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SCOLIOSIS
 
What is scoliosis?

Scoliosis is the word used to describe a spine (backbone) that is curved.

Normally, the spine is made up of 33 vertebrae (little blocks of bones stacked one on top of the other) forming a straight line when you look directly at the back.

Two types of curves exist.  The “C” shape (only one curve) or the “S” shape (two curves).  They are both noticeable when you look directly at the back.

With scoliosis, the spine can be curved in one of two directions: turm more to one side (lateral) instead of in the middle or on itself (like a corkscrew or a spiral staircase).

When the curve turns on itself, it may cause a gibbosity (hump on the back).

What causes scoliosis?

Scoliosis affects about 2 to 4% of females and 0.5% of males.  There seems to be a familial link.  Mothers who have scoliosis have a greater chance of having children with scoliosis, especially if the children are female.

There are many types of scoliosis:

Congenital scoliosis: a curved spine is diagnosed at birth. 

Neuromuscular scoliosis: this is seen in children with neurological or muscular diseases such as Spina bifida or cerebral palsy.

Degenerative scoliosis: comes about as a result of the wearing down of discs in the spine.  It occurs most frequently in people over 65 years of age.

In 80% of cases, the cause of scoliosis is unknown and is then called idiopathic.  This type of scoliosis occurs most frequently in pre-teens and teenagers.

What are the signs of scoliosis?

  • One hip may appear higher than the other – making clothing look like it is not fitting properly;
  • One shoulder may appear higher than the other;
  • One shoulder blade looks more prominent (bulging out)than the other;
  • There may be one or more gibbosities (humps) on the back;
  • It appears as if the person is leaning to one side;
  • The person may complain of back pain.

You may already have noticed these signs before seeing your doctor.

What tests are done to detect scoliosis?

First, the doctor will ask about your family’s medical history.  This is to rule out different causes of scoliosis, such as birth defects and neuromuscular diseases.

Then, the doctor will do a physical examination.  The legs, hips and shoulders are checked to see if they are all at the same height. The doctor might use a string attached to a weight to see if the spine is in line with the back of the neck (helps measure how shifted the spine is).  The back is also examined in a bending position, as if you are touching your toes.  This way, the doctor can look at the symmetry (both sides are similar) of the back.  A scoliometer is an instrument that may be used to estimate the rotation of the spine.

Scoliosis is measured in degrees.  This is mostly done through X-Ray.  The doctor can keep track of the progression of the scoliosis through measuring the changes in degrees from one visit to another.  X-Rays are also used to help the doctor estimate the amount of growth left for a teenager (Rigger Test).  All this information will help decide which type of treatment will be most beneficial for the child and family.

What are the treatments for scoliosis?

The choice of treatment is decided by the family, with the doctor’s support. 

The recommendations made are based on many factors:

  • Cause of scoliosis;
  • Size (degree) of the curve(s);
  • Location of the curve(s);
  • Stage of growth of the bones;
  • Individual issues and special considerations.

The recommendations can be any one of the following:

A) Wait and see:

When the curve is from 0-20°, the doctor may recommend regular visits.  This is especially true for teenagers who are nearing the end of their growth, as it is not expected the curve will progress further. 

In the meantime, physiotherapy sessions may be prescribed to help with posture.  Physiotherapy can also help with pain if there is any.

B) Bracing:

This is recommended for curves between 20-40°. It is also recommended for children who have not yet reached puberty and for teenagers in the midst of their growth spurts.  The role of the brace is to stop the curve from getting worse while the child is growing. Although it does not decrease the curve, it may prevent it from getting worse.  It is important to know that the brace is not always effective, even when worn properly.  The brace will be fitted in clinic by a professional orthotist.

C) Surgery:

Surgery is considered when the curves are more than 40°.  This is to prevent complications to the heart and lungs.  It involves the fusion of vertebrae in specific areas and placing metal rods into the back order to straighten the spine.  Usually, only one surgery is required.  If surgery is needed, the doctor and nurse will meet with the family to discuss the procedure and the associated risks and benefits.

Again, the decision to proceed with any treatment is decided by the patient with the family and doctor.

How could i have prevented scoliosis from developing?

Because there are no known causes of scoliosis, it is difficult to prevent.

It is important to note that:

  • Heavy backpacks do not cause scoliosis;
  • Exercises for the back or gymnastics do not cause scoliosis;
  • In order to strengthen the back muscles and improve posture, ask your doctor which exercises are best;
  • In general, scoliosis will not change the activities that be done;
  • Most children with scoliosis do not have back pain.  Back pain may be due to another cause.

Where can I get more information about scoliosis?

You may have more questions or concerns.  Feel free to contact your doctor or your orthotist.  You can also visit the following websites:

http://www.srs.org/patients/

http://www.scoliosis.org/

 
 
 
 
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