Scoliosis - Grade: B+ PDF

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Scoliosis an overview of the condition, cure, and treatments options...

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SCOLIOSIS An overview of a spinal deformity

By Sadama Sinayoko Anatomy and Physiology 2110 L Dr. Hollier, Mark February 24, 2019

A normal spine has a straight profile when seen from the posterior side. Scoliosis occurs when this profile is deformed by a curvature which may appear in one or more segments. This curvature is linked with a turning of the spine around its own axis and narrowing of the vertebrae. Scoliosis is a structural three-dimensional deformity of the spine commonly related to growth. Non-structural deformity can be caused by lower limb disorders resulting in limb length discrepancies such as hip dysplasia, limb deficiency syndromes and herniated discs in the older child. There are no known reasons for what causes scoliosis. It can happen to healthy children or the condition may be hereditary. Although scoliosis can develop at any age, the vast amount of the cases transpires during adolescence, when most children are growing rapidly. The majority of cases are with adolescent females with no obvious cause. A spinal deformity presence in younger children is most likely to have a hard identifying cause. Scoliosis can also be classified by cause into idiopathic or secondary. Idiopathic scoliosis is further classified into infantile, juvenile and adolescent types or early and late onset. Scoliosis can also be secondary to congenital disorders, neuromuscular conditions, tumors, and trauma or syndromic. Scoliosis is usually suspected during a wellness exam. Scoliosis is not always associated with pain. The individual may not have pain at all, especially if the curve is barely noticeable. As the spine grows, it may cause bending in the axial skeleton region, also affecting the ribs, they can rotate and make the chest look uneven. This deformity can also make the shoulders or waist look uneven. Common signs of scoliosis include: uneven shoulders and shoulder blades, an unequal distance between arms and body, uneven hips, ribs particularly noticeable on the surface of the skin, more so in the thoracic region, lower back muscles more defined on one side, uneven waist creases.

Because of the risk of progression and the consequences these curves need to be monitored and treated rapidly. Studies have shown that early treatment may prevent a more drastic treatment like surgery. Most studies involve a mixed group of patients and therefore the observations may not be wholly accurate but the general trend is that in severe curves, which are greater than 90 degrees there is an increased risk of morbidity and mortality. There is also a reduced self-image leading to psychological disturbance in later life. In congenital or early onset curves these consequences can be devastating if not treated early. In an adult, scoliosis can occur usually as secondary prognosis to a degenerative disease or a result from untreated adolescent deformity. The goal of treatment in all cases is to prevent curve progression. Factors that influence the natural history of the different curves are infantile idiopathic curves, Adolescent idiopathic curves, congenital curves, neuromuscular curves, and syndromal scoliosis. Treatments vary on the progression of the curve of the spine. Small curves require regular rechecks by a specialist. Rechecks examinations determine if the curve is getting worse as your child gets taller. If the small curve does not change, treatment will be required. The younger a patient is with a larger curve, the greater the probability of a progression in the curve. Observations such as radiographs, Spinal X-rays are used to diagnose more efficiently and will show skeletal maturity. In some cases, bracing is recommended only when your child is still growing and is used for moderate or progressive curves. Bracing keeps curves from getting worse. The casting of the axial region is a treatment method used for infants or really young children with an extreme curve. A spine surgery is usually recommended in those cases when the individual is old enough, or if a child hasn’t reached its growing potential. Spine fusion is a

procedure during which an orthopedic surgeon fuses some of the bones of the spine to stop the curve from getting worse. Often, orthopedics doctors will consider surgery for children whose bones are not yet mature and who have curves greater than 40 to 45 degrees. Of the common treatments offered to children with scoliosis, spinal fusion surgery aims to stop the curve progression immediately, balance the spine and pelvis region. It also helps correct the posture faster and sit upright again. Surgery also relieves the pressure on the lungs and improves their functions which may be altered by a spine curve. Lastly, Physical therapy can be beneficial when specialists certified in the Schroth method, a type of exercise especially for scoliosis designed to increase strength and improve posture. It is further beneficial along with a bracing program. Depending on the severity, scoliosis can cause heart and lung problems in childhood which may become increasingly problematic in adult years. When untreated, it may lead to an increased risk of early death due to heart and lung disease. A prognosis is also conditioned on the presence of any other disorders that may affect the treatments. Thoracic Insufficiency Syndrome (TIS) is commonly used to describe the potentially combined spine and lung problems in scoliosis patients. (Scoliosis research society) Cases likely to progress are Idiopathic early on set (EOS) with curves greater than 30-35 degrees. The ones likely to resolve without treatment are with Children younger than age 2 with infantile idiopathic curves less than 35 degrees. Juvenile curves that reach 30° tend to continue to worsen without treatment. (Scoliosis research society).

Below is an X-ray of a case undergone a spine fusion using the Veptr growing rods technique and correction of the curve. These images show immediate improvement in the spine and ribs alignment.

In summary, a diagnostic and treatment plan will depend on each specific condition. Having been a part of an orthopedic team of surgeons, physical therapists, and orthotists for over a decade, our team uses advanced technology and surgical implants to provide the safest and most helpful surgery we can. The ultimate goal is to get kids and teens back to their routine activities, including most sports, as soon as possible. Current surgical techniques have proven to be safe, also result in highly successful deformity correction and long-term patient-reported outcomes. While doctors may debate statics, most cases have mild spine curvature and do not require treatment. In adverse cases, when diagnosed on early set, various treatments may alleviate further curving of the spine and minimalize discomfort....