Scoliosis - Diseases

What is this condition?

Scoliosis is a sideways curvature of the spine that may affect any segment of the spine. The curve may be convex to the right (more common in chest-level curves) or to the left (more common in lower back curves). The spine may be rotated around its axis, deforming the rib cage. Scoliosis is often associated with humpback and swayback.

What causes it?

The deformity of scoliosis may be structural, in which the spinal curvature is fixed, or functional, in which the spine is temporarily deformed from poor posture or uneven leg heights.

Structural scoliosis may result from an inherited defect, such as wedge-shaped vertebrae, fused ribs or vertebrae, or partial vertebrae. It may be paralytic or musculoskeletal, developing several months after a one-sided paralysis of the trunk muscles due to polio, cerebral palsy, or muscular dystrophy. Or it may be idiopathic (the most common form), which may be acquired through several genetic traits. This form of scoliosis appears in a previously straight spine during the growth years.

Idiopathic scoliosis can be infantile (affecting mostly male infants between birth and age 3), juvenile (affecting both sexes between ages 4 and 10), or adolescent (usually affecting girls between age 10 and maturity).

What are its symptoms?

The most common deformity in either functional or structural scoliosis begins at chest level and creates an S curve in an attempt to balance the body. Scoliosis rarely produces discomfort until it's well established, when backache, fatigue, and difficulty breathing are among the symptoms.

Because many teenagers are shy about their bodies, a parent may only eventually notice uneven hemlines, pantlegs that appear unequal in length, or subtle physical signs such as one hip appearing higher than the other. Untreated scoliosis can cause decreased lung capacity, back pain, degenerative spinal arthritis, disk disease, and pain in the hips and thighs.

How is it diagnosed?

The doctor can see a change in the curvature and flexibility of the young person's spine, uneven shoulder height, and asymmetrical musculature. A series of spinal X-rays will confirm the scoliosis and tell how far it has gone.

How is it treated?

Treatment is guided by the severity of the deformity and potential spine growth. To be most effective, treatment should begin early when the curvature is still mild.

Here are some of the methods the doctor will use:

" A curve of less than 25 degrees is mild and monitored by X-rays and an exam every 3 months. An exercise program that includes sit­up pelvic tilts, spine stretching, push-ups, and breathing exercises may strengthen torso muscles and stop the curve's progression. A heel lift in the shoe also may help.

" A curve of 30 to 50 degrees requires management with spinal exercises and a brace. Stimulation with a mild electrical current may be an alternative. A brace stops progression in most children but doesn't reverse an established curvature. Braces passively strengthen the spine by applying asymmetrical pressure to the skin, muscles, and ribs, and can be adjusted as the child grows and completes bone growth.

" A curve of 40 degrees or more requires surgery (spinal fusion) because a lateral curve continues to progress at the rate of 1 degree a year even after skeletal maturity. Some surgeons prescribe a belt-pulley-weight system of traction and an exercise program for 7 to 10 days before surgery. The surgery often involves fusing part of the spine and implanting a metal rod as an internal splint to straighten the curve.