Idiopathic Scoliosis
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Dr. Frank Schwab being interviewed by FOX
Health. |
In children and adolescents, the most common type of scoliosis
is called Idiopathic Scoliosis. As its name implies (idiopathic
means that no specific or clear origin is identified) the cause
of this deformity is not known but may be caused by a combination
of factors (possibly hormonal, genetic, and neurologic). Idiopathic
scoliosis is commonly divided into different categories depending
upon the age at which the spinal deformity is first noted: infantile
scoliosis (0-3 years), juvenile (4-10 years) and adolescent (11-maturity).
Adolescent Idiopathic Scoliosis
This is by far the most common type of scoliosis in children.
It more commonly affects girls than boys. Progression of spinal
curvature is related to numerous factors, most notably the age
of the patient and the curve size. For example, a young girl that
has not reached menarche (when she has her first period) is at
much higher risk for scoliosis progression than a girl 2 years
after onset of menses (having her period regularly). The degree
of curvature is also important in that a 20 degree curve in a
young girl is much less likely to develop into a severe curve
than a 40 degree curve at the same age. In boys, growth can continue
well beyond 13 years of age so curve progression is still quite
possible at a later age than in girls. Once a child is skeletally
mature (no further growth in height), the likelihood of an idiopathic
scoliosis worsening is very unlikely unless the curve is around
50 degrees or greater.
There are many different type of curve patterns in idiopathic
scoliosis. Most curves tend have a thoracic and a lumbar
component. This means that there is one curve to the side in the
upper part of the spine (rib cage area) and another one in the
lower back. The two curves often balance each other out so that
the head is still centered over the pelvis
(although the shoulders may appear asymmetric). In some cases
this does not occur, and marked imbalance may be present. If a
curve appears to be very unusual in shape or rapidly progressive
then a suspicion must be raised that the scoliosis is perhaps
not idiopathic (possibly congenital, neuromuscular or other).
Treatment: Although severe curves carry a risk that lung
and heart function may become affected, most mild and moderate
curves lead rather to an aesthetic problem and rarely a true functional
disability. In fact the most noticeable aspect of a scoliosis
may be a rib hump on the back which is a result of spinal rotation
in scoliosis and not only the lateral deviation of the spine.
Because it is difficult to be certain which curves will progress
and by how much, all curves in an adolescent patient must be very
carefully evaluated and closely followed. The treatment must be
individualized in every case. For very mild curves (generally
10-20 degrees) regular check-ups and X-rays may be all that is
prescribed. For moderate curves, or those that are worsening over
time, a brace may be prescribed (custom orthosis). Brace treatment
may limit curve worsening in immature patients but does not permanently
correct a curve and is not effective once growth has stopped.
For severe curves (around 50 degrees or more), and those with
clear and substantial progression, surgery is often considered.
The optimal surgical treatment will depend upon the exact curve
type and its location. In some cases the curve is corrected from
the front although mostly a correction with a spinal fusion
is performed through the back. New techniques such as endoscopic
surgery can offer advantages in certain types of scoliotic curves:
minimizing the size of incisions and blood loss as well as permitting
a more rapid recovery.
Frequently
Asked Questions
Juvenile Idiopathic Scoliosis
This is a scoliosis, which develops well before the age of puberty
(4-10 years). The scoliosis commonly starts by the age of 6 with
a very small curve, which can rapidly become quite significant
long before skeletal maturation. For example, a 30 degree curve
on a 6-year-old girl may continue to progress until the end of
the growth spurt (18 months after the onset of menstruation).
By that time it can be severe and lead to marked deformity. It
has been shown that the application of a Milwaukee brace can improve
the juvenile curves and reduce the possible need for surgical
treatment. The worst results are seen in young children whose
curves are greater than 30 degrees at the time of diagnosis. Surgical
treatment with fusion and the use of spinal
instrumentation may be necessary early on to slow or stop
curve progression. In some cases surgical techniques of curve
correction without fusion have been applied. This may give some
continued growth of the spine until a later fusion procedure.
Infantile Scoliosis
This is a spinal curvature, which can develop even before a baby
has ever walked (0-3 years). It is very rare but when it happens
may lead to very severe deformity of the spine. This type of scoliosis
is not very frequent in North America where babies are nursed
in various positions, and part time prone positioning may reduce
the incidence of this deformity. When the scoliotic curve is more
than 30 degrees the application of a brace may correct the deformity
and prevent the curve from progressing. Many cases of infantile
scoliosis resolve completely without any long-term effects on
the infant.
In severe and progressive cases of scoliosis, surgical treatment
with fusion and the use of spinal
instrumentation may be necessary early on to slow or stop
curve progression. In some cases surgical techniques of curve
correction without fusion have been applied. This may give some
continued growth of the spine until a later fusion procedure.
Due to the complex nature of infantile scoliosis, several surgeries
over a span of years may be necessary in order to control the
deformity and maintain spinal balance.
Frequently
Asked Questions
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