Patient Information: Scoliosis
What is scoliosis?
Scoliosis is a lateral [sideways] curvature of the spine that usually develops in preadolescence or during early adolescence. In most cases the curve is slight, but in severe cases, it can resemble either an S or C in shape.
The normal spine appears curved when viewed from behind. In scoliosis, the opposite is true; the spine appears straight when viewed from the side yet curved from behind.
Facts about scoliosis
- 1 in 10 persons has scoliosis, generally with a mild curve.
- Curves of greater severity affect females more than males.
- Surgery may be necessary in 1 out of 1,000 cases.
- Scoliosis is generally not painful in adolescence, but become painful in adulthood.
- Scoliosis is best treated when the patient is younger. The body can respond better to treatment such as bracing while it is still growing.
- Scoliosis increases during the adolescent growth periods. However, only the larger curves continue to progress during adult life.
Frequent signs of scoliosis
Normal
- Shoulders are level.
- Shoulder blades are levels and have equal prominence.
- Hips are level.
- Both arms are an equal distance from the body.
Scoliotic
- One shoulder is higher than the other.
- One shoulder blade is higher and possibly more prominent.
- One hip is more prominent than the other.
- There is an unequal distance between the arms and body.
- Clothes don’t “hang right”.
- Prominent breast may be evident in females.
What causes scoliosis?
Approximately 80% of scoliosis cases are idiopathic [of unknown cause]. In most of these cases the condition develops between the ages of 10 and 15. It tends to run in families.
Other cases are congenital [present from birth], while still others are caused by accidents [spinal cord injury] or disease [cerebral palsy, muscular dystrophy].
How is scoliosis detected?
Scoliosis can be detected by observing the patient’s back from different angles and positions. This procedure is known as “screening” and is often carried out in schools. If your child is suspected of having scoliosis, an appointment should be made with your family doctor.
Your doctor will perform a forward bend test. When a person with scoliosis bends forward, one side of the spine will appear more prominent than the other. If the doctor detects an abnormal curve, an x-ray will be taken and an orthopaedic consultation arranged.
Progression of curve
After an x-ray has been taken of the patient in the standing position, the degree of scoliotic curvature is measured. This measurement is known as a Cobb measurement. The two most tilted vertebrae are marked, one at the top of the curve, the other at the bottom. Right-angled lines are drawn from each of these vertebrae until the lines inter-sect. the resultant angle is then measured to determine the degree of the scoliosis.
At present there is no way to predict, at the time of discovery, which curves will worsen. Some smaller curves do not increase.
Many curves remain stable for years but suddenly get worse during the adolescent growth spurt. The child’s potential for further growth is therefore an important factor in predicting curve progression. In general, patients who still have a lot of growth ahead have a higher risk of curve progression. Growth potential is evaluated by age at diagnosis, menstrual history, and radiologist signs [x-ray] of bone maturity.
Female patients have a greater risk of curve progression, and large curve will tend to increase during pregnancy.
The twisting that curvature causes at the spine and ribs compresses the lungs and thus impairs their function. Mild effects are seen in curves greater than 60 degrees, while more serious effects occur in curves greater than 80 degrees. The only way to prevent impairment of lung function is to stop the progression of scoliosis.
Treatment of Scoliosis
Scoliosis is treated to prevent curve increase and the resulting compromise of lung function, and to preserve good appearance. There are three main types treatment: observation, bracing, and operation. Choice of treatment depends on factors such as age, severity of curve, speed of progression, appearance, cause, lung function, home circumstances, and patient preference.
There has never been a single scientific article documenting the value of exercise, massage, or manipulation in the prevention of further curve progression. On the other hand, the curve will not get worse through participation in sports such as aerobatics, gymnastics, swimming, aerobics, ballet, modern dance, and cheerleading.
Nonsurgical treatment
Observation Patients with recently diagnosed mild curves are observed for a period of time to determine if a curve will progress. Since most curves do not become severe, observation is commonly all that is require. It enables the physician and require active treatment. The most accurate method of observation is to perform a standing 3-foot x-ray. Each x-ray is compared with previous ones to determine the amount of curve progression. In general, children with mild curves should be followed every 6 months to 1 year. Adolescent with larger spinal curves should be seen every 3 to 6 months.
Bracing Bracing is generally used when the child is still growing and the curve is between 20 and 40 degrees. Its purpose is to control the curve and prevent further progression. A program for use of the brace is developed by physician. Some braces are applied at night only, other both day and night. For maximum benefit, bracing must be started before a significant deformity has developed, and is usually used until growth is complete. In 15-20% of cases, however, this treatment is not effective, and so an operation becomes necessary. Braces can be stressful for adolescents to wear as their body image may be affected.
Surgical treatment
It is estimated that 85% of surgeries can be prevented if bracing is started when the curve is 20 to 30 degrees and the child is still growing.
Surgery is generally performed when the spine’s curve is greater than 50 degrees. Surgery consists of straightening out the spine with metal rods. These clip onto the spine in such a way that the spine is straightened and held rigid at the same. The bone is then fused using a bone graft from the pelvis. To stabilize the area after the fusion, one or two steel rods are implanted under the skin and the spine. Many kinds of instruments are used in scoliosis surgery. The exact type of rod used varies according to the particular condition. Some examples of instrumentation names you might hear are Harrington Rod, Cortel-Dubousset, And Luque.
This surgical procedure can reduce the curve by about 50%. The steel rod does reduce flexibility in part of the spine. However, if patients can touch their toes before the operation, they will be able to do so afterwards.
Before surgery, some general tests are performed [blood tests, urine samples, and x-ray]. No food or drinks are allowed for several hours before the operation. The surgery can be quite lengthy, depending on the factors involved [complexity of the procedure, other medical problems, etc.]. The average length of surgery is 3 to 5 hours.
Because of the length and complexity of this surgery, the patient can lose lot of blood. The lost blood may be washed and returned to the patient, but a blood transfusion is occasionally required. Thus some patients like to donate blood in advance.
After surgery
After the surgery is complete, the patient wakes up in the recovery room with an intravenous line attached and possibly with a brace or cast applied. The patient will be taught to roll from side to side every 3-5 days after surgery. These include showering, sitting, and walking. It is important to bend the knees when sitting and to keep the back straight.
Tips for parents
- Don’t panic! Many advances in surgical and other kind of treatment have been made in this field. Doctor who treat this condition are familiar with its details and have repeatedly demonstrated high levels of success in treating it.
- Ask questions. You should discuss your child’s problem thoroughly with your doctor. Write down your question so that they are not forgotten during the next visit.
- If your child needs to wear a brace, establish a daily routine for its use. This makes coping with the brace a little easier.
- Talk to other parents, and allow children to talk to peers with similar conditions.
- Your child will need your support throughout treatment.
- Encourage your child to resume normal activities as soon as is medically recommended.