Scoliosis

Scoliosis is a sideways curvature of the spine that occurs most often during the growth spurt just before puberty. It is defined as a curvature of more than 10 degrees based on the Cobb measurement on a standing radiograph

While scoliosis can be caused by conditions such as cerebral palsy and muscular dystrophy, the cause of most scoliosis is unknown.

What are the Sign and Symptoms of Scoliosis?

Patients may present with :-

One shoulder blade that appears more prominent than the other
Uneven Shoulders
Uneven waist
One hip higher than the other

If a scoliosis curve gets worse, the spine will also rotate or twist, in addition to curving side to side. This may manifest in the ribs on one side of the body to sticking out farther than on the other side.

In severe cases, it may cause compression of the viscera as well as body disfigurement

What is the incidence of Scoliosis

Develops between the age of 8-15

7 Times more prevalent in females

Risk Factors?

Age. Signs and symptoms typically begin during the growth spurt that occurs just prior to puberty.
Sex. Although both boys and girls develop mild scoliosis at about the same rate, girls have a much higher risk of the curve worsening and requiring treatment.
Family history. Scoliosis can run in families, but most children with scoliosis don’t have a family history of the disease.

What are the 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.
Back problems. Adults who had scoliosis as children are more likely to have chronic back pain than are people in the general population.
Appearance. As scoliosis worsens, it can cause more noticeable changes — including uneven hips and shoulders, prominent ribs, and a shift of the waist and trunk to the side. Individuals with scoliosis often become self-conscious about their appearance.

Treatment

Most children with scoliosis have mild curves and probably won’t need treatment with a brace or surgery. Children who have mild scoliosis may need regular checkups to see if there have been changes in the curvature of their spines as they grow.

While there are guidelines for mild, moderate and severe curves, the decision to begin treatment is always made on an individual basis. Factors to be considered include:

Sex. Girls have a much higher risk of progression than do boys.
Severity of curve. Larger curves are more likely to worsen with time.
Curve pattern. Double curves, also known as S-shaped curves, tend to worsen more often than do C-shaped curves.
Location of curve. Curves located in the center (thoracic) section of the spine worsen more often than do curves in the upper or lower sections of the spine.
Maturity. If a child’s bones have stopped growing, the risk of curve progression is low. That also means that braces have the most effect in children whose bones are still growing.

When is Bracing required?

The most common type of brace is made of plastic and is contoured to conform to the body. Newer braces area almost invisible under the clothes, as it fits under the arms and around the rib cage, lower back and hips.

Most braces are worn day and night. A brace’s effectiveness increases with the number of hours a day it’s worn.

Braces are discontinued after the bones stop growing. This typically occurs:

About two years after girls begin to menstruate
Roughly when there are no further changes in height

However, modern braces have improved and now resembles belts and straps. This improves the appearance, comfortability and compliance of the patient.

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When is Surgery required?

Severe scoliosis typically progresses with time. Scoliosis surgery to reduce the severity of the spinal curve is done only as a last resort and in severe cases. Surgery is done to prevent the curve from getting worse and avoid the complications related to this.