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Scoliosis is a
sideways curvature of the spine, or backbone. The bones that make up the
spine are called vertebrae. Some people who have scoliosis require
treatment. Other people, who have milder curves, may only need to visit
their doctor for periodic observation.
- Who Gets Scoliosis?
- People of all ages can have scoliosis,
but this fact sheet focuses on children and adolescents. Of every 1,000
children, 3 to 5 develop spinal curves that are considered large enough
to need treatment. Adolescent idiopathic scoliosis (scoliosis of unknown
cause) is the most common type and occurs after the age of 10. Girls are
more likely than boys to have this type of scoliosis.
Since scoliosis
can run in families, a child who has a parent, brother, or sister with
idiopathic scoliosis should be checked regularly for scoliosis by the family
physician.
Idiopathic
scoliosis can also occur in children younger than 10 years of age, but is
very rare. Early onset or infantile idiopathic scoliosis occurs in children
less than 3 years old. It is more common in Europe than in the United
States. Juvenile idiopathic scoliosis occurs in children between the ages of
3 and 10.
- What Causes
Scoliosis?
- In 80 to 85 percent of people, the
cause of scoliosis is unknown; this is called idiopathic scoliosis.
Before concluding that a person has idiopathic scoliosis, the doctor
looks for other possible causes, such as injury or infection. Causes of
curves are classified as either nonstructural or structural.
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Nonstructural (functional) scoliosis: A
structurally normal spine that appears curved. This is a temporary,
changing curve. It is caused by an underlying condition such as a
difference in leg length, muscle spasms, or inflammatory conditions such
as appendicitis. Doctors treat this type of scoliosis by correcting the
underlying problem.
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Structural scoliosis: A fixed curve
that doctors treat case by case. Sometimes structural scoliosis is one
part of a syndrome or disease, such as Marfan's syndrome, an inherited
connective tissue disorder. In other cases it occurs by itself. Structural
scoliosis can be caused by neuromuscular diseases (such as cerebral palsy,
poliomyelitis, or muscular dystrophy), birth defects (such as hemivertebra,
in which one side of a vertebra fails to form normally before birth),
injury, certain infections, tumors (such as those caused by
neurofibromatosis, a birth defect sometimes associated with benign tumors
on the spinal column), metabolic diseases, connective tissue disorders,
rheumatic diseases, or unknown factors (idiopathic scoliosis).
- Does Scoliosis Have
To Be Treated ? What Are the Treatments?
- Many children who are sent to the
doctor by a school scoliosis screening program have very mild spinal
curves that do not need treatment. When a child does need treatment, the
doctor may send him or her to an orthopedic spine specialist.
The doctor will
suggest the best treatment for each patient based on the patient's age, how
much more he or she is likely to grow, the degree and pattern of the curve,
and the type of scoliosis. The doctor may recommend observation, bracing, or
surgery.
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Observation: Doctors follow patients
without treatment and re-examine them every 4 to 6 months when the patient
is still growing (is skeletally immature) and has an idiopathic curve of
less than 25 degrees.
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Bracing: Doctors advise patients to
wear a brace to stop a curve from getting any worse when the patient:
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is still
growing and has an idiopathic curve that is more than 25 to 30 degrees;
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has at
least 2 years of growth remaining, has an idiopathic curve that is
between 20 and 29 degrees, and, if a girl, has not had her first
menstrual period; or
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is still
growing and has an idiopathic curve between 20 and 29 degrees that is
getting worse.
As a child
nears the end of growth, the indications for bracing will depend on how
the curve affects the child's appearance, whether the curve is getting
worse, and the size of the curve.
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Surgery: Doctors advise patients to
have surgery to correct a curve or stop it from worsening when the patient
is still growing, has a curve that is more than 45 degrees, and has a
curve that is getting worse.
- Which Brace Is Best?
- The decision about which brace to wear
depends on the type of curve and whether the patient will follow the
doctor's directions about how many hours a day to wear the brace.
There are two
main types of braces. Braces can be custom made or can be made from a
pre-fabricated mold. All must be selected for the specific curve problem and
fitted to each patient. To have their intended effect (to keep a curve from
getting worse), braces must be worn every day for the full number of hours
prescribed by the doctor until the child stops growing.
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Milwaukee brace: Patients can wear
this brace to correct any curve in the spine. This brace has a neck ring.
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Thoracolumbosacral orthosis (TLSO):
Patients can wear this brace to correct curves whose apex is at or below
the eighth thoracic vertebra. The TLSO is an underarm brace, which means
that it fits under the arm and around the rib cage, lower back, and hips.
- Can People With
Scoliosis Exercise?
- Exercise does not make scoliosis worse.
In fact, it is very important for all people, including those with
scoliosis, to exercise and remain physically fit. Girls have a higher
risk than boys of developing osteoporosis (a disorder that results in
weak bones that can break easily) later in life. The risk of
osteoporosis is reduced in women who exercise regularly all their lives;
and weight-bearing exercise, such as walking, running, soccer, and
gymnastics, increases bone density and helps prevent osteoporosis. For
both boys and girls, exercising and participating in sports also
improves their general sense of well being.
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