Everything you need to know about scoliosis

Scoliosis leads to curvature of the spine to one side .This can impact any part of the spine but the most common regions are at chest level and lower back level.

It also shows up in youth. Treatment is not necessary in most cases, because the curve corrects itself with growth. However, a combination of bracing and physical therapy is often prescribed, depending on the degree of curvature and the child’s age.

A very limited number of scoliosis patients may require surgery. Scoliosis risks include chronic pain, difficulty breathing and decreased exercise ability.

Important facts about scoliosis

Here are some key points about scoliosis. More detail is in the main article.

  • Often, the causes of scoliosis are not known.
  • A few people with scoliosis need surgery.
  • Symptoms in infants include a bulge on one side of the chest.
  • It is more common in females than in males

What is scoliosis?

A person with scoliosis has a C- or S-shaped curve in his or her spine.

It may manifest at any age, but it mostly occurs from 10 to 12 years of age or during adolescents, although symptoms may occur in infants.

The causes for the shape shift are generally not understood, but certain cases are associated with cerebral palsy, muscular dystrophy, spina bifida, or a birth defect.

A structural curve is permanent, and may be due to other situation. A non-structural curve is temporary, and will therefore vanish over time.

Treatment

Many children with scoliosis have a small curve that needs no care.

The doctor will prescribe testing of the spine curve in clinic and regularly with X-rays every 4 to 6 months.

When deciding on treatment choices the doctor should consider the following factors:

  • Sex: Females are more likely than males to have scoliosis that gradually gets worse.
  • Severity of the curve: The larger the curve, the greater the risk of it worsening over time. S-shaped curves, also called “double curves,” tend to worsen over time. C-shaped curves are less likely to worsen.
  • Curve position: A curve that is is located in the center part of the spine is more likely to get worse compared with curves in the lower or upper section.
  • Bone maturity: The risk of worsening is lower if the person’s bones have stopped growing. Braces are more effective while bones are still growing.

Casting

Casting is sometimes used for infantile scoliosis instead of bracing to help the child’s spine return to its normal position as it grows. This can be done using a cast made out of Paris plaster.

The cast is fixed to the outside of the patient’s body and will always be worn. The cast is adjusted periodically because the baby is growing rapidly.

Braces

If the patient has moderate scoliosis, and the bones still grow, a brace may be prescribed by the doctor. It will prevent any more curvature, but will not undo or heal it. Braces are usually worn throughout, even at night. The more hours the patient wears the brace a day, the more it appears to be successful.

The brace usually does not limit what the child can do. The braces will be taken off if the kid decides to take part in physical exercise.

The braces are no longer used when bones stop growing. There are 2 types of braces:

  • Thoracolumbosacral orthosis (TLSO) – the TLSO is made of plastic and designed to fit neatly around the body’s curves. It is not usually visible under clothing.
  • Milwaukee brace – this is a full-torso brace and has a neck ring with rests for the chin and the back of the head. This type of brace is only used when the TLSO is not possible or not effective.

One study showed that when bracing is applied to 10-15-year-olds with idiopathic scoliosis, it decreases the likelihood of the condition being worse or surgery required.

Chiropractic treatment

Many people consult a chiropractor to relieve the scoliosis pain and discomfort.

Chiropractors stimulate the spine and provide alternative treatments. They believe that reconfiguring the spine would facilitate well-being and healing.

Chiropractic treatment for a person with scoliosis can improve the quality of life. And it’s not a cure. Although this may make people with scoliosis feel better, it does not fix the spine curvature.

Visiting a Chiropractor who is skilled in scoliosis is important. Receiving non-specialist chiropractic care may make the symptoms worse.

Symptoms

Scoliosis normally becomes apparent from infancy or adolescence.

Symptoms in adolescents

Symptoms in adolescents
Often, the clothes of people with scoliosis do not hang properly.

The most common type of scoliosis is found in adolescents. It’s called adolescent idiopathic scoliosis. It can have an effect on children from age 10.

“Idiopathic” means no known cause is detected. Symptoms may include the following fact:

  • the head is slightly off center
  • the ribcage is not symmetrical, so the ribs may be at different heights
  • one hip is more prominent than the other
  • a person’s clothes do not hang properly
  • one shoulder, or shoulder blade, is higher than the other
  • the person may lean to one side
  • uneven leg lengths

Symptoms in infants

In infants, symptoms can include:

  • a bulge on one side of the chest
  • consistently lying curved to one side (in babies)
  • problems with the heart and lungs, leading to shortness of breath and chest pain (in more severe cases)

Some forms of scoliosis can cause back pain but typically it is not very painful. Back pain in older adults with longstanding scoliosis is not uncommon.

