All Things Scoliosis

Scoliosis

Scoliosis is defined as an abnormal curvature of the spine. Scoliosis affects between 2% - 3% of the population in the US, or about 6 to 9 million people according to the American Association of Neurological Surgeons (AANS).

Etiology

The etiology, or underlying condition for scoliosis can either be idiopathic, congenital, or neuromuscular.

  • The majority of cases of scoliosis are idiopathic, meaning the underlying cause is unknown. This may also mean that there may not be one single factor that is contributing to the occurrence of scoliosis.

  • Congenital scoliosis is usually a result of a spinal defect that occurred in utero and is present at birth.

  • Neurological disorders, degenerative muscular disease, and cerebral palsy are examples of Neuromuscular scoliosis. Change in muscle tone, body position, or movement patterns can cause the curvature of the spine to change.

Types of Scoliosis

Types of scoliosis are indicated by the location and direction of the spinal curvature abnormality. The best way to explain this is through a visual representation.


Scoliosis may also present as an abnormal curvature of the spine in the sagittal plane. See the graphic


Diagnostic testing

The Adams Forward Bend Test is a standard exam often used by pediatricians and clinicians as an initial screening to detect potential problems. For this test, the patient would lean forward, bending 90 degrees at the waist with their feet together. Any abnormal spinal curvatures or trunk asymmetry can be easily seen by the examiner from this angle. However, the exact condition and severity requires further diagnostic testing.



Typically, scoliosis is confirmed through a physical examination, radiograph, CT scan, MRI or an x-ray. The Cobb method is then used to diagnose the severity by the number of degrees of the spinal curvature. A curve of greater than 25 to 30 degrees is considered significant, while a curve exceeding 45-50 degrees is considered severe, and may require more aggressive treatment.


Bracing

Once there is a confirmed diagnosis of scoliosis there are several issues to address that will help determine the best treatment option for the patient.

  • Spinal maturity – is the patient's spine still growing and changing?

  • Degree and extent of curvature – how severe is the curve and how does it affect the patient's lifestyle?

  • Location of curve – according to some experts, thoracic curves are more likely to progress than curves in other regions of the spine.

  • Possibility of curve progression – patients who have large curves prior to their adolescent growth spurts are more likely to experience curve progression.

Research shows that braces are an effective method of treatment for patients who have not yet reached skeletal maturity. Although there are many different types of braces there is significant evidence that most braces successfully stop spinal curve progression in about 80% of children with scoliosis. However, the braces need to be used with full compliance with a typical wear schedule of 16-23 hours a day (full-time) every day until growth stops. Additional braces may be worn at only at night which depends on the severity of scoliosis present (see types of braces below for common full-time and night-time braces).


Types of Braces

Most common full-time braces:

While we use the most advanced technology available and provide the LA Brace at Orthopedic Motion, there are other types of scoliosis braces including:

Depending on the bracing system, up to 50% of angle correction can be achieved with a brace.

X-Ray of In LA Brace Correction with OMI Patient

Surgical Intervention

Spinal fusion is the surgery used to reduce the severity of the spinal curve and prevent the curve from getting worse. Spinal fusion connects two or more of the vertebrae together so they cannot move and pieces of bone, or bone-like material, are placed between the vertebrae. Metal rods, screws, hooks, or wires are placed to hold the structures together and straighten the spine in the area being treated. The rod can be adjusted over time as the child grows.




Non-surgical treatment outcomes include bracing to prevent the worsening of the curvature of the spine. Bracing does not cure or reverse scoliosis, however more time wearing the brace is correlated with increasing the effectiveness at preventing further deformative curvature of the spine. The brace can be discontinued after the bones stop growing which typically occurs:

  • About two years after female begin to menstruate

  • When male need to shave daily

  • When there are no further changes in height


Factors which influence outcomes include:

  • Sex- Females have a higher risk of progression compared to males.

  • Severity of curve- Larger curves have a higher risk of progressing over time.

  • Curve pattern- S-shaped curves (double curves) tend to worsen more than C-shaped curves.

  • Location of curve- The center of the spine (thoracic region) tends to worsen more often compared to the upper and lower regions of the spine (cervical and sacral regions).

  • Maturity- Children who are still growing are at risk for progression of curvature if not treated. On the other hand, children who are still growing may respond better to the effects of bracing.


If left untreated

Children with mild scoliosis may not require any treatment and can be monitored with imaging to ensure the curve does not get worse overtime. However, should moderate to severe scoliosis be left untreated, it typically increases the risk of progressing the scoliosis curvature of the spine (about one degree per year).

This progression of deformity in the spine can lead to noticeable changes in appearance such as uneven shoulders, ribs that stick out more prominently unilaterally, uneven hips, and a shift of waist and trunk unilaterally.

Additionally, the curvature may increase pain in the back from misaligned posture and create extra pressure on the lungs and heart due to the ribs shifting to one side. This extra pressure from the ribs can make it more difficult for the heart and lungs to function properly causing difficulty with breathing and circulation.


References

AANS Scoliosis. Neurosurgical conditions and treatments for scoliosis. Retrieved June 21st, 2021 https://www.aans.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Scoliosis#:~:text=Scoliosis%20is%20usually%20confirmed%20through,by%20the%20number%20of%20degrees.

Boston Orthotics & Prosthetics. Boston Orthotics and Prosthetics. (n.d.). https://www.bostonoandp.com/products/scoliosis-and-spine/boston-brace/.