Scoliosis means curvature in Greek where the condition develops during childhood and the spine either turns to the right or the left. The spine does have natural curves in the area of cervical, thoracic and lumbar regions. The curves do work as shock absorbers for the body as well as distribute stress throughout the body. Depending on the curvature the abnormal rotation which can for example occur at the thoracic level of the spine can cause rib protrusion on the reverse side of the curve. In USA it is estimated that 3-5 out of 1,000 children will have scoliotic curvature that would require treatment and in the world there is 1% of scoliosis. Congenital scoliosis is when it occurs during birth and idiopathic is without known reason.
Infantile scoliosis – more seen in boys and usually before age 3. Can improve on its own or can become worse.
Juvenile scoliosis – usually observed in girls up to age 10 and more likely to advance into and may need surgery.
Adolescent scoliosis: adolescent idiopathic scoliosis (AIS)- can begin at onset of puberty. Females are at higher risk and if curvature is not interrupted with bracing surgery may be required.
Curve progression and deformity can be prevented with early recognition of scoliosis because if not treated can worsen with inflexible, rounded spine which can increase risk of complications.
Primary care visit is of major importance where medical history can be further discussed as well as The physician looks for any underlying medical condition that might be causing scoliosis and attributing factors could be discussed. A complete physical examination reveals a lot about the health of the patient and during which progress can be measured. The patient is observed standing front to back and any asymmetry can be noted. The physical examination includes Adam’ s Forward Bending test, measure for leg length discrepancy, palpation for spinal abnormalities, range of motion to measure the degree of movements that can be performed. Neurological evaluation which evaluation of pain, paresthesias, muscle spams, weakness, bowel and/or bladder changes. X-rays can be a first diagnostic test to observe the entire length of spine with two views: anterior- posterior (PA) and lateral (side).
How much growing is left to do? Risser sign allows one to see iliac crest growth plate which is part of the pelvis which at maturity the crest will together with the pelvis. Another way to observe skeletal maturation is with a hand x-ray. Scoliosis curve can progress if child has growing to do.
This depends on the child’s age and the remaining growth potential, curve pattern and magnitude, anticipated rate of progression, and appearance. Bracing plaster jackets can be used to treat infant scoliosis otherwise plaster jackets suffice.
Bracing (for curves ranging 20-40 degrees otherwise surgical intervention maybe needed) is ideal to prevent curve progress which in turn can improve the deformity. In the past, plaster casting was routinely used to treat scoliosis. Today plaster jackets are used to treat some cases of infantile scoliosis. Curves that are greater than 45-50 degrees can be treated surgically with bars, wires, screws which allow the child to be in seated position thus decreasing risk of cardio complications. Instrumentation- hardware allows child to move much more freely and are able to have the spine be in a straight position while the fusion occurs. The goals of spinal instrumentation for adolescent scoliosis include: spine segment stability, helps improve spinal fusion. After scoliosis surgery physical therapy and pain medications maybe prescribed. The Doctor will make a scoliosis treatment plan specific to each patient.