by Jeffrey R. Carlson, M.D.
The spine is naturally curved. Looking at the spine from a lateral point of view, it looks like a soft ‘S’ shape. The spine viewed from a posterior angle appears vertically straight, unless scoliosis has occurred. The medical term scoliosis is derived from the Greek word, “skolios” which means “crooked”. Scoliosis is any irregular, sideways curvature of the spine. When the spine curves, it can do so in one of three ways:
• Levoscoliosis: There is a single curve to the left of the spine
• Dextroscoliosis: There is a single curve to the right of the spine
• The spine has curves on both sides
Causes:
• A problem with the formation of the spine while in the womb or as a young child grows (approximately 15% of cases)
• As a secondary result of a disease like muscular dystrophy, cerebral palsy or polio (approximately 10% of cases)
• From an unknown or idiopathic cause (approximately 65% of cases)
• A genetic link has been theorized, but not yet proven to exist
Symptoms/Diagnosis
One important fact to note about scoliosis is that back pain is not a typical symptom. Back pain may indicate another issue of the spine and should be examined appropriately by a spine specialist.
Although scoliosis can occur in anyone, the chances for this condition developing are more prevalent during periods of high growth in adolescents. If a curve is detected early in a child, there is the chance for it to worsen as they continue to grow. The growth rate of the body is fastest during puberty, which makes the risk for the spine curving the highest during this time. Girls are at a much greater risk to develop scoliosis.
Scoliosis is often detected during a regular physician visit or school screening. When examining a patient, I will look for the following:
• Curvature of the spine
• Asymmetry of the waist
• One hip or shoulder being higher than the other
• Uneven shoulders
• One leg being shorter than the other
• Protruding shoulder blade
Treatment
Once scoliosis has been detected, I will monitor the curvature of the patient’s spine over time. Spinal curvature is measured in degrees, and treatment decisions will be based on the degree of the spinal curve and how quickly it progresses. If the curve is less than 10 degrees, this is considered spinal asymmetry and not scoliosis. Curves between 20 to 30 degrees and beyond should be closely observed and may need to be treated.
There are both non-surgical and surgical options available for scoliosis. For curves that are progressing, or already in the range of 20 to 30 degrees of curvature, back braces can be worn. Bracing is typically done in adolescents who have not reached skeletal maturity and still have time for growth. Bracing will not straighten the already curved spine, but prevent it from continually curving as the child grows. If the patient has already reached skeletal maturity, bracing will not do much to correct the spinal curve. These patients’ spines will be observed to determine if surgical treatment is necessary in the future.
It is appropriate to perform surgery on an adolescent with scoliosis only if their spinal curve is greater than 40 degrees, and for a skeletally mature patient with a spinal curve over 50 degrees. Surgical procedures for scoliosis can correct the spinal curves and prevent future curving as well. This surgical procedure can be done from a posterior or anterior approach, and involves anchoring long rods to the spine with screws. The rod is put in place to reduce the amount of spinal curve and secure the spine in place while bone graft that is added fuses with the existing bone. The bones will fuse over the following 3 to 6 months, and can take up to a year to be fully healed. Once fused, the spinal curve cannot progress and the rods can either be removed or left in place.
Postoperative Care
The spine should be kept as immobile as possible after surgery to allow the bones to fuse together. Any activities that involve bending or lifting should be avoided for the first few months following surgery. Sometimes I will have patients wear a back brace to limit their range of motion and keep the spine in place. I will also continue to monitor the condition of the spine for the following year to ensure the bones completely fuse. The risks with this type of procedure are very limited, but some post-operative risks can include blood loss, paraplegia, infection, continued progression of the curve, or the rods coming out of place.