Scoliosis is a sideways curvature of the spine. Most cases are mild; however, as some children develop or adults age, spinal deformities can continue to get more severe.
The spine is made up of 24 bones, called vertebrae, which are stacked on top of one another. These bones connect to protect the spinal cord and form the natural curves of your back. The seven small vertebrae that begin at the base of the skull and form the neck comprise the cervical spine.
Your spinal cord and nerves travel through the spinal canal carrying messages between your brain and muscles. The intervertebral discs between your vertebrae are flexible, flat and round discs and are about a half-inch thick. They act as shock absorbers when you walk or run and allow motion between the vertebrae.
The natural curvature of the spine helps us stand up straight and stay balanced. The c-shaped curves of the neck (cervical spine) and lower back (lumbar spine) are called lordosis. In between these curves is the reverse c-shaped curve of the chest (thoracic spine) called kyphosis. If any of the curves becomes too large or small, or develop sideways, our posture will appear abnormal.
Severe curvature of the spine can become disabling, reducing the amount of space within the chest and making it difficult for the lungs to function properly.
- Idiopathic scoliosis: The most common type, usually becomes noticeable during adolescence. It tends to run in families, but other than that it has no known cause. Idiopathic is categorized by the age it develops
- Infantile idiopathic: from birth to 3 years old
- Juvenile idiopathic: from 4 to 9 years old
- Adolescent idiopathic: from 10 to 18 years old (the most common idiopathic because it is when rapid growth typically occurs)
- Degenerative adult scoliosis: Occurs when age and deterioration of the spine leads to the development of a curve in the spine. It is most common in older patients, particularly women and is often related to osteoporosis.
Types of Curves
A curve usually looks like a backward C, when the spine bends sideways to the right, called dextroscoliosis. Sideways spinal curvature on the left side of the back is more like a regular C shape, called levoscoliosis.
- Right thoracic curve: Curve bends to the right side of the upper back
- Right thoracolumbar curve: Curve bends to the right side starting in the upper back and ending in the lower back
- Right lumbar curve: Curve bends to the right side, starting and ending in the lower back
- Double major curve: Typically involves the right thoracic curve on top and left lumbar curve on the bottom
Most often occurs right before puberty during the growth spurt and can be caused by cerebral palsy and muscular dystrophy; however, the most common cause is unknown; however, it has been connected to hereditary factors. Additionally, some types can be caused by birth defects or injuries or infections of the spine.
Any sideways or lateral curvature of the spine that measures at least 10 degrees on an X-ray is considered scoliosis. However, a curve that small does not usually show any symptoms. As the curve grows to 20 degrees or beyond, more obvious symptoms can be noticed, such as:
- Uneven shoulders
- Uneven waist
- Ribs that stick out farther on one side of the body
- A rotating spine
- Back pain
- Problems breathing
A curve in the spine is often noticed during screening at school, which causes a parent to make an appointment with a spine specialist for their child. To determine whether your child has a curve in the spine, your physician will ask you for a complete medical history, have your child describe symptoms and conduct a physical examination.
Children who have mild cases are monitored closely, usually with regular physician visits and X-rays, to see if the curve is getting worse. In many cases, no treatment is necessary.
Bracing may also be necessary if the curve is past 20 or 25 degrees, a back brace may be worn until the adolescent has finished growing. A brace will prevent the curve from getting worse and avoid surgery.
Scoliosis surgery may be necessary if the curve continues to progress with bracing. A posterior spinal fusion is the most common surgical treatment.
During a spinal fusion the affected vertebrae will be fused together so that they heal as a single, solid bone. First the surgeon will align the vertebrae to reduce the curve. Then, small pieces of bone (bone graft) are placed into the spaces between the vertebrae to be fused. Similar to how a broken bone heals, the bones will then grow together. The size of the fusion depends on the severity of the curve.
In early diagnosis, most cases are treated successfully without scoliosis surgery and children lead active and healthy lives. If left untreated, curve progression could lead to pain or problems during adulthood.
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