SCOLIOSIS

DEFINITION

Scoliosis (pronounced SKO-lee-OH-siss) is a side-to-side curvature of the spine (backbone).

DESCRIPTION

When viewed from the back, the spine usually appears perfectly straight. In some cases, however, the spine is curved rather than straight. In addition, the vertebrae (the bones that make up the spinal column) are twisted. This condition is known as scoliosis.

A small degree of curving in the spine does not usually cause any medical problems. But larger curves can lead to certain disorders, such as posture imbalance, muscle fatigue, and back pain. Severe scoliosis can interfere with breathing and lead to spondylosis (arthritis of the spine; pronounced spon-dl-OH-siss).

About 10 percent of all adolescents have some degree of scoliosis. Less than 1 percent, however, require medical attention other than careful observation of the problem. Scoliosis occurs in both sexes, but appears in girls about five times more often than in boys. Scoliosis appears most often in adolescents between the age of ten and thirteen.

CAUSES

Scoliosis is not caused by poor posture, diet, or carrying heavy objects. The cause of scoliosis is known in only about 20 percent of all cases. These cases are classified as follows:

• Congenital scoliosis is caused by defects in the spine present at birth. This form of scoliosis is also accompanied by other disorders of various organs.
• Neuromuscular scoliosis is caused by problems with the nerves or muscles. They are unable to support the spine in its normal position. The most common causes of this type of scoliosis are cerebral palsy (see cerebral palsy entry) and muscular dystrophy (see muscular dystrophy entry).
• Degenerative scoliosis is caused by deterioration of the bony material (discs) that separate the vertebrae. Arthritis in the spinal cord can also lead to degenerative scoliosis.

In four out of five scoliosis cases, however, the cause is unknown. Such cases are known as idiopathic scoliosis. Children with idiopathic scoliosis have not suffered from related disorders such as bone or joint disease early in life. Some researchers believe that the condition may be inherited, but scientists have yet to find a gene responsible for the disease.

SYMPTOMS

Scoliosis causes a curvature in the upper body that is easy to notice from the front or back. The curvature may be noticed when a child is wearing a bathing suit or underwear. The child may appear to be standing with one shoulder higher than the other, or one shoulder blade may be pushed forward because the body has been rotated by scoliosis.

The amount of curvature increases during the adolescent years. During this period, a person's bones are growing and developing. Any curvature present before adolescence is likely to become more pronounced. As a result, cases of scoliosis that begin early in life tend to get worse than those that develop later in life.

More than thirty states have set up screening programs for scoliosis. A screening program is a plan for the detection of some specific medical problem.

DIAGNOSIS

Diagnosis for scoliosis is usually done by an orthopedist. An orthopedist is a doctor who specializes in bones and joints. The orthopedist normally takes a complete medical history and conducts a physical examination. In the medical history, the orthopedist attempts to find out whether scoliosis has been present in other family members.

One purpose of the medical examination is to look for specific physical causes for the scoliosis. For example, the doctor might look for nerve or muscle disorders that might cause the problem.

A major part of the examination involves a careful observation of the patient's upper body. The patient may be asked to stand, bend over, and lie down. The doctor is able to study the patient's spine in all of these positions. A simple device called a scoliometer can be used to determine the extent to which the spine is curved.

The most conclusive diagnosis of scoliosis is based on X rays. An X ray of the back shows exactly where and how much the spine is curved. The doctor can make very precise calculations from the X-ray photograph to determine a measurement known as the Cobb angle. The Cobb angle combines all of the data provided by an X-ray photograph to determine the extent of a person's scoliosis.

Occasionally, magnetic resonance imaging (MRI), which uses electro-magnets and radio waves to produce images of a patient's internal tissue and organs, can be used in the diagnosis of scoliosis. MRI shows the condition of the spinal cord and the nerves extending from it. It can be used to tell if problems with the nervous system are responsible for the scoliosis.

TREATMENT

A number of factors determine the kind of treatment for scoliosis. These factors include the amount of curvature, the likelihood of improvement, and the amount of pain that may be involved, if any.

Observation

A perfectly straight spine is said to have a curvature of 0 degrees. Children who have curvature of less than 20 degrees usually do not receive any form of treatment.

In many cases, the only medical attention required for scoliosis is careful observation over time. This observation allows doctors to decide whether some form of treatment may be necessary or not. Observation is usually used with adolescents whose spine has a curvature of 20 to 30 degrees. It is also used with adults with a curvature as high as 40 degrees, as long as there is no pain.

