Signs, Symptoms and Treatment of Adolescent Scoliosis
Scoliosis can be defined as a lateral deviation in the spinal column. It occurs in over twice as many females than males and it tends to run in families. It can have many causes. These include neuromuscular problems, congenital spine deformities, spina bifida, cerebral palsy, leg length discrepancies, muscular dystrophy, genetic conditions and tumors. However, in over 80% of the scoliosis sufferers it is just found to be idiopathic, which basically means there is no cause. AIS, which stands for Adolescent Idiopathic Scoliosis, is the most common form of scoliosis and makes up about 80% of all idiopathic scoliosis cases. As stated above, having spinal deformities in your genetic tree predisposes you to spinal abnormalities and puts you at a much higher risk of developing them. Therefore, it is imperative that this be detected as early in life as possible.
The first signs of scoliosis are signaled by:
-an unevenness to the waist, rib cage, or hip area
-leaning to one side
-one shoulder slightly higher than the other
-one shoulder blade protruding out more than the other
-changes in the skin over the spinal area
-head and pelvis approximation
Noticing any of the above symptoms should signal a “red flag” and your child should see his or her pediatrician as soon as possible.
Children are generally checked for scoliosis around the ages of 10 or 11 at the pediatrician’s office or at school. The simple testing procedure that is used is called the Adam’s Forward Bend Test and can be done by a parent as well. With feet together, have the child bend at the waist at a 90 degree angle. Carefully observe the child’s back at every angle and take note of any abnormalities. Observe for asymmetry in the back itself. This simple test should be preformed on a yearly basis, if not more often. If any abnormalities are found your child will need further testing to confirm this. Confirmation of scoliosis is done with an MRI, bone scan, x-ray, spinal radiograph, or a CT scan of the spine. Once scoliosis has been diagnosed, the curve is then measured using the Cobb Method where the curve is measured in degrees. A curve that measures 25 to 30 degrees is cause for concern. Severe curvatures of the spine measuring 45 to 50 degrees and above require more intense treatment interventions.
Once the degree of scoliosis is determined your doctor will inform you of all options to treatment that are available. Treatment will depend on the degree of the spinal curve and its risk of advancing slowing or dramatically. The location of the curve is also said to play a factor in treatment planning. Upper spinal curves, which are called thoracic curves, are noted to be more apt to progress than middle spinal curves, which are called thoracolumbar curves and lower spinal curves, which are referred to as lumbar curves. Age, impending growth spurts, spinal maturity and the severity of the curve will all be taken in to consideration as well.
Treatment, depending on the degree of the curve, can take several paths. If the curve is less than 40 degrees and your child is almost at the completion of his or her growth, then observation is a reasonable option. The chances of progression are slim at this point. Frequent x-ray of the spine is recommended for several years. If the curve is 40 degrees or less and your child has not completed his or her growth, then bracing is recommended. Keep in mind though that bracing will only prevent further spinal curvature. It will not repair the existing curve. In about 80% of scoliosis cases bracing has been noted to be successful in stopping the spinal curvature. There are several types of braces available. These include the Boston Brace, the Charleston Bending Brace, the Milwaukee Brace and the less constricting thoracic-lumbar-sacral orthosis, also called a TLSO. There is obviously an adjustment period for an adolescent wearing a brace which they quickly adapt to.
For spinal curvatures over 45 degrees surgery is usually recommended. This degree of curvature is more severe and usually does not respond to bracing. Some 30 or so years ago, surgery was very intensive and required months in a body cast. With thanks to several spinal professionals, advancements have been made in this procedure in regards to the actual techniques and recovery period involved. Posterior spinal fusion and bone grafting is most often used now to perform this type of surgery. Although it is a complicated and delicate procedure that takes several hours most people are able to leave the hospital within a week without any casting or bracing required. Light activity is possible within 2 to 4 weeks and normal activity within 4 to 6 months.
The other surgery that is sometimes used is an anterior procedure. Bracing is necessary, in most cases, in this type of procedure for several months. Each approach has its advantages and disadvantages, but it is a long way from the days of yesteryear.
As with any surgery there are risks, benefits, and complications that could arise. The best plan of action can be determined for your child’s particular situation in consultation with your health care professional.
