Scoliosis

Written by Staff | 08 September 2011

Scoliosis is a condition of abnormal curvature and rotation of the spine, and has been estimated to affect as many as 2–3% of the US population¹. Scoliosis is a structural defect resulting from a variety of possible conditions, which have been classified into three broad groups²:

• Neuromuscular — neurologic and/or musculoskeletal conditions such as dystrophy and cerebral palsy can lead to a lack of muscle stability and control; this instability allows the spine to grow at an abnormal curvature.
• Idiopathic — pathology for which the cause can’t be determined is termed idiopathic. The most common form of scoliosis, idiopathic scoliosis can occur anytime between infancy and adolescence.
• Congenital — any abnormality in spine curvature present at birth as a result of a developmental defect in the womb represents a congenital etiology.

For cases of scoliosis that manifest after birth, pain and fatigue are the most common symptoms¹. In severe cases, the abnormal curvature of the spine can affect the development of the chest wall and lead to heart and lung problems.

Scoliosis is a progressive disease that can get worse as the spine continues to grow with abnormal curvature and/or rotation². Therefore the future severity of disease can be estimated by the number growth-years remaining. Advanced curvature at an earlier age is generally indicative of more severe scoliosis which may require aggressive treatment.

Diagnosis and Treatment

Diagnosis of scoliosis is made by a doctor via history, physical exam and supplemental imaging. A variety of techniques exist for visualizing spinal curvature, and a measurement device known as a scoliometer can be used to measure curvature and rotation². If a scoliometer suggests abnormal curvature, or if curvature is readily visible, X-ray imaging can be ordered to provide the definitive diagnosis. X-ray imaging can help physicians determine the severity of the scoliosis as well as estimate future growth potential¹. The severity of scoliosis is determined by the ‘Cobb angle’ as measured on a radiograph.

A variety of treatment options are available for scoliosis, but are dependent upon the severity of the condition, as well as anticipated progression. Treatment strategies include^{1, 3}:

• Watchful waiting — for curvature angles less than 20 degrees (Cobb angle), patients can be assessed once every 6–12 months. For younger patients with significant growth remaining, increases in curvature of 5 or more degrees between check-ups may warrant more aggressive treatment.
• Bracing — typically chosen for curvature angles between 20 and 50 degrees, bracing protects against scoliosis progression in patients with growth remaining; although it cannot cure or reverse existing damage.
• Surgery — a last resort for curvature angles exceeding 50 degrees where significant growth is still expected, progression of scoliosis can be halted by fusing adjacent vertebrae together. In some cases it may be possible to reduce existing curvature as well.

With treatment, scoliosis patients can enjoy a high quality of life. The best treatment, however, is prevention; regular pediatric check-ups can help catch scoliosis early in childhood, leading to earlier treatment and better outcomes^{1, 2}.

References

1. Nidus Information Services (2010). Scoliosis. Patient Education. MD Consult Web site, Core Collection. Retrieved from www.mdconsult.com.ezproxy2.library.arizona.edu.
2. Scherl, S. (2011). Clinical features; evaluation; and diagnosis of adolescent idiopathic scoliosis . In: UpToDate, Basow, DS (Ed), UpToDate, Waltham, MA.
3. Scherl, S. (2010). Treatment and prognosis of adolescent idiopathic scoliosis . In: UpToDate, Basow, DS (Ed), UpToDate, Waltham, MA.