Bracing

In more serious cases of curvature, a procedure known as bracing may be used. Bracing is a method of treatment in which the upper body is held in position by metal rods. Three types of bracing are used for scoliosis:

• The Milwaukee brace consists of metal rods attached to pads at the hips, rib cage, and neck.
• The underarm brace uses rigid plastic to surround the lower rib cage, abdomen, and hips.
• The Charleston bending brace is used at night to bend the spine in the opposite direction.

Braces are usually worn for twenty-two to twenty-four hours each day. Bracing is used with children or adolescents whose curvature is greater than 30 degrees and who are expected to grow for at least another year.

The procedure cannot correct curvature that has already occurred. But it can help to prevent the problem from getting worse. Bracing is seldom used with adults. Two situations in which it may be used are with people who suffer great pain and those who cannot undergo surgery.

Surgery

Scoliosis can also be treated with surgery. Surgery is usually recommended under the following conditions:

• The curvature has progressed despite bracing.
• The curvature is greater than 40 to 50 degrees before growth has stopped in an adolescent.
• The curvature is greater than 50 degrees and continues to increase in an adult.
• The patient is in significant pain.

Surgery for neuromuscular surgery is often done earlier. The three goals of surgery are to correct the curvature as much as possible, to prevent further curvature, and to relieve pain. Surgery can usually correct 40 to 50 percent of the curvature, and sometimes as much as 80 percent. It is not always successful in completely removing pain.

The surgical procedure for scoliosis is called spinal fusion. The goal of this procedure is first to straighten the spine as much as possible. Then, the vertebrae are joined together to prevent further curvature.

The first step in spinal fusion is to uncover the vertebrae in the region of curvature. These vertebrae are then scraped clean to produce smooth surfaces. The vertebrae are then joined to each other. When joined in this way, the vertebrae eventually grow together. Metal rods are then inserted along the spine. The vertebrae are attached to the rods with hooks, screws, or wires. The rods hold the spine in position until the vertebrae grow together.

Spinal fusion leaves the involved section of the spine permanently stiff and inflexible. A person no longer has a full range of motion. However, most activities are usually not affected by this change. Normal mobility (movement), exercise, and even contact sports are possible after spinal fusion. Full recovery following spinal fusion takes about six months.

Alternative Treatment

Exercise may help relieve the pain of scoliosis. However, it has no effect on the overall development of the disorder. Good nutrition is also helpful in maintaining a healthy body. But nutrition also has no effect on the progression of scoliosis.

Chiropractic treatment can sometimes relieve the pain of scoliosis. But it does not stop or slow down the progress of the disorder. It also should not be used in place of standard medical treatments. Acupuncture and acupressure may also help reduce and pain and discomfort, but have no effect on the disorder itself.

Illustration of side-to-side spinal curvature that occurs with scoliosis. (© 1994

J. McDermott

. Reproduced by permission of

Custom Medical Stock Photo

.)

PROGNOSIS

The prognosis for a person with scoliosis depends on many factors. One of the most important factors is the age at which scoliosis begins. Another factor is the kind of treatment used and the stage at which it was started. Probably the most important factors of all are those beyond the control of medical science, that is, the unknown factors that produce scoliosis in the first place.

Most cases of mild adolescent idiopathic scoliosis need no treatment and do not progress. Untreated severe scoliosis may lead to arthritis of the spine and impair breathing.

PREVENTION

There is no known way to prevent scoliosis. Bracing or surgery, however, can prevent the disorder from progressing.

FOR MORE INFORMATION

Books

Eisenpreis, Bettijane. Coping With Scoliosis. New York: Rosen Publishing Group, 1999.

Neuwirth, Michael, and Kevin Osborn. The Scoliosis Handbook. New York: Henry Holt & Co., 1996.

Schommer, Nancy. Stopping Scoliosis: The Complete Guide to Diagnosis and Treatment. Garden City Park, NY: Avery Publishing Group, 1991.

Organizations

National Scoliosis Foundation, 72 Mount Auburn St., Watertown, MA 02172. (617) 926–0397.

Scoliosis Research Society. 6300 N. River Rd., Suite 727, Rosemont, IL 60018–4226. (708) 698–1627.

The Scoliosis Association. P.O. Box 811705, Boca Raton, FL 33481–0669. (407) 368–8518.