Scoliosis
G Traitses
Scoliosis affects 5 to 7 million people in Canada and the U.S.
More than a half million visits are made to doctors’
offices each year for evaluation and treatment of
scoliosis. Although scoliosis can begin at any age, it
most often develops in adolescents between the ages
of 10 and 15. Girls are more commonly affected than
boys. Because scoliosis can be inherited, children
whose parents or siblings are affected by it should definitely
be evaluated by a trained professional.
What is scoliosis?
Because we walk on 2 feet, the human nervous system
constantly works through reflexes and postural control
to keep our spine in a straight line from side to side.
Occasionally, a lateral (sideways) curvature develops. If
the curvature is larger than 10 degrees, it is called scoliosis.
Curves less than 10 degrees are often just postural
changes. Scoliosis can also be accompanied by
lordosis (abnormal curvature toward the front) or
kyphosis (abnormal curvature toward the back). In
most cases, the vertebrae are also rotated.
In more than 80% of cases, the cause of scoliotic curvatures
is unknown; we call this condition idiopathic
scoliosis. In other cases, trauma, neurological disease,
tumors, and the like are responsible. Functional scoliosis
is often caused by some postural problem, muscle
spasm, or leg-length inequality, which can often be
addressed. Structural scoliosis does not reduce with
postural maneuvers. Either type can be idiopathic or
have an underlying cause.
What are the symptoms of scoliosis?
Scoliosis can significantly affect the quality of life by
limiting activity, causing pain, reducing lung function,
or affecting heart function. Diminished self-esteem and
other psychological problems are also seen. Because
scoliosis occurs most commonly during adolescence,
teens with extreme spinal deviations from the norm are
often teased by their peers.
Fortunately, 4 out of 5 people with scoliosis have
curves of less than 20 degrees, which are usually not
detectable to the untrained eye. These small curves
are typically no cause for great concern, provided
there are no signs of further progression. In growing
children and adolescents, however, mild curvatures
can worsen quite rapidly—by 10 degrees or more—in a
few months. Therefore, frequent checkups are often
necessary for this age group.
How is scoliosis evaluated?
Evaluation begins with a thorough history and physical
examination, including postural analysis. If a scoliotic
curvature is discovered, a more in-depth evaluation is
needed. This might include a search for birth defects,
trauma, and other factors that can cause structural
curves.
Patients with substantial spinal curvatures very often
require an x-ray evaluation of the spine. The procedure
helps determine the location and magnitude of
the scoliosis, along with an underlying cause not evident
on physical examination, other associated curvatures,
and the health of other organ systems that might
be affected by the scoliosis. In addition, x-rays of the
wrist are often performed. These films help determine
the skeletal age of the person, to see if it matches an
accepted standard, which helps the doctor determine
the likelihood of progression. Depending on the scoliosis
severity, x-rays may need to be repeated as often
as every 3 to 4 months to as little as once every few
years.
Other tests, including evaluation by a Scoliometer™,
might also be ordered by the doctor. This device
measures the size, by angle, of the rib hump associated
with the scoliosis. It is non-invasive, painless, and
requires no special procedures. A Scoliometer™ is
best used as a guide concerning progression in a person
with a known scoliosis—not as a screening device.
Is scoliosis always progressive?
Generally, it is not. In fact, the vast majority of scolioses
remains mild, is not progressive, and requires little
treatment, if any.
In one group of patients, however, scoliosis is often
more progressive. This group is made up of young
girls who have scolioses of 25 degrees or larger, but
who have not yet had their first menstrual period. Girls
generally grow quite quickly during the 12 months
before their first period and if they have scolioses, the
curvatures tend to progress rapidly. In girls who have
already had their first periods, the rate of growth is
slower, so their curves tend to progress more slowly.
What is the treatment for scoliosis?
There are generally 3 treatment options for scoliosis—
careful observation, bracing, and surgery. Careful
observation is the most common “treatment,” as most
mild scolioses do not progress
and cause few, if any, physical
problems. Bracing is generally
reserved for children who have
not reached skeletal maturity
(the time when the skeleton
stops growing), and who have
curves between 25 and 45
degrees. Surgery is generally
used in the few cases where
the curves are greater than 45
degrees and progressive,
and/or when the scoliosis
may affect the function of the
heart, lungs, or other vital organs.
Spinal manipulation, therapeutic exercise, and electrical
muscle stimulation have also been advocated in
the treatment of scoliosis. None of these therapies
alone has been shown to consistently reduce scoliosis
or to make the curvatures worse. For patients with
back pain along with the scoliosis, manipulation and
exercise may be of help.
Most people with scoliosis lead normal, happy, and
productive lives. Physical activity including exercise is
generally well-tolerated and should be encouraged in
most cases.
