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Scoliosis
Overview | Causes
| Symptoms | Diagnosis
| Treatment | FAQ
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Overview
Scoliosis is a disease characterized by an abnormal
curvature to the spine, in which the vertebrae twist like a bent corkscrew.
In less severe cases, scoliosis may cause the bones to twist slightly,
making the hips or ribs appear uneven. When this occurs, the problem
is more cosmetic and less of a health risk.
Scoliosis does present a health risk if bones are so severely
twisted that they compress vital organs, or if the spinal deformity
is so severe that spine health and posture is threatened. If this happens,
surgery may be necessary. If left untreated, severe cases of scoliosis
can shorten a person's life span.
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Causes
The exact cause of scoliosis is unknown. Only 1-4
percent of the population has this condition. It is more common in women
than men and most often affects adolescents between the ages of 10 and
18. A child's likelihood to develop scoliosis is much higher if their
parent or a sibling has it. Scoliosis can also develop over time in
mid- to late childhood, usually before puberty. In other cases, the
disease is congenital, meaning a person is born with a vertebral abnormality
that causes it.
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Symptoms
Sometimes, the symptoms of scoliosis are visible.
For instance, the child may have uneven shoulders, chest, hips,
shoulder blades, waist, or a child may have a tendency to lean
to one side. In other cases, there are no visible symptoms. To
diagnose a child with scoliosis, have them touch their toes.
If either one or both shoulder blades are prominent, the waist
is shifted or ribs are uneven, scoliosis may be present. For a
child or teenager, your pediatrician often screens for scoliosis.
There are school screening programs as well.
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Diagnosis
Outlined below are some of the diagnostic tools that
your physician may use to gain insight into your condition and determine
the best treatment plan for your condition.
- Medical history: Conducting a detailed medical history
helps the doctor better understand the possible causes of your back
and neck pain which can help outline the most appropriate treatment.
- Physical exam: During the physical exam, your physician
will try to pinpoint the source of pain. Simple tests for flexibility
and muscle strength may also be conducted.
- X-rays are usually the first step in diagnostic testing
methods. X-rays show bones and the space between bones. They are of
limited value, however, since they do not show muscles and ligaments.
- MRI (magnetic resonance imaging) uses a magnetic field
and radio waves to generate highly detailed pictures of the inside
of your body. Since X-rays only show bones, MRIs are needed to visualize
soft tissues like discs in the spine. This type of imaging is very
safe and usually pain-free.
- CT scan/myelogram: A CT scan is similar to an MRI in
that it provides diagnostic information about the internal structures
of the spine. A myelogram is used to diagnose a bulging disc, tumor,
or changes in the bones surrounding the spinal cord or nerves. A local
anesthetic is injected into the low back to numb the area. A lumbar
puncture (spinal tap) is then performed. A dye is injected into the
spinal canal to reveal where problems lie.
- Electrodiagnostics: Electrical testing of the nerves
and spinal cord may be performed as part of a diagnostic workup. These
tests, called electromyography (EMG) or somato sensory evoked potentials
(SSEP), assist your doctor in understanding how your nerves or spinal
cord are affected by your condition.
- Bone scan: Bone imaging is used to detect infection,
malignancy, fractures and arthritis in any part of the skeleton. Bone
scans are also used for finding lesions for biopsy or excision.
- Discography is used to determine the internal structure
of a disc. It is performed by using a local anesthetic and injecting
a dye into the disc under X-ray guidance. An X-ray and CT scan are
performed to view the disc composition to determine if its structure
is normal or abnormal. In addition to the disc appearance, your doctor
will note any pain associated with this injection. The benefit of
a discogram is that it enables the physician to confirm the disc level
that is causing your pain. This ensures that surgery will be more
successful and reduces the risk of operating on the wrong disc.
- Injections: Pain-relieving injections can relieve back
pain and give the physician important information about your problem,
as well as provide a bridge therapy.
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Treatment
There are roughly three tiers of treatment for adolescent
scoliosis. General scoliosis treatment options include observation,
bracing, and if the curve is large and progressive, surgery. Patients
with pain and function issues can be treated with therapy, as well as
physiatry (physical medicine and rehabilitation physician-supervised
programs). Sometimes, shoe inserts (orthotics) are prescribed for those
whose legs are uneven.
For adults, the emphasis is on function and movement.
Bracing is used only as a temporary pain relief measure; it cannot correct
the curve in an adult. Treatment focuses on medications and physical
therapy. If other problems exist that are caused by the scoliosis (sacroiliac
dysfunction, flatback, spinal stenosis, nerve root pinching), there
are many non-operative treatments for each of these issues.
Surgery may be required in order to correct the spinal
curve. Surgery is usually only recommended for large, progressive curves
or in those patients who have nerve pain that steadily worsens. These
surgeries can be extremely complicated, and a person should invest a
great deal of time in selecting a spine surgeon who subspecializes in
using the most current (fourth generation) corrective techniques. As
with any spine surgery, finding a doctor with experience in this specific
type of surgery is key.
As with any disease, the sooner the problem is discovered,
the more treatment options there are available to arrest the progress
of the condition.
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FAQs
How can I tell if I have scoliosis?
Your doctor will take X-rays of your spine which
will reveal whether or not scoliosis is present as well as how severe
it may be.
When is scoliosis considered dangerous to my
health?
Scoliosis can be life-threatening when bones are
so severely twisted that they compress vital organs. Surgery is most
likely the best option in such cases. If left untreated, severe cases
of scoliosis can shorten a person's life span.
What are some of the nonsurgical ways to treat
scoliosis?
There are some nonsurgical ways to treat scoliosis
such as physical therapy, exercise, bracing, shoe inserts and medication.
However, only a spine specialist can determine if any of these options
might apply to you.
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