What is Scoliosis?
Scoliosis is not a disease – it is a descriptive term. All spines have curves. Some curvature in the neck, upper trunk and lower trunk is normal. Humans need these spinal curves to help the upper body maintain proper balance and alignment over the pelvis. However, when there are abnormal side-to-side (lateral) curves in the spinal column, we refer to this as scoliosis.
What to look for?
There are several different “warning signs” to look for to help determine if you or someone you love has scoliosis. Should you notice any one or more of these signs, you should schedule an exam with a doctor.
- Shoulders are different heights – one shoulder blade is more prominent than the other
- Head is not centered directly above the pelvis
- Appearance of a raised, prominent hip
- Rib cages are at different heights
- Uneven waist
- Changes in look or texture of skin overlying the spine (dimples, hairy patches, color changes)
- Leaning of entire body to one side
What causes Scoliosis?
Doctors define scoliosis in a particular person based on a number of factors related to the curve, including:
- Shape. Aside from appearing like the letter C or S, a curve may occur in two or three dimensions. A nonstructural curve is a side-to-side curve. A structural curve involves twisting of the spine and occurs in three dimensions.
- Location. The curve may occur in the upper back area (thoracic), the lower back area (lumbar) or in both areas (thoracolumbar).
- Direction. The curve can bend to the left or to the right.
- Angle. Doctors figure out the angle of the curve using the vertebra at the apex of the curve as the starting point.
- Cause. About 80 percent of scoliosis cases are idiopathic, meaning the cause is unknown.
Many theories have been proposed regarding the causes of scoliosis. They include connective tissue disorders, hormonal imbalance and abnormality in the nervous system.
Scoliosis runs in families and may involve genetic (hereditary) factors. But researchers haven’t identified the gene or genes that may cause scoliosis. Doctors also recognize that spinal cord and brainstem abnormalities play a role in some cases of scoliosis.
Is there any treatment?
There are three basic types of treatments for scoliosis: observation, orthopaedic bracing, or surgery.
Observation is appropriate for small curves, curves that are at low risk of progression, and those with a natural history that is favorable at the completion of growth. These decisions are based on the expected natural history of a given curve. For example, if your child is diagnosed with a curve of 25 to 40 degrees and has completed growth (i.e., boys older than 17, girls older than 15), then observation is appropriate. Statistically, these curves are at low risk of progression and are not likely to cause problems in adulthood. Follow-up x-ray once per year for several years would then confirm that the curve is not progressing after completion of growth. As an adult, an x-ray every five years, or if there are symptoms, is sufficient.
Orthopaedic braces are used to prevent further spinal deformity in children with curve magnitudes within the range of 25 to 40 degrees. If these children already have curvatures of these magnitudes and still have a substantial amount of skeletal growth left, then bracing is a viable option. It is important to note, however, that the intent of bracing is to prevent further deformity – it is not to correct the existing curvature or to make the curve disappear.
Surgery is an option used primarily for severe scoliosis (curves greater than 45 degrees) or for curves that do not respond to bracing. There are two primary goals for surgery: to stop a curve from progressing during adult life and to diminish spinal deformity.
Until the last few decades, patients undergoing scoliosis surgery endured intensive surgery, treatment and casting, as well as months of slow recuperation. Since that time, spinal surgery pioneers such as Paul Harrington, Yves Paul Cotrel and Jean Dubousset have made great strides in improving the techniques and instruments used in surgery and post-operative care for patients with scoliosis.
There are different techniques and methods used today for scoliosis surgery. The most frequently performed surgery for adolescent idiopathic scoliosis involves posterior spinal fusion with instrumentation and bone grafting. This kind of surgery is performed through the patient’s back while the patient lies on his or her stomach. Two common instrumentation techniques are called Cotrel-Dubousset (CD®) instrumentation (rod rotation technique) and COLORADO™ instrumentation (translation technique). During these types of surgery, the surgeon attaches a metal rod to each side of the patient’s spine by using hooks attached to the vertebral bodies. Then, the surgeon fuses the spine with a piece of bone from the patient’s hip (a bone graft). The bone grows in between the vertebrae and holds them together and straight. This process is called spinal fusion. The metal rods attached to the spine ensure that the backbone remains straight while the spinal fusion takes place.
The operation usually takes several hours. With recent advances in technology, most people with idiopathic scoliosis are released within a week of surgery and do not require post-operative bracing. Most patients are able to return to school or work in two to four weeks after the surgery and are able to resume all pre-operative activities within four to six months.
Another surgery option for scoliosis is an anterior approach, which means that the surgery is conducted through the chest walls instead of entering through the patient’s back. The patient lies on his or her side during the surgery. During this procedure, the surgeon makes incisions in the patient’s side, deflates the lung and removes a rib in order to reach the spine. This approach allows the surgeon to operate higher up in the spine than through posterior approaches, and studies have shown favorable results with this type of surgery. Video-assisted thoracoscopic surgery allows surgeons to enhance their vision of the spine and to conduct a less invasive surgery than with an open procedure. The anterior spinal approach has several advantages: better cosmetic results, quicker patient rehabilitation, improved spine mobilization, and fusion of fewer segments. Most patients require bracing for several months after this surgery.
What is the prognosis?
At this time, cerebral palsy cannot be cured, but due to medical research, many patients can enjoy near-normal lives if their neurological problems are properly managed.