Human Diseases and Conditions

All Kind Of Disease

Scoliosis

What Is Scoliosis?

The word scoliosis (pronounced: sko-lee-oh-sis) comes from a Greek word meaning crooked. If you have scoliosis, you're not alone. About 3 out of every 100 people have some form of scoliosis, though for many of them it's not much of a problem.
Someone with scoliosis may have a back that curves from side to side like an "S" or a "C." Although small curves generally do not cause problems, if the curve gets severe it can be visible and cause discomfort.
Xray of curved spineScoliosis is sort of a medical mystery — no one knows for sure what causes the most common form of scoliosis, idiopathic scoliosis. ("Idiopathic" is a medical term that means it's not known what caused the condition or disease.) Doctor do know that scoliosis can run in families, though. So a person who has scoliosis may have family members who have it.
Most types of scoliosis are more common in girls than boys, and girls with scoliosis are more likely to need treatment.

 Sign And Symptoms
Signs and symptoms of scoliosis may include:
  • Uneven shoulders
  • One shoulder blade that appears more prominent than the other
  • Uneven waist
  • One hip higher than the other
If a scoliosis curve gets 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.

Causes
Doctors don't know what causes the most common type of scoliosis — although it appears to involve hereditary factors because the disorder tends to run in families. Experimental testing is being done to determine if blood tests can determine the risk that scoliosis will get worse in a given individual. This type of testing is likely to be more common in the future.
Less common types of scoliosis may be caused by:
  • Neuromuscular conditions, such as cerebral palsy or muscular dystrophy
  • Birth defects affecting the development of the spine
  • Wear-and-tear arthritis in the spine
  • Having one leg longer than the other

How is scoliosis diagnosed?

If you think you have scoliosis, you can see your doctor for an examination. The doctor will ask questions, including if there is any family history of scoliosis, or if you have had any pain, weakness, or other medical problems.
The physical examination involves looking at the curve of the spine from the sides, front, and back. The person will be asked to undress from the waist up to better see any abnormal curves. The person will then bend over trying to touch their toes. The doctor will also look at the symmetry of the body to see if the hips and shoulders are at the same height. Any skin changes will also be identified that can suggest scoliosis due to a birth defect.
The more growth that a person has remaining increases the chances of scoliosis getting worse. As a result, the doctor may measure the person's height and weight for comparison with future visits. Other clues to the amount of growth remaining are signs of puberty such as the presence of breasts or pubic hair and whether menstrual periods have begun in girls.
If the doctor believes you have scoliosis, you could either be asked to return for an additional examination in several months to see if there is any change, or the doctor may obtain X-rays of your back. If X-rays are obtained, the doctor can make measurements from them to determine how large of a curve is present. This can help decide what treatment, if any, is necessary. Measurements from future visits can be compared to see if the curve is getting worse.

How is scoliosis treated?

Treatment of scoliosis is based on the severity of the curve and the chances of the curve getting worse. Certain types of scoliosis have a greater chance of getting worse, so the type of scoliosis also helps to determine the proper treatment. There are three main categories of treatment: observation, bracing, and surgery.
Functional scoliosis is caused by an abnormality elsewhere in the body. This type of scoliosis is treated by treating that abnormality, such as a difference in leg length. There is no direct treatment of the spine because the spine is normal in these people.
Neuromuscular scoliosis is caused by an abnormal development of the bones of the spine. These types of scoliosis have the greatest chance for getting worse. Observation and bracing do not normally work well for these people. The majority of these people will eventually need surgery to stop the curve from getting worse.
Treatment of idiopathic scoliosis is based on the age when it develops.
In many cases, infantile idiopathic scoliosis will improve without any treatment. X-rays can be obtained and measurements compared on future visits to determine if the curve is getting worse. Bracing is not normally effective in these people.
Juvenile idiopathic scoliosis has the highest risk for getting worse of all of the idiopathic types of scoliosis. Bracing can be tried early if the curve is not very severe. The goal is to prevent the curve from getting worse until the person stops growing. Since the curve starts early in these people, and they have a lot of time left to grow, there is a higher chance for needing more aggressive treatment or surgery.
Adolescent idiopathic scoliosis is the most common form of scoliosis. If the curve is small when first diagnosed, it can be observed and followed with routine X-rays and measurements. If the curve stays below 25 degrees, no other treatment is needed. If the curve is between 25-40 degrees, a brace may be recommended. If the curve is greater than 40 degrees, then surgery may be recommended.
As explained above, scoliosis is not typically associated with back pain. In cases with back pain, the symptoms can be lessened with physical therapy, massage, and exercises, including yoga. These can help to strengthen the muscles of the back. They are not, however, a cure for scoliosis and will not be able to correct the abnormal curve.
There are several different types of braces available for scoliosis. Some need to be worn nearly 24 hours a day and are removed only for showering. Others can be worn only at night. The ability of a brace to work depends on the person following the instructions from the doctor and wearing the brace as directed. Braces are not designed to correct the curve. They are used to help slow or stop the curve from getting worse.
If the curve stays below 40 degrees until the person is finished growing, it is not likely to get worse later in life. However, if the curve is greater than 40 degrees, it is likely to continue to get worse by 1-2 degrees each year for the rest of the person's life. If this is not prevented, the person will eventually be at risk for heart or lung problems.
If a tumor such as osteoid osteoma is the cause of the scoliosis, surgery to remove the tumor is generally able to correct the curve.
People with degenerative scoliosis will often have more complaints of back and leg pain. This is related to the arthritis in the back and possible compression of the nerve roots that lead to the legs. Nonoperative treatment including physical therapy, exercises, and gentle chiropractic can help relieve these symptoms in some cases. People who fail to improve with these treatments may benefit from surgery. X-rays and possible MRIs will be obtained to plan for surgery. The surgery could include only a decompression or removal of bone spurs that are compressing the nerves. In some cases, a fusion will be necessary to stabilize the spine and possibly correct the abnormal curve.

Is there a cure for scoliosis?

At this time, there is no cure for scoliosis. There are good treatment options as discussed above. Researchers are trying to find the causes of the different types of scoliosis. This will hopefully lead to better treatments or a cure.

Refrence

  1. Scoliosis. National Institute of Arthritis and Musculoskeletal and Skin Diseases. http://www.niams.nih.gov/Health_Info/Scoliosis/default.asp#curved. Accessed Sept. 29, 2009.
  2. Spiegel DA, et al. The spine. In: Kliegman RM, et al. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa.: Saunders Elsevier; 2007. http://www.mdconsult.com/das/book/body/162865946-4/894858399/1608/1580.html#4-u1.0-B978-1-4160-2450-7..50680-0--cesec11_12494. Accessed Sept. 29, 2009.
  3. Scheri SA. Clinical features, evaluation and diagnosis of adolescent idiopathic scoliosis. http://www.uptodate.com/home/index.html. Accessed Sept. 29, 2009.
  4. Thomas MA, et al. Scoliosis and kyphosis. In: Frontera WR, et al. Essentials of Physical Medicine and Rehabilitation. 2nd ed. Philadelphia, Pa.: Saunders Elsevier; 2008. http://www.mdconsult.com/das/book/body/162865946-4/894858399/1678/200.html#4-u1.0-B978-1-4160-4007-1..50145-0--cesec11_2436. Accessed Sept. 29, 2009.