Scoliosis, a condition defined as a curving of the spine sideways or away from the middle, affects about one out of 100 people with most cases being mild. The condition typically begins in childhood with cases severe enough to require treatment being most common in girls. Only about ten percent of children who are diagnosed with this condition require bracing or surgery to correct it.
Causes of Scoliosis
There are three causes of spinal curvature. It can be congenital or present at birth as the result of a problem in the formation of vertebrae or ribs that are fused during the development in the womb. Weakness, poor muscle control, or paralysis can result in neuromuscular scoliosis. This is common with diseases such as muscular dystrophy, cerebral palsy, and spina bifida. The most common type is idiopathic scoliosis which is of unknown cause. It is most common in adolescents with curvature generally worsening during growth spurts.
Symptoms
Scoliosis may be suspected when the pelvis appears to be tilted or if one shoulder looks to be higher than the other. To an untrained eye, early stages of the condition typically go unnoticed. Other symptoms may be low back pain or backache, fatigue in the spine after sitting or standing for long periods, hips that appear uneven, and/or a spine that curves unusually to the side. Kyphoscoliosis, or abnormal front to back curvature, can be recognized by the appearance of a rounded back.
Treatment
Treatment protocols are determined by a number of factors including the cause of the curvature, its size and location, and how much more growth is expected in the patient. Cases of adolescent idiopathic scoliosis in which the curvature is less than 20 degrees typically do not require treatment but should be watched for further progression. If it gets worse, advancing to 25 or 30 degrees or more, bracing is often recommended for a child who is still growing to reduce the rate of progression and help to straighten the spine. Bracing is ineffective for neuromuscular and congenital scoliosis.
When nonoperative or conservative treatment cannot correct the problem, surgery may be necessary. When the curvature is greater than 40 degrees surgery is generally required. Surgeons often wait until the bones have stopped growing unless the condition is severe or worsening quickly. With surgery the curve is corrected by fusing the bones together, holding them in place with metal rods until the bones heal. A brace may be needed after surgery to stabilize the spine.
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