If a person is not treated for their scoliosis, complications can occur later in life, such as reduced function of the heart and lung.

Exercises

Various exercises can help with scoliosis and various schools recommend different approaches. However to achieve the “normal” posture, they all aim to realign the spine, rib cage, shoulders and pelvis.

Some researchers clarified in 2016 that there is growing evidence suggesting that exercise could help treat scoliosis. There is also a need for more research to find out which exercises are most successful.

Surgery

Scoliosis can develop over time, in extreme cases. In these cases , the doctor can prescribe spinal fusion. This surgery decreases the spine curve and stops it from getting worse.

Scoliosis surgery involves the following:

  • Bone grafts: A surgeon will connect two or more vertebrae with new bone grafts. Sometimes, they will use metal rods, hooks, screws, or wires to hold a part of the spine straight while the bone heals.
  • Intensive care: The operation lasts 4–8 hours. After surgery, the hospital will transfer a child to an intensive care unit (ICU), where they will receive intravenous fluid and pain relief medication. In most cases, the child will leave the ICU within 24 hours, but they may have to remain in the hospital for a week to 10 days.
  • Recovery: Children can usually go back to school after 4–6 weeks and can take part in sports roughly 1 year after surgery. In some cases, they may need a back brace to support the spine for about 6 months.

They will need to come back to hospital every 6 months to lengthen the rods. Typically this is an outpatient procedure, so that the person is not spending the night. When the spine has grown a surgeon will remove the rods.

A doctor will recommend spinal fusion only if they think the benefits outweigh the risks. The danger lies in:

  • Rod displacement: A rod may move from its correct position, so making further surgery necessary.
  • Pseudarthrosis: One of the bones used to fuse the spine into place does not stick properly, leading to mild discomfort, and unsuccessful correction of the spine. Further surgery may be needed.
  • Infection: If this occurs, it will usually treated with antibiotics.
  • Nerve damage: Damage occurs to the nerves of the spine, leading to mild symptoms, such as numbness in one or both legs, to severe problems, such as paraplegia, a loss of all lower body function.

There may be a neurosurgeon present during scoliosis surgery.

Causes

Scoliosis images
Scoliosis is sometimes caused by neuromuscular conditions.

Below are some of the possible causes of scoliosis:

  • Neuromuscular conditions: These affect the nerves and muscles and include cerebral palsy, poliomyelitis, and muscular dystrophy.
  • Congenital scoliosis (present at birth) This is rare and occurs because the bones in the spine developed abnormally when the fetus was growing inside the mother.
  • Specific genes: At least one gene is thought to be involved in scoliosis.
  • Leg length: If one leg is longer than the other, the individual may develop scoliosis.
  • Syndromic scoliosis: Scoliosis can develop as part of another disease, including neurofibromatosis and Marfan’s syndrome.
  • Osteoporosis: This can cause secondary scoliosis due to bone degeneration.
  • Other causes: Bad posture, carrying backpacks or satchels, connective tissue disorders, and some injuries.

Risk factors

The risk factors for scoliosis include:

  • Age: Signs and symptoms often start during a growth spurt just before puberty.
  • Gender: Females have a higher risk.
  • Genetics: People with scoliosis may have a close relative with the condition.

Types

The Scoliosis Assocition of the United Kingdom describes five main types of scoliosis:

  • Congenital scoliosis, when the spine does not form correctly before birth
  • Early-onset scoliosis appears between birth and 10 years
  • Adolescent idiopathic scoliosis, which occurs as the child grows, leading to a curving and twisting of the spine
  • Degenerative scoliosis can affect adults due to wear and tear of the skeletal system, whether or not they already have scoliosis
  • Neuromuscular scoliosis stems from a problem with the muscles or nervous system
  • Scheuermann’s kyphosis, where the front sections of the vertebrae grow more slowly than the back sections, making them smaller
  • Syndromic scoliosis is linked to one of a range of syndromes, including Marfan’s syndrome and trisomy 21

Diagnosis

A doctor will do a physical exam on the spine, ribs, hips, and shoulders.

The doctor may calculate the degree of scoliosis with the help of a instrument called an inclinometer, or scoliometer.

One should refer the patient to an orthopedic specialist.

Imaging scans such as X-rays , CT scans, and MRIs can aid in determining curve shape, direction, location, and angle.

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