Scoliosis is defined as an abnormal curving of the spine in one or more places. This condition affects the alignment of the body as well as balance and hampers the body’s ability to move naturally and normally. Two percent of people are affected by this condition—essentially a deformation of the spine—which develops most often before puberty. Sometimes traced to hereditary factors, it can also develop from degenerative disc disease or osteoporosis (secondary); be present at birth (congenital); occur when the muscles around the spine are failing, such as in people suffering from cerebral palsy or muscular dystrophy (myopathic); be the result of a spinal cord injury (paralytic); or come from an unknown cause (idiopathic, which accounts for 80 percent of cases in adolescents.)
Uneven shoulders, waists or hips or single shoulder blade protrusion are the most common signs that scoliosis is present. Often pediatricians will use the Adam’s Forward Bend Test to screen for the condition. The test has the patient lean forward and bend 90 degrees at the waist while keeping their feet together. During the movement the physician can then view any abnormal curvature of the spine or asymmetry in the trunk.
A diagnosis of scoliosis is ultimately confirmed by imaging—x-rays, CT scans or MRIs. Furthermore the Cobb Method can determine the extent to which the abnormal curve has reached by categorizing it in terms of degrees—greater than 25 to 30 degrees is significant and 45 to 50 degree curves is severe and requires aggressive treatment.
While observing the patient to ensure the condition doesn’t worsen, bracing is the most common early treatment. There are several different braces used to treat the condition, including the Boston Brace (most used) which covers the portion of the body from under the shoulder blades to the tail bone; the Milwaukee Brace, which includes a pelvic girdle custom made to fit the patient’s body coupled with a neck ring that connects to bars in the back and front; the Charleston Bending Brace, which is worn at night and over-corrects the curve by forcing the patient to bend towards the outward bulge; the Providence Brace, similar to the Charleston Bending Brace in that it is also worn at night but is custom computer designed; and the Wilmington Brace, known as a total-contact “orthosis” that takes the form of a jacket with adjustable straps. Made of plastic, it covers the body from the thoracic area all the way to the sacrum.
Surgical treatment in adolescents is rare as it’s important to allow the growth plates to finish joining. But if surgery is performed it’s likely that follow up surgeries will be required as the body continues to develop and screws and other equipment shift and cause pain. However, a physician may perform spinal surgery if the condition hasn’t improved with normal treatments or if a 40-degree curve is reached. In addition, surgery may be necessary if the patient begins to experience weakness or tingling or numbness.
When surgery for the treatment of the condition is necessary, the goals are to alleviate pressure from the spinal cord and surrounding nerves and protect these areas; reduce the curve to the greatest extent possible; and stop the curve from worsening. It’s important to note that note taking action for scoliosis has the potential to aggravate the condition, and surgery specifically may provide significant relief from pain.