Scoliosis

Musculoskeletal

Scoliosis is an abnormal curvature of the spine. Normally, when looking at the spine it is in a straight line down the back however in scoliosis it curves to the right or left. Our spine has normal curvatures, for example in the lower back, but at these locations, the spine curves inward, not to the side.Most cases are mild and do not progress to the production of symptoms nor do they require treatment. This occurs in adolescents during growth spurts around the time of puberty and is particularly common in young girls. Starting around the fifth grade, most schools in the U.S. will begin annual screening of students for scoliosis.

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Symptoms

Most often there are not any symptoms as the disease has a mild presentation in the majority of individuals. It is only when the curvature in the spine progresses that it may start to cause disfigurement and subsequent symptoms. The upper body starts to bend to one side along with the curving spine. This causes the shoulders to become uneven and protrusion of the shoulder blade. The rib cage on the same side will appear to bulge out giving the waist an irregular appearance. Similarly, the hips will not appear to be in line with each other and cause the legs to have unequal lengths. Patients in whom scoliosis progresses may also experience difficulty breathing as the lungs become compressed within an abnormally shaped rib cage. Patients also complain of chronic back pain.

Risk Factors

  • Female sex
  • History of congenital heart disease (CHD)
  • Genetic syndrome (i.e., Down’s syndrome)
  • Developmental delay
  • Age (before puberty)
  • Family history of scoliosis
  • History of childhood cardiothoracic surgery

Diagnosis

The screening test used for scoliosis requires the patient to bend forward, keeping the knees straight and arms dangling on the side of the body. This will allow the healthcare professional to visualize the type and degree of spinal curvature. The spine may curve at one location only to the right or only to the left and it may also curve at two locations. A part of the physical examination can include neurological and muscular testing. This can involve reflexes and checking for muscle weakness. Imaging studies including an x-ray are done to confirm the diagnosis. They also helpassess whether there is an underlying pathology causing scoliosis. For example, the presence of a tumor mass may be pushing the spine to one side. If a secondary cause is suspected, further imaging tests may be required.

Treatments

Most patients presenting with only mild scoliosis don’t require any kind of treatment. Instead, they are monitored every few months to make sure the condition is not progressing. The patients who require treatment are managed based on their particular severity, age, and other factors. Children who are still growing are often asked to wear a brace. The most common type is a contoured plastic brace that can be worn under clothes and is not seen. The efficacy of the brace is based on the duration of time it is worn. They can also be worn to sleep and do not prevent the child from participating in physical activities.

If the curvature of the spine is progressing and the brace has proven ineffective then the patient may require surgery. Usually, surgery is avoided in children who are still growing and doctors try to wait until the bones have stopped growing. If surgery cannot be delayed then an adjustable rod is put in place. This will allow the bones to continue growing and not leave the child with stunted growth. If the child has reached an age where the bones are no longer growing then the surgical procedure is different and can include fusing the bones of the spinal column.

Alternative Treatments and Home Remedies

Scoliosis is a spinal condition that must be treated by a physician and/or surgeon who will recommend bracing or surgery in extreme cases. Alternative treatments will not “cure” the condition. However, there are alternative treatments that can be used to complement treatment. Discuss any treatment you are planning to use with your physician before you begin. Alternative options to treat scoliosis include yoga, chiropractic treatment, and physical therapy exercises. If you plan to practice yoga, find an instructor who has specific experience in teaching people with scoliosis to safely practice yoga maneuvers. There is a resource for those who want to take yoga with scoliosis found here.

References

Mery, C. M., et. al. (2018). Risk factors for development and progression of scoliosis after pediatric cardiothoracic operations. Annals of Thoracic Surgery,105, 1835-1841. Retrieved from:https://www.annalsthoracicsurgery.org/action/showPdf?pii=S0003-4975%2818%2930082-1

Mayo Clinic Staff. (2019, June 22). Scoliosis. Retrieved from Mayo Clinic:https://www.mayoclinic.org/diseases-conditions/scoliosis/symptoms-causes/syc-20350716

Scoliosis SOS Clinic Writing Staff. (2017, July 19).Scoliosis complications later in life. Retrieved from:https://www.scoliosissos.com/news/post/scoliosis-complications-later-in-life

Shah, S. S. (2021). Scoliosis. Retrieved from Nemours: https://www.nemours.org/content/dam/nemours/www/filebox/service/medical/orthopedics/scoliosis.pdf

Soucacos, P. N. (2000, August). Risk factors for idiopathic scoliosis: review of a 6-year prospective study. Orthopedics, 23(8), 833-838. Retrieved from: https://pubmed.ncbi.nlm.nih.gov/10952046/

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