COMMON CHARACTERISTICS
Scoliosis means abnormal curvature of the spine. Some people have an abnormal spinal curvature that is so minor that it is barely noticeable and does not interfere with normal posture and gait. In a small percentage of patients, however, scoliosis is progressive, and can become severe enough to cause deformity and even interfere with the function of the lungs because of chest wall compression. Fortunately, there are now a variety of techniques to treat the earliest stages of scoliosis and prevent the pronounced deformities often seen in the past.
FINDING THE CAUSE
Normally, when viewed from behind, the spine is aligned perfectly straight up and down. When a slight lateral curve develops, it is called scoliosis.
The most common form of scoliosis develops for unknown reasons, usually between the ages of ten and fourteen years, when pubertal growth is very rapid. This type of scoliosis tends to run in families and is far more common in girls than in boys. In the United States, scoliosis is estimated to affect more than 2 percent of teenagers, and most suffer little deformity. However, in its severe form, scoliosis tends to be progressive, and it can cause back pain and cosmetic deformity and even interfere with breathing.
Scoliosis also may be caused by some specific disorders affecting the muscles along the spine. Imbalance of muscle tone tends to pull the spinal column out of normal alignment. Historically, polio and tuberculosis were frequent culprits; however, as the incidence of these diseases has been reduced in our country, so has their contribution to abnormal spinal alignment. The muscular response accompanying vertebral arthritis and bone or nerve tumors also can cause scoliosis.
A small percentage of cases are present at birth, caused by congenital malformation. These include the absence of half a vertebra, unequal leg length, and faulty function of a hip joint.
DIAGNOSIS
Scoliosis is often first detected during a routine physical examination. But parents should be aware of how their children’s backs are developing, especially during the adolescent growth spurt. The child’s back should be carefully observed, both while standing and bending forward. The spinal column should appear straight when the youngster “stands tall.” Note particularly whether one shoulder is higher than the other, or whether there is any protrusion of a shoulder blade, a waist crease that appears deeper on one side, any hump on the back, the appearance of one arm being longer than the other or one hip being more prominent.
If parent or physician spots any curvature, it should be monitored regularly. X-ray films may be taken to chart any progression. Most cases are minor and require little, if any treatment. For example, if the cause is unequal leg length, treatment may simply involve using a shoe lift for the shorter leg. However, if the scoliosis is of the progressive type, prompt intervention is important. The more the spine is deformed, the longer corrective measures will be needed.
TREATMENT
If the curvature is caused by a spinal abnormality, the underlying problem must be identified and treated. Treatment may arrest or reverse the scoliosis.
The scoliosis that develops in adolescence, however, can sometimes be difficult to treat and may warrant several approaches. One, physical therapy, improves posture and tones up spinal muscles but will not improve structural scoliosis. The youngster also may have to wear a spinal brace, which is fitted by an orthopedist. The brace gently nudges the spine into a normal position over the course of months of wear. As progress is made the brace is periodically readjusted. Most youngsters adapt easily to its use, which can help prevent the need for surgery. Those who require neck support usually are fitted with the Milwaukee brace, which encases the wearer from the top of the neck to the pelvis and is made of leather or plastic with metal rods. If neck support is not needed, a plastic brace–which is less conspicuous because it begins below shoulder level–may be worn. However, both should be used twenty-three hours a day and removed only for bathing.
A newer approach involves using electrical stimulation to correct the spinal curvature. A specially fitted device that administers low amounts of electrical current to the back muscles, strengthening them to realign the spine, is worn at night. This treatment is still new and in the research stages.
Early diagnosis, followed by appropriate bracing and exercise, has reduced the need for scoliosis surgery. With age, however, the spinal column becomes less responsive t0o bracing. Then, surgery may be required to correct the deformity. This usually involves inserting rods on either side of the spinal column. The patient must spend ten days to two weeks in bed after surgery. In some cases, a plaster cast may have to be worn following the operation. However, once the cast is removed, the good results are permanent. While surgery is best performed when the patient is still a teenager, it can be successful even later in life.
SUMMING UP
Scoliosis usually is a minor problem for most people but should be monitored by a physician. Recent advances have made treatment more effective and less inconvenient than in the past. With prompt care, debilitating deformity almost always can be avoided.
