Scoliosis

by Gavin Morrison on December 30, 2014

Scoliosis is a condition that causes the spine to curve abnormally. A scoliotic curve can also have some abnormal rotation to it. This is called a rotoscoliosis.

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Scoliosis curves are seen when viewing the spine from the back and are measured in degrees. A normal spine will have a curve of less than 10 degrees. In mild scoliosis, the spine curves 10 to 20 degrees. Moderate forms have a 20 to 50 degree curve. Severe scoliosis curves that are 50 degrees and higher.

Types of Scoliosis

* Idiopathic Spinal Curves, are frequently discovered in children from ages 10 through 12, although the condition can appear in younger children and older teens as well.

* Juvenile Spinal Curves that begin in early childhood and progress quickly are serious and need immediate and aggressive treatment.

* Adult Spinal Scoliosis appears in older adults, often after middle age.

* A Congenital Spinal Curvature occurs in-utero when the fetus in forming and is considered a type of spinal defect.

The Facts on Scoliosis

 

C shaped curves, those that look like a “ C” or S shaped curves those like an “S” are the typical scoliosis curves. These curves frequently occur in the thoracic spine (middle back).

90% of scoliosis cases have no associated pain or symptoms.

Diagnosis of a curve generally happens during a regular exam from a school nurse, healthcare professional or family doctor. These consist of bending and measuring the spine and legs for abnormalities and checking height differences. A chiropractor can also diagnose scoliosis. In cases where a scoliosis is suspected, X-rays will be taken to measure the degree and type of curve.

 

Scoliosis symptoms

Signs that the condition is present include:

· Asymetric shoulder height.
· Uneven waist or hip height.
· Ribs higher on one side.
· Torso leaning to one side.
· Disproportionate or uneven shoulder blades.

Severe Scoliosis

Scoliosis curves that measure over 70 degrees are dangerous. These curves can result in the ribs constricting lungs and heart function. Breathing problems can leave the patient at risk for pneumonia or cardiovascular problems. Severe scoliosis ultimately requires treatment. Therapy options are quite limited. However studies are currently being done to investigate new treatment and prevention methods. Surgical options include a spinal realignment and vertebral fusion.

Pain From Scoliosis

Mild scoliotic curves require only minimal treatment, generally in the form of physical therapy. Moderate to severe cases are not often painful but need to be monitored by a health professional. Some severe types of scoliosis can threaten the integral structure of the spine.

Spine specialists and surgeons monitor and treat the chronic pain from severe scoliosis. Unfortunately, invasive surgeries are the only treatment at present for severe curves. The discovery of a genetic component of scoliosis may eventually assist doctors in preventing the disease rather than merely treat it.

Scoliosis Treatment

There are two common treatments that have been proven to be effective. The first is surgery and the second is having younger patients wear a back brace.

Back Braces For Scoliosis

Back braces are recommended for controlling scoliosis in children as soon as the condition becomes serious. The brace is fitted and then worn for up to 23 hours a day. This approach is used for spinal curves larger than 10 degrees but less than 45 degrees. The brace needs to be worn during the child’s growing years. While the brace will not fix the curve, it is a temporary method to prevent the condition from worsening. Once the brace is discontinued there is some evidence that the curve can return. Braces are mostly effective at keeping mild to moderate curves from progressing.

Types of Back Braces

 

The original back brace was called a Milwaukee Brace but is rarely prescribed by anymore. This bulky device, made of metal limits activity and movement. Modern plastic braces are less obvious and allow the patient freedom of movement.

New designs are being created using high tech materials that are more comfortable and less obvious and restrictive.

Alternatives in Scoliosis Treatment

Even with modern medical technology treatment for scoliosis still inadequate.

* Chiropractic care will not correct a curve but may lessen pain and symptoms.

* Electrotherapy and stimulation can also relieve symptoms.

* Physical therapy techniques help increase the patient’s range of motion, reduce pain and potential disability.

Scoliosis Surgery

Scoliosis surgery is the most serious and extreme of all the spine surgeries. Surgeons  hold back on surgery unless the curve measures over 50 degrees. Children are not candidates for this type of surgery until the spine and other structural bones are fully developed. The surgery for scoliosis is a spinal fusion using grafts from the patient’s bones, taken from the hip or cadaver bones. Fixation devices such a screws, hooks and rods are used to realign and stabiliza the spine thus inhibiting the progression of the scoliosis.

 

Spinal Fusion Scoliosis Surgery

With a severe thoracic scoliosis, at least ten vertebrae are fused during the surgery. Bone grafts cause the vertebrae to permanently grow together over time. One consequence of this is procedure is severely restricted motion in the back.

The surgery involves a preparatory procedure that removes the intervertebral discs between the vertebrae that will be fused. This requires incisions to be made in the abdomen (anterior approach) or the back (posterior approach) or a combination of the two in order for the surgeon to gain access to the spine. Once the discs are removed the empty spaces between the vertebrae are filled in with bone chips (grafts) and the spine is fixated with screws plates and rods.

Posterior fusions require more recovery time because the muscle and healthy tissue the must be stretched and moved to get access to the spine are traumatized by the procedure. The abdominal or anterior approach requires fusing fewer vertebral levels however it cannot be used on all types of curves.

Precautions and Concerns for Scoliosis Surgery

As with all surgeries there is a significant risk of infection. In addition, the cadaver bone grafts used in surgery may be rejected by the patient’s body during recovery. There can also be spinal fluid that leaks out of the spinal cord due to the invasiveness of the procedure. Post-operative bleeding is also a risk. After fusion surgeries healthy vertebrae that were not fused have a greater risk of injury. Peripheral nerve damage and the possibility that the vertebrae will not fuse are also risks. 10 to 20 percent of scoliosis surgery patients experience some sort of post surgical complications.

The fusion procedure for scoliosis is very invasive. The surgery itself lasts several hours and the rehabilitation process is rigorous and can take several months. You can expect up to 7 days of hospitalization for observation post surgery.

In cases of scoliosis in children the physician should reassure the child that has been diagnosed that they are not destined to experience pain from their condition. Psychologically, the physician has a big influence on whether on not the child will suffer pain from the condition or not in later life.

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