 Idiopathic Scoliosis
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A normal spine, when viewed from behind, appears straight. However, a spine affected by scoliosis shows evidence of a lateral, or sideways, curvature, and a rotation of the back bones (vertebrae), giving the appearance that the person is leaning to one side. The Scoliosis Research Society defines scoliosis as a curvature of the spine measuring 10 degrees or greater on x-ray.
Scoliosis is a type of spinal deformity and should not be confused with poor posture.
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According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, three to five out of every 1,000 children develop spinal curves that are considered large enough to require treatment.
The American Academy of Orthopaedic Surgeons, in cooperation with the Scoliosis Research Society, describe three different types of scoliosis that can occur in children - congenital (present at birth), neuromuscular, or idiopathic.
In most (80-85 percent) cases, the cause of scoliosis is unknown - a conditional called idiopathic scoliosis.
Idiopathic scoliosis is categorized into three types. These are:
- Infantile - occurs from birth to 3 years of age. The curve of the vertebrae is to the left and it is more commonly seen in boys. Typically, the curve resolves as the child grows.
- Juvenile - Occurs in children from 3 to 9 years of age
- Adolescent - occurs in children from 10-18 years of age. This is the most common type of scoliosis and is more commonly seen in girls.
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Four common types of curve patterns seen in scoliosis include the following:
- thoracic - 90 percent of the curves occur on the right side.
- lumbar - 70 percent of the curves occur on the left side.
- thoracolumbar - 80 percent of the curves occur on the right side.
- double major - curves that occur on the right and left side.
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The following are the most common symptoms of scoliosis. However, each adolescent may experience symptoms differently. Symptoms may include:
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difference in shoulder height
- the head is not centered with the rest of the body
- difference in hip height or position
difference in shoulder blade height or position
- when standing straight, difference in the way the arms hang beside the body
- when bending forward, the sides of the back appear different in height
Back pain, leg pain, and changes in bowel and bladder habits are not commonly associated with idiopathic scoliosis. An adolescent experiencing these types of symptoms requires further medical evaluation by a physician.
The symptoms of scoliosis may resemble other spinal conditions or deformities, or may be a result of an injury or infection. Always consult your adolescent's physician for a diagnosis.
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The physician makes the diagnosis of scoliosis with a complete medical history of the adolescent, physical examination, and diagnostic tests. The physician obtains a complete prenatal and birth history of the adolescent and asks if other family members are known to have scoliosis. The physician will also ask about developmental milestones since some types of scoliosis can be associated with other neuromuscular disorders. Developmental delays may require further medical evaluation.
Diagnostic procedures may include the following:
- x-rays - a diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film
- bone scans - a nuclear imaging method to evaluate any degenerative and/or arthritic changes in the joints; to detect bone diseases and tumors; to determine the cause of bone pain or inflammation.
- magnetic resonance imaging (MRI) - a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.
- computerized tomography scan (Also called a CT or CAT scan)- a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.
- blood tests
- ultrasound (Also called sonography) - a diagnostic imaging technique which uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Ultrasounds are used to view internal organs as they function, and to assess blood flow through various vessels.
Early detection of scoliosis is most important for successful treatment. Pediatricians or family physicians, and even some school programs, routinely look for signs that scoliosis may be present.
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Specific treatment of scoliosis will be determined by your adolescent's physician based on:
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your adolescent's age, overall health, and medical history
- the extent of the condition
- your adolescent's tolerance for specific medications, procedures, or therapies
- expectations for the course of the condition
- your opinion or preference
The goal of treatment is to stop the progression of the curve and prevent deformity. Treatment may include:
- observation and repeated examinations - Observation and repeated examinations may be necessary to determine if the spine is continuing to curve.
- Progression of the curve depends upon the amount of skeletal growth, or the skeletal maturity of the child. Curve progression slows down or stops after a child reaches puberty.
- bracing - Bracing may be used when the curve measures between 25 to 40 degrees on an x-ray, but skeletal growth remains. The type of brace and the amount of time spent in the brace will depend on your adolescent's condition.
- surgery - Surgery may be recommended when the curve measures 50 degrees or more on an x-ray and bracing is not successful in slowing down the progression of the curve.
According to the Scoliosis Research Society, there is no scientific evidence to show that other methods for treating scoliosis (i.e., manipulation, electrical stimulation, and corrective exercise) prevent the progression of the disease.
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The management of scoliosis is individualized for each adolescent depending on his/her age, amount of curvature, and amount of time remaining for skeletal growth. Scoliosis will require frequent examinations by your adolescent's physician to monitor the curve as your adolescent grows and develops. Early detection is important. If left untreated, scoliosis can cause problems with heart and lung function.
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