Scoliosis is an abnormal curvature of the spine. Most cases are mild and do not progress to the production of symptoms nor does they require treatment. This occurs in adolescents during growth spurts around the time of puberty and is particularly common in young girls. Starting around the fifth grade, most schools in the U.S. will begin annual screening of students for scoliosis.
This is a condition in which the spine is curved toward the side. Normally, when looking at the spine it is in a straight line down the back however in scoliosis it curves to the right or left. Our spine has normal curvatures, for example in the lower back, but at these locations the spine curves inward, not to the side.
Most often there aren’t any symptoms as the disease has mild presentation in the majority of individuals. It is only when the curvature in the spine progresses that it may start to cause disfigurement and subsequent symptoms. The upper body starts to bend to one side along with the curving spine. This causes the shoulders to become uneven and protrusion of the shoulder blade. The rib cage on the same side will appear to bulge out giving the waist an irregular appearance. Similarly, the hips will not appear to be in line with each other and cause the legs to have unequal lengths. Patients in whom scoliosis progresses may also experience difficulty breathing as the lungs become compressed within an abnormally shaped rib cage. Patients also complain of chronic back pain.
The most common type of scoliosis is idiopathic, meaning the exact cause of the disease is unknown. Family history of scoliosis has been suggested as a strong contributor to the inheritance of this condition. Children may be born with an abnormally curved spine, in which case the condition is called congenital. Individuals with diseases affecting the neuromuscular system have been associated with developing scoliosis as well.
The screening test used for scoliosis requires the patient to bend forward, keeping the knees straight and arms dangling on the side of the body. This will allow the healthcare professional to visualize the type and degree of spinal curvature. The spine may curve at one location only to the right or only to the left and it may also curve at two locations. A part of the physical examination can include neurological and muscular testing. This can involve reflexes and checking for muscle weakness. Imaging studies including an x-ray are done to confirm the diagnosis. They also help
assess whether there is an underlying pathology causing the scoliosis. For example, the presence of a tumor mass may be pushing the spine to one side. If a secondary cause is suspected, further imaging tests may be required.
Most patients presenting with only mild scoliosis don’t require any kind of treatment. Instead they are monitored every few months to make sure the condition is not progressing. The patients who require treatment are managed based on their particular severity, age, and other factors. Children who are still growing are often asked to wear a brace. There are two types of braces used:
Milwaukee Brace. The underarm brace is used most of the time as it is smaller and well hidden under the patient’s clothes however, if this brace cannot be used then the Milwaukee brace, which is bulkier, is worn. The efficacy of the brace is based on the duration of time it is worn. They can also be worn to sleep and do not prevent the child participating in physical activities. If the curvature of the spine is progressing and the brace has proven ineffective then the patient may require surgery. Usually surgery is avoided in children who are still growing and doctors try to wait until the bones have stopped growing. If surgery cannot be delayed then an adjustable rod is put in place. This will allow the bones to continue growing and not leave the child with stunted growth. If the child has reached an age where the bones are no longer growing then the surgical procedure is different and can include fusing the bones of the spinal column.
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