Scoliosis

Scoliosis an abnormality of spinal growth which causes a deformity. The deformity has two components; curvature and rotation.

The curvature is what is measured on a plain x-ray in terms of degrees. It represents the tilting of a vertebra of the spine.

The rotation is what is looked for on school screenings and in the doctor’s office when a child bends forward. This movement may reveal some asymmetry from one side to another. As the spine rotates it may also rotate one’s ribs or trunk forming a rib hump causing a soft tissue fullness, which is evident only on one side of the patient.

The amount of curvature often increases as the amount of rotation increases, but they do not always match up, so both should be evaluated. Some curves with a lot of rotation have little curvature and vice-versa.

Scoliosis is usually diagnosed in adolescents, predominately girls by a margin of almost ten to one.

Scoliosis can found in any age child. It is termed infantile scoliosis in very young children, juvenile scoliosis in children younger than ten, and adolescent idiopathic scoliosis in children ten and older.

Idiopathic means the etiology or specific cause of scoliosis is unknown. There is no one specific cause known for scoliosis although there are many factors which make it more common for a person to develop scoliosis, such as being a female, or having a family member who has scoliosis. The most common type of scoliosis is idiopathic, although scoliosis can be associated with many other medical problems.

The initial evaluation of a patient with scoliosis must be thorough and include a detailed neurologic examination to pick up any medical conditions which are associated with the development of scoliosis.

A standing x-ray of the spine is taken and the degree of curvature is measured. This is called the Cobb angle. Many of our treatment decisions are based on this angle.

Scoliosis can progress rapidly during growth, and if very large, slowly after growth is finished. Our goal in treating scoliosis is to keep the curve small so it does not progress after growth has stopped.

Curves that have a Cobb angle less than thirty degrees will not progress after skeletal maturity(end of growth), while curves that are greater than fifty degrees will progress after skeletal maturity. The graph demonstrates the relationship between the degree of curvature and the percentage of curves that progress.

Skeletal maturity usually occurs at age fourteen or two years post menarchal (start of period) in girls and at age sixteen to seventeen for boys.

Only two things have been scientifically proven to halt the progression of a curve; bracing and surgical fusion. Bracing is first considered for curves approaching thirty degrees if there is a chance that some growth remains and surgery is considered for curves approaching or over fifty degrees. Other potential treatments such as physical therapy or a chiropractor have not been proven to stop a curve that wants to get bigger.

A brace has done its job if it has kept a curve from getting bigger. Sometimes, if a brace is used aggressively in a young child, it can decrease the curvature. Bracing, once begun, is continued until the child has reached skeletal maturity.

There are many different types of braces which can be used to treat scoliosis. We prefer to use a NYU style braces that has dynamic pads which can be adjusted to better hold the curve.

Once a brace is delivered, the patient will wear the brace for a few weeks to get used to it and then we will get an x-ray of their back in the brace to make sure the pads are at the correct levels and the brace is doing what we want is to do. The brace is then adjusted as needed. Follow-up x-rays are taken every four to six months to check for any progression of the curve.

If the curve progresses past forty-five to fifty degrees then surgical fusion of the curve is considered. Many factors are used to determine how the fusion is best accomplished. These factors include the age of the patient, the location and magnitude of the curve, and the flexibility of the curve.

The spine can be fused posteriorly or anteriorly, or both. The goal is to make the fusion as small as possible, thereby maintaining as much motion of the spine as possible.

The x-ray to the right is of a young girl after she underwent a posterior spinal fusion. The spine is held stable with a series of hooks, which are attached to two rods.  The hooks and rods correct the curvature and rotation of the spine as the fusion heals.