Scoliosis is the term given to abnormal lateral (to the side)
curvatures of the spine. Although this abnormality of the spine
is a rather common deformity (2-3% of the pediatric population,
up to 20% of older adults), it rarely requires any form of treatment. Scoliosis may develop due to a number of causes, and thus several types of scoliosis exist.
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). In idiopathic scoliosis, a
portion of the spine rotates and shifts away from the midline.
Seen from the back the spine is thus no longer straight and a
"hump" can be noted on the side to which the curved spine has
shifted. When this abnormal curvature of the spine is examined
by X-ray, the exact degree of curvature can be measured (often
called the Cobb angle). Depending upon several factors such as
the patient age, sex, degree of curvature and how fast the abnormal
curve is developing, a treatment plan is designed. Most patients
who have scoliosis do not have severe curves and thus may require
no treatment. When a scoliosis with a significant or progressive
curvature is noted, then treatment may be necessary. Treatment
for scoliosis can involve doing nothing (for mild curves), bracing
(for moderate curves), or in some instances performing surgery
for severe or progressive (worsening with time) curves. The risks
and benefits of each of these approaches for a particular patient
must be carefully reviewed. Sometimes there is no one correct
treatment. When different options exist the physician must work
closely with the family and patient to follow a plan designed
for the particular individual. If the decision is not to operate,
then X-rays must be obtained at regular intervals to ensure that
the scoliosis is being controlled and not progressing too rapidly.
If a decision to operate is made, the patient must be aware of
the risks involved, the recovery period required, and the limited
activities possible during that time. With the new spinal
instrumentation systems dramatic corrections of deformity
are now possible and patients are often out of bed walking in
Aside from idiopathic scoliosis, there are many other (less common)
types of scoliosis seen in children. Other types of scoliosis
include congenital scoliosis, neuromuscular scoliosis, metabolic
and traumatic scoliosis.
In adults, scoliosis can occur due to a number of different
conditions. The most common causes for spinal deformity include
a childhood scoliosis which has progressed or become painful in
adult life, or a new scoliosis which has developed due to aging.
In some cases it is difficult to tell when exactly the spine developed
a scoliosis, and sometimes it is even hard to tell that there
is a spinal problem just by looking at someone. In severe cases,
the spine can become quite hunched and twisted causing problems
with posture, walking and even breathing. The exact cause of scoliosis
in adults is not clearly understood. We know that aging leads
to a gradual collapse of the intervertebral
discs along the spine, and that the ligaments that the support
the spine lose their strength and elasticity. Furthermore, the
bones can become weakened and partially collapse (as in osteoporosis).
All of this combined can weaken the structure of the spine so
that a gradual deformity occurs that usually combines an increased
forward curvature (kyphosis)
as well as a lateral deviation of the spine (scoliosis).
Aside from scoliosis due to degeneration, or progression from
childhood, there are a number of other causes for spinal deformity
in an adult. Some of the less common types include: fractures,
metabolic diseases, infections, cancer.
Prior to planning a treatment for scoliosis in an adult it is
essential to understand what caused the deformity. The evaluation
may include X-rays and possibly other test such as an MRI, blood
tests, and a bone density evaluation. The treatment for adult
scoliosis is then dependant upon the cause of the deformity as
well as the symptoms. In most cases of mild degenerative scoliosis
the treatment is directed at muscular rehabilitation and pain
control. A focused therapy program and anti-inflammatory and/or
pain medication can help most patients in this category. For patients
suffering from other specific types of scoliosis the treatment
is directed at the underlying cause for spinal collapse.
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