Introduction

Scoliosis is an abnormal curvature of the spine. Scoliosis is defined as a spinal curvature of greater than 10 degrees. Although it usually doesn’t cause pain, Scoliosis impacts infants, adolescents, and adults worldwide. The age of onset for scoliosis is 10-15 years old. Scoliosis occurs equally among both genders. However, females are eight times more likely to progress to a curve magnitude that requires treatment. Scoliosis affects 6 million people (2-3% of the population) Hinged Support in the United States. Each year scoliosis patients make more than 600,000 visits to private physician offices, and an estimated 30,000 children are put into a brace for scoliosis.

Scoliosis runs in families. Of every 1,000 children, three to five develop spinal curves that are severe enough to need treatment. Onset of scoliosis rarely occurs in adults. Sometimes, adult scoliosis is a worsening of a condition that began in childhood, but wasn’t diagnosed or treated. In other cases, it may result from a degenerative joint condition in the spine.
The cause of most scoliosis is unknown (idiopathic). Scoliosis is often first noticed just before and during adolescence, during a growth spurt. Growth is the biggest risk factor for worsening of an existing curve. Other than growth, risk factors that make it more likely that a scoliosis curve will get worse include:

Sex

Curves in girls are more likely to worsen than curves in boys.

Age

The younger the age when scoliosis appears, the greater the chance of progressive disease

Angle of the curve

The greater the curve angle, the higher the likelihood that it will worsen

Location

Curves in the middle to lower spine are less likely to progress than those in the upper spine

Spinal problems at birth

Children who are born with scoliosis (congenital scoliosis) may have rapid progression of the curve. Congenital scoliosis is thought of as a birth defect in the spine itself.

Symptoms

Scoliosis can impact the quality of life with limited activity, pain, reduced respiratory function. There are several different “warning signs” to look for. In case you notice one or more of these signs, you should start doing something.

  1. Shoulders are different heights.
  2. One shoulder blade is more prominent than the other.
  3. Rib cages are at different heights
  4. Appearance of a raised, prominent hip
  5. Uneven waist
  6. Leaning of entire body to one side

The curve may occur in the upper back area (thoracic), the lower back area (lumbar) or in both areas (thoracolumbar). The curve can bend to the left or to the right. As scoliosis curves get worse, the spine will also rotate or twist, in addition to curving side to side. This causes the ribs on one side of the body to stick out farther than on the other side. Severe scoliosis can cause back pain and difficulty breathing.

Diagnosis

Usually scoliosis revealed by physician at routine well-child visits or during screening program at school. Many schools also have screening programs for scoliosis.
The spine should appear as a straight line from the base of the neck to the tailbone. If your child has scoliosis, the view from behind may reveal one or more abnormal curves. Most cases of scoliosis don’t get worse, and periodic checkups may be all that your child needs. A standard exam that is often used by pediatricians and in initial school screenings is bending test (Adam’s Forward Bend Test). For this test, the patient is asked to lean forward with his or her feet together and bend 90 degrees at the waist. The examiner can then easily view from this angle any asymmetry of the trunk or any abnormal spinal curvatures.
Once suspected, scoliosis has to be confirmed with an x-ray, CT scan or MRI. Bone scan of the spine can also be used.
The curve is then measured (Cobb Method) and is discussed in terms of degrees. A curve greater than 25 to 30 degrees is considered significant. Curves exceeding 45 to 50 degrees are considered severe and require aggressive treatment.

Treatment

The vast majority of people with this condition are not expected to require
treatment. Sometimes, an underlying disease that affects the neuromuscular system, a leg-length discrepancy, or a birth defect may cause scoliosis.

Braces

If your child has a curve of 25 to 40 degrees and he or she is still growing, your doctor may recommend using a brace. Wearing a brace won’t cure scoliosis, or even improve the curve, but it usually prevents further progression of the curve.
The brace may correct the curve as much as 50 percent during treatment. However, once the brace is discontinued, the spine often reverts back to its pretreatment curve. Once the skeleton is mature, or if the curve is too large, a brace doesn’t help.
Children who wear braces can usually participate in most activities and have few restrictions. Kids can take off the brace to participate in sports or other physical activities.
Braces aren’t useful for the treatment of congenital scoliosis.

Physical therapy

Physical therapy is the best non-invasive treatment of scoliosis. Usually muscles on one side are weak and extended, and tense and shortened on the other side. It causes rotation of the vertebras.
The goals of physical therapy are:

  1. Improve circulation and microcirculation in the area
  2. Work with the muscles to relax them on one side and improve their function on other side
  3. Optimization of nerve and muscle work

Physical therapy includes manual therapy as a main part of treatment. In addition — electrical stimulation of weak muscles, low frequency magnetic therapy and ultrasound therapy. Every physical therapist will provide you with necessary set of exercises, which will help you to stop the progressing of the disease, improve muscle strength and maintain treatment effect in between treatments.

Unfortunately, this condition is chronic and progressive without the treatment. It requires at least 2 courses a year with 12-15 sessions each. During the course, treatment has to continue everyday or every other day. In between patient has to follow instructions and continue exercising.

Surgery

This is the last option in treatment of scoliosis. If your child’s curve is greater than 40 to 50 degrees, doctors typically recommend surgery. Scoliosis surgery involves techniques to fuse or join the vertebrae along the curve. Scoliosis surgery is one of the longest and most complicated orthopedic surgical procedures performed on children. The operation takes several hours. Hospitalization can last several days, and activities are restricted for several months.

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