Health Issues
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What is Scoliosis?
Scoliosis is not a disease – it is a descriptive term. All spines have curves. Some curvature in the neck, upper trunk and lower trunk is normal. Humans need these spinal curves to help the upper body maintain proper balance and alignment over the pelvis. However, when there are abnormal side-to-side (lateral) curves in the spinal column, we refer to this as scoliosis.
What to look for?
There are several different "warning signs" to look for to help determine if you or someone you love has scoliosis. Should you notice any one or more of these signs, you should schedule an exam with a doctor.
- Shoulders are different heights – one shoulder blade is more prominent than the other
- Head is not centered directly above the pelvis
- Appearance of a raised, prominent hip
- Rib cages are at different heights
- Uneven waist
- Changes in look or texture of skin overlying the spine (dimples, hairy patches, color changes)
- Leaning of entire body to one side
What causes Scoliosis?
Doctors define scoliosis in a particular person based on a number of factors related to the curve, including:
- Shape. Aside from appearing like the letter C or S, a curve may occur in two or three dimensions. A nonstructural curve is a side-to-side curve. A structural curve involves twisting of the spine and occurs in three dimensions.
- Location. The curve may occur in the upper back area (thoracic), the lower back area (lumbar) or in both areas (thoracolumbar).
- Direction. The curve can bend to the left or to the right.
- Angle. Doctors figure out the angle of the curve using the vertebra at the apex of the curve as the starting point.
- Cause. About 80 percent of scoliosis cases are idiopathic, meaning the cause is unknown.
Many theories have been proposed regarding the causes of scoliosis. They include connective tissue disorders, hormonal imbalance and abnormality in the nervous system.
Scoliosis runs in families and may involve genetic (hereditary) factors. But researchers haven't identified the gene or genes that may cause scoliosis. Doctors also recognize that spinal cord and brainstem abnormalities play a role in some cases of scoliosis.
Is there any treatment?
There are three basic types of treatments for scoliosis: observation, orthopedic bracing, or surgery.
Observation is appropriate for small curves, curves that are at low risk of progression, and those with a natural history that is favorable at the completion of growth. These decisions are based on the expected natural history of a given curve. For example, if your child is diagnosed with a curve of 25 to 40 degrees and has completed growth (i.e., boys older than 17, girls older than 15), then observation is appropriate. Statistically, these curves are at low risk of progression and are not likely to cause problems in adulthood. Follow-up x-ray once per year for several years would then confirm that the curve is not progressing after completion of growth. As an adult, an x-ray every five years, or if there are symptoms, is sufficient.
Orthopedic braces are used to prevent further spinal deformity in children with curve magnitudes within the range of 25 to 40 degrees. If these children already have curvatures of these magnitudes and still have a substantial amount of skeletal growth left, then bracing is a viable option. It is important to note, however, that the intent of bracing is to prevent further deformity – it is not to correct the existing curvature or to make the curve disappear.
Surgery is an option used primarily for severe scoliosis (curves greater than 45 degrees) or for curves that do not respond to bracing. There are two primary goals for surgery: to stop a curve from progressing during adult life and to diminish spinal deformity.
What is the prognosis?
At this time, cerebral palsy cannot be cured, but due to medical research, many patients can enjoy near-normal lives if their neurological problems are properly managed.