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Scoliosis is an abnormal curvature of the spine. In scoliosis, the spine curves to the side when viewed from the front, and each vertebra also twists on the next one in a corkscrew fashion.
Our spine is an engineering marvel that supports our weight and ties our body together. The spinal column consists of a stack of small bones that range in size from 2-3 inches to 5-6 inches in diameter. When viewed from the front, the spine appears to be straight, but when looked at from the side, the normal spine has 2 gentle s-curves.
Scoliosis affects girls twice as often as it affects boys. About 3-5 of 1,000 people are affected. Scoliosis usually occurs in those older than 10 years, but the condition can be seen in infants.
In most cases (85%), the cause of
scoliosis is unknown (what doctors call idiopathic). The other 15% of cases fall
into 2 groups:
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Nonstructural (functional): This type of scoliosis is a temporary condition when the spine is otherwise normal. The curvature occurs as the result of another problem. Examples include 1 leg being shorter than another from muscle spasms or from appendicitis. |
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Structural: In this type of scoliosis, the spine is not normal. The curvature is caused by another disease process such as a birth defect, muscular dystrophy, metabolic diseases, connective tissue disorders, or Marfan syndrome. |
Note: Some form of scoliosis occurs in the majority of people with Coffin-Lowry syndrome. -MCH
These symptoms are only those
associated with the spine being curved:
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Your head may be off center. |
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One hip or shoulder may be higher than the other. |
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You may walk with a rolling gait. |
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The opposite sides of the body may not appear level. |
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You may experience back pain or
tire easily during activities that require excessive trunk (chest and belly)
movement. |
Scoliosis usually occurs around age 10 years.* Most school systems have screening programs that look for scoliosis. The most common test is to have the child stand with his or her feet straight ahead and with knees locked and then slowly bend over to touch their toes. If the school notifies you that they are concerned, you should contact your doctor to make a routine appointment within the next 1-2 months.
If your doctor (or pediatrician) examines your child and is suspicious, the doctor may repeat the exam in 4-6 months to see if there is any change. Most children do not need to be treated for scoliosis when the curvature is mild.
*In Coffin-Lowry syndrome, some curvature may be present even in infancy. -MCH
The physical exam involves having the child undressed from the waist up. The child faces forward with the feet straight ahead and the palms inward. With the knees locked, the child slowly bends over at the waist and tries to touch their toes. The doctor then looks at the spine for the appearance of straightness.
X-rays may be necessary in order to measure the curvature. Depending on the degree of the curvature and whether it gets worse over time, the doctor may recommend treatment.
The majority of cases of scoliosis do not require treatment.
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If the curve is less than 25°, no treatment is required, and the child can be reexamined every 4-6 months. |
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If the curve is more then 25° but less than 30°, a back brace may be used for treatment. |
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Curves more than 45° will need to be evaluated for the possibility of surgical correction. Surgical correction involves fusing vertebrae together to correct the curvature and may require inserting rods next to the spine to reinforce the surgery. |
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Treatment options depend more on how likely it is that the curve will worsen than on the angle of the curve itself. A child with a 20° curve and 4 more years of growth may require treatment while a child with 29° of curvature who has stopped growing may not require treatment.* |
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*It is important to note that children with CLS have delayed bone development. This is important when considering scoliosis surgical intervention. The normal spine obtains 90% of its growth by age 12 which is the time that surgical intervention is usually done. However, in CLS, that same point may not occur until the child is 14. This additional growth needs to be accounted for when considering when and how to perform surgical correction. If delaying surgery is not an option due to the severity of the curve, specialized hardware can be used which will allow for additional growth. -MCH |
Follow-up
If your child is referred by the
school for a scoliosis evaluation, you should make an appointment to see your
pediatrician within the next month or so. Your pediatrician can then evaluate
your child and decide whether they should be monitored with a repeat exam or
referred to a specialist.
If your child is treated with a brace
or surgery, you should follow the instructions provided by your doctor.
Prevention
Scoliosis is not preventable. At this
time, we do not understand what causes the condition in the majority of
children.
Outlook
With early screening and detection, most children with scoliosis can be treated to prevent more curvature. They can lead normal lives and have the same life span as other healthy people. The prognosis depends more on why the scoliosis occurred. If it occurs because of another disease, the outcome is related to the other disease rather than to the scoliosis.
Support Groups and Counseling
You may find more information on the
Internet or by contacting the following organizations:
National Scoliosis Foundation
5 Cabot Place
Stoughton, MA 02072
(781) 341-6333
Fa (781) 341-8333
Email: Scoliosis@aol.com
This nonprofit voluntary organization provides pamphlets, a newsletter, and
other informational material on childhood and adult scoliosis. The foundation
also provides support group information and lists of doctors in each state who
specialize in scoliosis.
The Scoliosis Association, Inc.
PO Box 811705
Boca Raton, FL 33481-1705
(800) 800-0669
(561) 994-4435
Fa (561) 994-2455
This association publishes a quarterly newsletter and pamphlets. The association also provides information about local chapters and support groups.
The
Scoliosis Research Society
6300 North River Road, Suite 727
Rosemont, IL 60018-4226
(847) 698-1627
Fa (847) 823-0536
E-mail: Goulding@aaos.org
The society is a professional organization for orthopedic surgeons interested in scoliosis. It provides pamphlets about the diagnosis and treatment of scoliosis. Price information for ordering pamphlets is available from the society. The society also can provide referrals to physicians.
American Physical Therapy Association
1111 North Fairfax St.
Alexandria, VA 22314
(800) 999-2782
To obtain a copy of the American
Physical Therapy Association's brochure about scoliosis, you may send a
self-addressed, stamped envelope.