Scoliosis is an abnormal curvature of the spine that can affect children, teenagers, and adults. Mild scoliosis may not be visible to most people. As the curve worsens, it becomes more visible. A curve maybe seen on the spine. It is usually an ‘S’-shaped curved or can be a ‘C’-shaped curve. The shoulders may also be seen to be tilted. On x-rays, scoliosis of the spine is clearly seen as an ‘S’-shape or a ‘C’-shape. Scoliosis is a 3-dimensional abnormality where there is a rotation of the spine with sideway curves.
Most of the time, there is no known cause for scoliosis. This is called idiopathic scoliosis. Rarely, a child can be born with a spine deformity and this is called congenital scoliosis.
Idiopathic scoliosis has no known cause but there is a tendency to occur in families. However, there is no definite gene that is identified to cause this in families. Scoliosis occurs in 3% of the population. There is 3 main types of idiopathic scoliosis:
- Infantile idiopathic scoliosis-birth to 3 years
- Juvenile idiopathic scoliosis-4 to 9 years
- Adolescent idiopathic scoliosis-10-18 years old
Scoliosis with known causes are:
- Congenital scoliosis is present from birth and is the result of the spine not forming properly.
- Neuromuscular scoliosis occurs when there is some kind of muscle or nerve weakness like cerebral palsy or muscular dystrophy.
- Degenerative scoliosis occurs in adults, usually the older patients who have degeneration in their spine.
- Nonstructural scoliosis occurs due to a temporary cause that only affects lateral curvature without spinal rotation. This may occur when there is s tilt of the pelvis resulting from a shortened leg. If the shortened side of the body is raised, say with a shoe raise, then the scoliosis will be corrected.
If the above causes are absent, then the scoliosis is deemed idiopathic.
Scoliosis Assessment and Treatment
Scoliosis assessment is arrived at with a full history and examination.
In the examination for scoliosis, the shoulders are assessed if they are level. Next, a forward bending test is used to check for asymmetry in the trunk. A rib hump(rib cage) maybe present. There maybe uneven waist. The pelvis is observed to see if it is level. The legs are checked to see if they are of equal length.
A scoliometer maybe used to measure the tilt of the body. If the angle of trunk rotation is found to be greater than 5%, further assessment will ned to be done.
Xrays of the spine(scoliosis film) is usually required for scoliosis assessment and treatment. A full xray of the spine is done and the Cobb angle is measured.
By definition, scoliosis is only diagnosed when the Cobb angle is greater than 10°. In the assessment of scoliosis, the rotation of the spine is assessed as well as the lateral curvature of the spine. The maturity of the child’s skeleton is also assessed by looking at Risser sign.
Treatment
The treatment of scoliosis depends on the amount of growth potential the child has. Surgery is considered if the Cobb angle is more than 40° with growth potential present.
Usually, a child is observed for further curve progression. However, a brace is considered if the Cobb angle
- Progresses past 25 or 30 degrees with significant growth remaining
- Progresses at least 5 degrees during any 4- to 6-month period
For bracing to work, the child will need to be compliant with brace wear. The brace should be worn for as long as possible except for bathing, skin care and exercising.
Other non-surgical treatments of scoliosis treatment is not proven to be effective.
Surgical treatment for Scoliosis
Despite brace usage, if curves further progress past 40°, then surgery is indicated.
Surgery aims to stop further worsening of the Cobb Angle. It can also try to reduce the deformity. There can be a 50-70% reduction in the Cobb angle. The surgery will also try to maintain the truncal balance.
Surgery for scoliosis involves the insertion of pedicle screws, hooks and rods to reduce and fuse the spine.
