Spinal Program Diagnosis and Treatment

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The Spine

Illustration of normal spine

Made up of many individual bones called vertebrae, the spine is joined together by muscles and ligaments. Flat, soft discs separate and cushion each vertebra from the next. Because the vertebrae are separate, the spine is flexible and can bend. Together, the vertebrae, discs, muscles and ligaments make up the vertebral column or spine.

The spine is divided into three regions. The cervical spine refers to the neck, the thoracic spine to the chest and the lumbar and sacral spines to the lower back.

Illustration on right shows the spine from the front and the side.

 

Normal Spine CurvesScoliosis Spine illustration

Just as the shapes of peoples’ bodies differ, the normal spine varies in size and shape. You may have been told to stand up straight, but no one’s spine is perfectly straight. A healthy spine has front-to-back curves. It is only when these curves become too large that they present a potential problem.

Abnormal Spine Curves

Spinal abnormalities are more common than you think. Many people are affected with some type of spine abnormality, and may not even be aware or need treatment.

Abnormal spinal curves can be the result of many different causes. Some children or adolescents may have a nerve or muscle disease (neuromuscular), injury or other illness that may have attributed to their spinal abnormality. Examples of neuromuscular injuries or illnesses include cerebral palsy, spina bifida and muscular dystrophy.

Some people are born with spinal defects that cause the spine to grow unevenly- referred to as congenital (present at birth). While in other cases, the spine may not grow as straight as it should without a known cause or means of prevention, which is known as idiopathic.

What Is Scoliosis?

Although the spine does curve from front to back, it should not curve sideways very much. A side-to-side curve, called scoliosis, may take the shape of an "S" (double curve) or a long "C" (single curve).

Scoliosis is more than just a curve to the side. The scoliotic spine is also rotated or twisted. As the spine twists, it pulls the ribs along with it, so that one side of the chest becomes higher than the other or the shape of the breastbone may change. You may have noticed that one of your shoulders is higher than the other or that your clothes hang unevenly at the waist, because one hip is higher than the other.

Idiopathic scoliosis, which accounts for 80-85 percent of scoliosis cases, develops gradually over time and may worsen quickly during rapid growth in the preteen and teen years.

Early detection of abnormal spinal curves by school screening programs and pediatricians is intended to find scoliosis early enough to begin brace treatment and avoid surgery. Once an abnormal spine curve has been detected, it is important to monitor the curve during growth. Your child's physician will decide on a treatment plan and follow-up based upon her x-rays and physical exam. Even though your child’s curve may not bother her now, it should be watched throughout growth.

Why Treat Scoliosis: Avoiding Future Problems

Scoliosis rarely seems a problem to the teen patient. However, it is necessary to monitor curves because adults with moderate or severe scoliosis can have progressively worsening curves, which cause cosmetic disfigurement, back pain and in the worse cases, difficulty breathing. Treatment after the curve has already become severe in adulthood is much less successful than treatment during childhood or adolescence. By finding progressive curves early, we hope to keep them from becoming problems in adulthood.

Treatment options

Whether your particular spinal conditional is congenital, idiopathic or neuromuscular related, the Orthopedic Center's Spinal Program provides comprehensive treatment including evaluation, diagnosis, consultation, and follow-up care.

Observation: Keeping Watch On Curves

Once an abnormal spine curve has been detected, it is important to monitor the curve. In many cases, a child's spinal condition may only require close monitoring during skeletal growth. The physician will decide on the treatment plan and follow-up based upon x-rays and the physical exam.

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Non Surgical Management of Scoliosis at Boston Children's Hospital

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The future of pediatrics will be forged by thinking differently, breaking paradigms and joining together in a shared vision of tackling the toughest challenges before us.”
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