Scoliosis

Definition 

A spine affected by scoliosis displays evidence of side-to-side curvature, with the spine looking like a letter "C" or "S," with a rotation of the vertebrae. The Scoliosis Research Society defines scoliosis as a spinal curvature of 10 or more degrees. Scoliosis lends the appearance that the affected person is leaning to one side.

Causes 

Congenital scoliosis is caused by a bone abnormality that is present at birth.

Neuromuscular scoliosis results from abnormalities in muscles or nerves. Those with spina bifida or cerebral palsy may display this condition, as well as those with conditions accompanied by, or resulting in, paralysis.

Degenerative scoliosis can result from traumatic bone collapse, previous major back surgery, or osteoporosis.

Idiopathic scoliosis, the most common type, has no clear cause, although several theories persist. Some evidence suggests that idiopathic scoliosis may be genetically inherited. It is seen most commonly in children and teens.

In adults, this idiopathic scoliosis may be the result of age-degenerative changes in the spine, or of osteoarthritis.

Symptoms 

The following are the most common symptoms:

  • Difference in shoulder height
  • The head isn't centered with the rest of the body
  • Difference in hip height or position
  • Difference in shoulder blade height or position
  • When standing straight, difference in the way the arms hang beside the body
  • When bending forward, the sides of the back appear different in height

Back pain, leg pain, and changes in bowel and bladder habits aren't commonly associated with this condition. A person experiencing these types of symptoms requires immediate further medical evaluation by a doctor.

 

The symptoms may resemble other spinal conditions or deformities, or may be a result of an injury or infection. Always consult your doctor for a diagnosis.

Diagnosis 

In addition to a complete medical history and physical examination, X-rays are the primary diagnostic tool. In establishing a diagnosis, the doctor measures the degree of spinal curvature on the X-ray.

 

The following other diagnostic procedures may be performed for nonidiopathic curvatures, atypical curve patterns, or congenital scoliosis:

 

  • Magnetic resonance imaging (MRI). A diagnostic procedure that uses a combination of large magnets and a computer to produce detailed images of organs and structures within the body.
  • Computed tomography (CT) scan. This diagnostic imaging procedure uses a combination of X-rays and computer technology to produce horizontal, or axial, images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.

 

Early detection is most important for successful treatment.

Non-surgical Treatment

Non-surgical treatment may include routine exams by a doctor to check for any curve progression, or the use of a brace to stop a spinal curve from getting worse. Children typically have these checkups about every 4 to 6 months. Adults are usually checked about once each year.

Braces :  Bracing is the usual treatment choice for adolescents who have a spinal curve between 25 degrees and 40 degrees -- particularly if their bones are still maturing, and if they have at least 2 years of growth remaining.

The purpose of bracing is to halt progression of the curve. It may provide a temporary correction, but usually the curve will assume its original magnitude when bracing is eliminated.

Surgical Treatment

Specific treatment will be determined by your doctor based on:

 

  • Your age, overall health, and medical history
  • The underlying cause
  • Extent of the condition
  • Your tolerance for specific medications, procedures, or therapies
  • Expectations for the course of the condition
  • Your opinion or preference

 

The goal of treatment is to stop the progression of the curve and prevent deformity. Treatment may include:

 

  • Observation and repeated examinations - Observation and repeated examinations may be necessary to determine if the spine is continuing to curve, and are used when a person has a curve less than 25 degrees and is still growing.
  • Bracing - Bracing may be used when the curve measures more than 25 degrees to 30 degrees on an X-ray, but skeletal growth remains. It may also be necessary if a person is growing and has a curve between 20 degrees and 29 degrees that isn't improving. The type of brace and the amount of time spent in the brace will depend on the severity of the condition.
  • Surgery - Surgery may be recommended when the curve measures 45 degrees or more on an X-ray and bracing isn't successful in slowing down the progression of the curve when a person is still growing.

 

According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, there's no scientific evidence to show that other treatment methods (for example, chiropractic manipulation, electrical stimulation, nutritional supplementation, and exercise) prevent the progression of the disease.

Recovery

Patients usually may begin to shower one week after surgery. Before showering, tape plastic wrap to cover the incision. Remove the tape and plastic wrap after each shower. This should be done for showers taken during the first week at home. After that time, shower without the plastic wrap over the incision. For safety, have a helper accompany you during showers for the first two to three weeks.

Steri-Strips are usually placed across the incision(s) and will fall off on their own. Do not remove the Steri-Strips unless instructed to do so, or if they are dangling.

If a dressing was placed over the surgical site, change it once each day until no staining appears on the sterile gauze. Beyond this point a dressing is no longer needed.

Medication 

The surgeon will often list medications that may be taken and those that should be avoided. In most cases all non-steroid medication (ibuprofen, aspirin, Motrin®, etc.) are not allowed. Tylenol® is usually allowed. Prior to surgery, birth control pills are stopped since they increase the risk of blood clots following surgery.

Smoking 

Smoking impairs bone healing and hinders fusion. Patients must be committed to stop smoking two months before surgery, and for a minimum of six months after surgery. Of course, it would be better just to give up the habit for a lifetime.

Transportation

When returning home from the hospital by car, patients should place a pillow behind their back and use the seat belt. For six weeks following surgery, patients should avoid frequent car rides and mass transit. 

Walking is usually encouraged for most patients. Bending, lifting, and twisting are not allowed in most cases for several months, or until approved by the surgeon. Sports activities are prohibited for at least the first three months following surgery.  

When the surgeon approves, it is best to begin activities gradually. Conditioning exercises are good to begin with -- swimming, treadmill, bicycling, jogging, etc.

Patients should develop an awareness and regular use of good body mechanics for the rest of their lives. These are invaluable for example during bending and lifting.

Most patients will not have activity restrictions once healing is fully completed. Some sports activities such as gymnastics, however, may no longer be practical. Your surgeon will discuss activities that may be prohibited with you. 

 

Adults often find these items to be helpful following surgery:

 

  • Electric adjustable bed
  • Shower chair
  • Elevated toilet seat
  • Extended grasper