scoliosis curve. For very large, deforming curves, surgical correction may be considered.

According to the Scoliosis Research Society, there is no scientific evidence to show that other methods for treating scoliosis (i.e., manipulation, electrical stimulation, and corrective exercise) prevent the progression of the disease.

Long-term outlook for a child with scoliosis:

The management of scoliosis is individualized for each child depending on his/her age, amount of curvature, and amount of time remaining for skeletal growth. Scoliosis will require frequent examinations by your child's physician to monitor the curve as your child grows and develops. Early detection is important. If left untreated, scoliosis can cause problems with heart and lung function.