Scoliosis

Definition
Scoliosis is an abnormal sideways curvature of the spine (backbone).

Causes/associated factors
Scoliosis can occur at any age including adulthood, but most cases become apparent during middle to late childhood. At this age, scoliosis typically develops spontaneously without an identified cause. (This is known as idiopathic scoliosis.) Because scoliosis can run in families, a genetic factor may be involved. In certain cases, other factors may play a role, including:
connective tissue disorders, such as Marfan's syndrome or Ehlers-Danlos syndrome
neuromuscular conditions, such as cerebral palsy, poliomyelitis and muscular dystrophy, which weaken the muscles that support the spine
birth defects of the spinal column
injuries, infections or tumors
rheumatic diseases
A temporary curvature can occur if one leg is longer than the other or you have persistent muscle spasms associated with a back disorder. It can also result from certain inflammatory conditions, such as appendicitis.

Except during infancy, females have a considerably higher rate of scoliosis than males. The upper back is affected most often, but the lower back can also be involved. Rarely, the neck area is affected. Depending on your growth stage, the larger the curve, the more likely the condition will progress.


Sign/symptoms
Scoliosis can develop slowly or rapidly depending on the cause. In mild to moderate cases, scoliosis is considered a painless condition identified by curvature of the spine to one side, often in an "S" or "C" shape. Your shoulders and waist may not correspond evenly to the opposite side of your body, and your chest or lower back may be uneven when you bend forward. Finally, your head may no longer be centered over your pelvis.
For parents, it's best to be on the lookout for these characteristic symptoms in children from about age 8. Treatment is usually most effective when it begins early.

If scoliosis is severe, it may cause back pain, breathing difficulty and loss of balance when sitting. Any underlying disorders may cause additional symptoms.


Diagnosis
The doctor will review your medical history and do a physical exam. You may be asked to lean forward with your palms together to check for symmetry or evenness on opposite sides of your body. Differences in limb length will be taken into account. You may also need a neurological exam or a spinal X-ray. The severity of your condition may be calculated through measurements of the upper and lower segments of your spine's structural curve, called Cobb's angle. In some cases, additional tests may be necessary.
If the doctor finds significant abnormalities, you may be referred to a specialist. An orthopedic surgeon (a bone and joint specialist) may be recommended. If you have a neuromuscular condition, you may also need to consult a neurologist, a doctor who specializes in treating diseases of the nervous system.


Screening
There is currently no consensus on screening for scoliosis. The American Academy of Pediatrics recommends that doctors screen children at ages 10, 12, 14 and 16 during routine checkups. Regular screenings are especially important for children who have a parent or sibling with scoliosis that developed during middle or late childhood without an identified cause.
Some experts credit the discovery of many scoliosis cases to school screening programs that provide routine checks for signs of scoliosis. School screening has been questioned by others, however, because of the risk of false positives (when someone who does not have scoliosis is given a positive result). If your child has been screened for scoliosis at school, discuss the results with your child's doctor.


Treatment
Again, treatment is usually most effective when it begins early. To determine the best treatment for scoliosis, the doctor will first determine the risk of the curve worsening by considering three factors:
sex (Spinal curvature is more likely to worsen in girls than in boys.)
the amount of spinal curvature that's already present
the amount of spinal growth that may still occur (Spinal curvature often worsens during growth spurts.)
Most spontaneous spinal curves in children are mild (less than 20 degrees) and don't require treatment. As the child continues to grow, the doctor will regularly monitor the curvature to detect any further changes. In contrast, scoliosis caused by a neuromuscular disorder typically worsens. In this case, treatment for mild curves usually begins promptly.

In some cases, a back brace may be necessary to prevent a substantial curve (usually from 20 to 40 degrees) from worsening. It may also be necessary for less severe curves that are worsening during the growing years. For a girl, the timing of her first period is also considered. For example, a girl who has a significant curve who has at least two years of estimated growth remaining but hasn't had her first menstrual cycle is considered a candidate for back bracing. To prevent the condition from worsening, the brace must be worn daily according to the doctor's directions until she reaches her adult height.

Corrective surgery may be recommended when a severe spinal curve (usually greater than 40 degrees) worsens during the growing years, continues to worsen despite brace use, or the degree of curvature may not allow a brace to be used. Instruments can be held to the spine with internal fixation devices, then fused permanently into the adjusted position. The exact procedure chosen by the surgeon will be based on the particular patient's individual condition. However, because spinal surgery can cause complications, it's typically done only when necessary to prevent severe consequences. Be sure to discuss the risks of spinal surgery with the surgeon.

Researchers have not found various other treatments to be helpful, including physical therapy, chiropractic care, biofeedback, electric stimulation and dietary supplements.


Complications
Recent research indicates that long-term complications of mild scoliosis that develops with no apparent cause after about age 10 are usually limited to back pain and cosmetic concerns due to deformity. If scoliosis that meets the criteria for treatment is left untreated, however, more serious complications may develop. A large curve (usually 100 degrees or more) can crowd the lungs, making it difficult for them to function normally. This may lead to infection, difficulty breathing and eventually respiratory failure.

Pregnancy-specific information
If you wear a back brace beyond your adolescent years, you'll need to stop wearing it during the latter months of pregnancy. Surgical rod implants do not hinder pregnancy, but they may aggravate the pregnancy-related back pain.
Pelvic distortion from spinal curvature can impact childbirth, possibly necessitating a cesarean section (delivery through an incision in the abdomen and uterus). When vaginal birth is thought possible, your doctor will keep an eye out for cephalopelvic disproportion (a condition in which the measurements of the baby's head are not proportional to the diameter of your pelvis). Spinal or epidural anesthesia is sometimes less suitable for labor when the spine is severely curved.


Senior-specific information
Growing older is not a common risk factor for the development of scoliosis. However, conditions that cause scoliosis (neuromuscular diseases, for example) could prompt changes in the spine at any age. Progression of spinal curvature can occur with aging and may be aggravated by associated conditions, such as osteoporosis.

Prevention
Researchers are continuing to determine the cause of idiopathic scoliosis to help develop strategies to prevent the condition.