What is Scoliosis: Symptoms, Causes, Diagnosis and Treatment?

Scoliosis is the abnormal twisting and sideways curvature of the spine. It is usually first noticed by a change in appearance of the back.  Although it is a complex three-dimensional condition, on an x-ray, viewed from the rear, the spine of an individual with scoliosis can resemble an "S" or a "C", rather than a straight line.  Scoliosis is about two times more common in girls than boys. It can be seen at any age, but it is most common in those over about 10 years of age.

Back pain, shoulder pain, and neck pain are common in adults with scoliosis.  Young people with scoliosis may also experience some discomfort, but it's less likely to be severe.  Slow nerve action is seen (in some cases).  Constipation may occur due to tightened organs from curvature.  There is limited mobility.  Among females, painful menstruation (dysmenorrhea) might be prevalent due to a secondary pelvic tilt.  Chest pain and shortness of breath can also occur in some.

  1. A visibly curved spine.
  2. One shoulder being higher than the other.
  3. One shoulder or hip being more prominent than the other.
  4. Clothes not hanging properly.
  5. A prominent rib cage.
  6. A difference in leg lengths.
  1. Idiopathic scoliosis:  No definite cause is found in around 8 out of every 10 cases. However, researchers have found there is a family history of the condition in some idiopathic cases, which suggests a possible genetic link.  This type is sub-classified as infantile, juvenile, and adolescent.
  2. Congenital scoliosis.  This is caused by the bones in the spine developing abnormally in the womb.
  3. Degenerative scoliosis:  Some parts of the spine become narrower and weaker (osteoporosis) with age.
  4. Secondary scoliosis:  A small number of cases are caused by other medical conditions, including:
    1. Cerebral palsy – a condition associated with brain damage.
    2. Muscular dystrophy – a genetic condition that causes muscle weakness.
    3. Marfan syndrome – a disorder of the connective tissues.
    4. Neurofibromatosis – a genetic condition that causes benign tumors to grow along your nerves.
    5. Rett syndrome – a genetic disorder, usually affecting females, which causes severe physical and mental disability.
Scoliosis can usually be diagnosed after a physical examination of the spine, ribs, hips, and shoulders.

X-ray:  The orthopedic specialist will take an x-ray to confirm the diagnosis of scoliosis.  The x-ray images will also help determine the shape, direction, location, and angle of the curve. The medical name for the angle the spine curves is known as the Cobb angle.

In some cases, scans such as a magnetic resonance imaging (MRI) scan or a computerized tomography (CT) scan may also be recommended.

Treating scoliosis in children:
If your child has scoliosis, their treatment will depend on their age and how severe it is.

The main treatment options are:

1. Observation:
Treatment is not always necessary for very young children because their condition often corrects itself as they grow.  However, if the curve does not correct itself, it can reduce the space for the internal organs to develop in, so careful monitoring by a specialist is important. Your specialist will usually recommend having regular x-rays to monitor the curvature to see if it improves, stays the same, or gets worse.

2. Casting:
In some cases affecting young children, the spine may need to be guided during growth in an attempt to correct the curve. In a child aged under two years of age, this can sometimes be achieved by using a cast. A cast is an external brace to the trunk made out of a lightweight combination of plaster and modern casting materials. The cast is worn constantly and cannot be removed, but is changed regularly to allow for growth and remodeling. The cast will be changed under anesthetic every two to three months with the aim of gradually straightening the spine.

3. Bracing:
If the curve of your child's spine is getting worse, your specialist may recommend they wear a back brace while they are growing.  A brace cannot cure scoliosis or correct the curve, but it may stop the curve from getting worse.  However, it’s not recommended by all scoliosis specialists.  Braces are often made of rigid plastic, although flexible braces are sometimes available.  In general, modern back braces are designed so they are difficult to see under loose-fitting clothing.  It's usually recommended that the brace is worn for 23 hours a day, and is only removed for baths and showers. The brace is removed during contact sports and swimming, however.
Regular exercise is important for children wearing a brace. This helps improve muscle tone and body strength, and will help make wearing the brace more comfortable.

4. Surgery:
If your child has stopped growing and the scoliosis is severe or other treatments have been unsuccessful, corrective surgery may be recommended. They type of surgery will depend on your child’s age.  Growing rods are inserted to allow for continued controlled growth of the spine while partially correcting the scoliosis.  Every 4-6 months the rods lengthened to keep up with the child's growth.  Magnets are used to lengthen the rods. When your child stops growing, the adjustable rods can be removed and a spinal fusion (see below) will be carried out.  Lumbar spinal fusion is an operation that causes the vertebrae (bones of the spine) in the lower back to grow together. The goal of the lumbar fusion is to have the two vertebrae fuse (grow solidly together) so that there is no longer any motion between them.  In spinal fusion, the spine is straightened using metal rods attached with screws, hooks, and/or wires, and bone grafts are used to fuse the spine in place.

Treating scoliosis in adults:
Nonoperative treatment including pain medications, physical therapy, exercises, and gentle chiropractic can help relieve the symptoms in adults.

The surgery could include only a decompression or removal of bone spurs that are compressing the nerves or a classical spinal fusion surgery.

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