Scoliosis is a disorder that causes an abnormal curve of the spine, or backbone. The spine has normal curves when looking from the side, but it should appear straight when looking from the front. Kyphosis is a curve seen from the side in which the spine is bent forward. Lordosis is a curve seen from the side in which the spine is bent backward. People with scoliosis develop additional curves to either side, or the bones of the spine twist on each other like a corkscrew. Scoliosis is about two times more common in girls than boys. It can be seen at any age, but it is most common in those over 10 years old. Scoliosis is hereditary in that people with scoliosis are more likely to have children with scoliosis; however, there is no correlation between the severity of the curve from one generation to the next.
Alternative Names of Scoliosis are: kyphosis, lordosis.
Complications of Scoliosis
While most people with scoliosis have a mild form of the disorder, scoliosis may sometimes cause complications, including:
Lung and heart damage. In severe scoliosis, the rib cage may press against the lungs and heart, making it more difficult to breathe and harder for the heart to pump. In very severe scoliosis, damage to the lungs and the heart can occur. Anytime breathing is compromised, the risk of lung infections and pneumonia increases.
Back problems. Adults who had scoliosis as children are more likely to have chronic back pain than are people in the general population. Also, people with untreated scoliosis may develop arthritis of the spine.
Causes of Scoliosis
In most cases (85%), the cause of scoliosis is unknown (what doctors call idiopathic). The other 15% of cases fall into two groups:
Nonstructural (functional): This type of scoliosis is a temporary condition when the spine is otherwise normal. The curvature occurs as the result of another problem. Examples include one leg being shorter than another from muscle spasms or from appendicitis.
Structural: In this type of scoliosis, the spine is not normal. The curvature is caused by another disease process such as a birth defect, muscular dystrophy, metabolic diseases, connective tissue disorders, or Marfan syndrome.
Signs & Symptoms of Scoliosis
These symptoms are only those associated with the spine being curved:
Your head may be off center.
One hip or shoulder may be higher than the other.
You may walk with a rolling gait.
The opposite sides of the body may not appear level.
You may experience back pain or tire easily during activities that require excessive trunk (chest and belly) movement.
Diagnosis of Scoliosis
The physical exam involves having the child undressed from the waist up. The child faces forward with the feet straight ahead and the palms inward. With the knees locked, the child slowly bends over at the waist and tries to touch their toes. The doctor then looks at the spine for the appearance of straightness.
X-rays may be necessary in order to measure the curvature. Depending on the degree of the curvature and whether it gets worse over time, the doctor may recommend treatment.
Treatments of Scoliosis
The majority of cases of scoliosis do not require treatment.
If the curve is less than 25°, no treatment is required, and the child can be reexamined every four to six months.
If the curve is more then 25° but less than 30°, a back brace may be used for treatment.
Curves more than 45° will need to be evaluated for the possibility of surgical correction. Surgical correction involves fusing vertebrae together to correct the curvature and may require inserting rods next to the spine to reinforce the surgery.
Treatment options depend more on how likely it is that the curve will worsen than on the angle of the curve itself. A child with a 20° curve and four more years of growth may require treatment while a child with 29° of curvature who has stopped growing may not require treatment.
Prevention of Scoliosis
Scoliosis is not preventable. At this time, we do not understand what causes the condition in the majority of children.
When to seek Medical Advice
Scoliosis usually occurs around age 10 years. Most school systems have screening programs that look for scoliosis. The most common test is to have the child stand with his or her feet straight ahead and with knees locked and then slowly bend over to touch their toes. If the school notifies you that they are concerned, you should contact your doctor to make a routine appointment within the next one to two months.
If your doctor (or pediatrician) examines your child and is suspicious, the doctor may repeat the exam in four to six months to see if there is any change. Most children do not need to be treated for scoliosis when the curvature is mild.