Scoliosis

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at February 29, 2016
StartDiseasesScoliosis

Scoliosis is a disorder of the spine characterized by a side-to-side curvature. It can be detected at many stages of life from infancy to adulthood and can be caused by a variety of reasons. It can be a minor issue or it can seriously impair health. There are several treatment options for various types and stages of the disease.

Contents

Definition & Facts

Scoliosis is a lateral, meaning side-to-side, curvature of the spine. It is an obvious curve when looking at the back of the individual, while a side view appears to show a normal spine. It is a spinal abnormality and disorder of the bones of the back. It will generally be treated by an orthopedist or orthopedic surgeon.

Symptoms & Complaints

Symptoms may include uneven shoulders or a prominent shoulder blade. The person will often seem to lean to the side when walking or standing. They may have an uneven waist or hips. It is usually not painful.

If severe scoliosis is not addressed, compromise of heart and lung function may ensue. As the vertebrae in the spine twist, the ribs can cause the chest cavity to alter. The heart and lungs can succumb to this type of pressure and difficulty breathing can occur. Heart function can also be impaired as the area around it may be under pressure.

The signs may not be obvious on a day to day basis, so it is important for children to have regular pediatric check ups. The pediatrician will check for signs of scoliosis as part of routine examinations.

Causes

Scoliosis can be present at birth. It can be a result of an injury or muscular disorder, such as spina bifida or cerebral palsy. Many cases are simply deemed idiopathic, meaning the cause is unknown, although there may be evidence the condition is hereditary in some cases. It can develop between the ages of 8 and 15. It is more common in girls and can be developed when rapid physical growth is accompanied by the onset of puberty.

Diagnosis & Tests

The pediatrician will recommend consultation with an orthopedist or orthopedic surgeon. Tests for scoliosis include observation of the spine while walking and bending. Females will be asked at what age menstruation began, as it is a good indicator of the end of the growth spurt in girls. X-rays will be taken of the spine from different views. They will also rule out tumors, infections or other abnormal masses as well as evaluate bone density.

There is a type of ruler that it used to measure the severity of any curve present and that number is recorded in degrees. This result can be compared to future examinations and any changes can be easily noted. A few children will have some slight degree of curvature at around the age of 16. However, about one in 1,000 will have a curve of greater than 40 degrees. This is usually the point where surgery may be considered.

Treatment & Therapy

Early treatment of initial curvature of small percentages will be observed on a watch and wait basis. Patient may be asked to come in every 4 to 6 months for recording of degree of curvature and to watch for significant changes. Back braces may be prescribed as a measure to avoid further progression. They can be made of strong fabric or a stronger, more rigid plastic. The brace would need to be worn daily except when sleeping.

If the change in curvature is greater than 40 degrees, patient will be recommended to an orthopedic surgeons. The orthopedic surgeon will review X-rays and probably take new ones. The surgeon will also discuss risks and benefits of surgery and paperwork will be reviewed and signed by the patient or patient's guardian.

Surgical treatment will involve implanting metal rods and screws to fuse the spinal bones where the curvature is most apparent. This will straighten the spine and keep the curvature from worsening. The procedure is called a spinal fusion. Eventually the hardware rod will grow with the bone and fuse with it.

Surgical treatment should be done within 6 months of a diagnosis of scoliosis that is over 40 degrees. As with all surgery, pre-admission tests will need to be performed. The patient will have to get a medical clearance from their family doctor or pediatrician prior to surgery. Blood loss during surgery is expected and some hospitals use technology that redirects lost blood back into the patient's veins to curtail post operative anemia and speed recovery.

A blood donation from the patient or a compatible family member may be given prior to surgery for use during the patient's surgery. It is called an autologous donation if the patient will be donating back to themselves during surgery.

This is a major surgery that will take 4-8 hours. The patient will spend time in recovery and oftentimes, in the intensive care unit for at least a few days. Physical therapy will begin a day or two after surgery. The patient will be kept on medication for pain control but will be expect to move to aid healing.

When released, the patient will have a custom fit brace that will be adjusted with plastic adjusters for easier on and off. It will need to be worn while patient is not in bed. Moving is encouraged. Full recovery ranges from 1 to 6 months.

Prevention & Prophylaxis

There is no way to prevent scoliosis, but the best outcomes are when patients' symptoms are detected early. Regular checkups are the best way to diagnosis scoliosis and secure treatment early.