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What is Scoliosis

The causes of scoliosis are many, and although we well understand the consequences, the origins of this condition remain complex and obscure. There are two main types of scoliosis—namely, idiopathic (no known cause) and syndromic (the curvature is part of a recognised disease pattern, such as Marfan's syndrome). Idiopathic scoliosis accounts for most spinal curvatures and they may either be of early onset, before age seven years, or late onset, after that age and usually in adolescence.

There is a definite genetic connection, with around 25% of those with a scoliosis have a direct relative with a curvature. 80% of adolescence idiopathic scoliosis arises in girls, and 80% of these girls have their rib prominence on the right side.

  • Scoliosis is viewed (in general) as a lateral curvature of the spine with an axial twist that causes a distortion of the ribs.
  • Current research shows that idiopathic scoliosis (hereafter called, AIS) is a multifaceted disease that compromises five of the body's systems: digestive, hormonal, muscular, osseous (bones), and neurological.
  • Scoliosis affects the entire skeletal system including the spine, ribs, and pelvis. It impacts upon the brain and central nervous system and affects the body's hormonal and digestive systems. It can deplete the body's nutritional resources and damage its major organs including the heart and lungs.
  • Some factors that can cause scoliosis include: cerebral palsy, birth defects, muscular dystrophy and Marfan syndrome. However, 80% of scoliosis is idiopathic (cause unknown).
  • According to the International Scoliosis Society, one in nine females and a smaller percentage of males have some sign of scoliosis.
  • Approximately 4% of the general population is affected. While the average patient is between 10-15 years of age, many adults do suffer also.
  • Conditions arising as a result of scoliosis include rib deformity, shortness of breath, digestive problems, chronic fatigue, acute or dull back pain, leg, hip, and knee pain, acute headaches, mood swings, and menstrual disturbances.
  • Scoliosis is a progressive condition that can continue to progress even after skeletal maturity. Millions of scoliosis sufferers are routinely misinformed about the accelerating nature of their spinal curvature progression.
Janett Arnott

If the part of the spine that is in the chest, called the thoracic Scoliosis is defined as a lateral curvature of the spine, the presence of which is abnormal, its name is derived from the Greek word for curvature. It can be disfiguring because when the spine bends to the side, the vertebrae (the individual bones that make up the spine) become twisted and pull the ribs round with them, which sometimes form a "bulge" on the back and cause the shoulder blade to stick out. bone structure.

If the part of the spine that is in the chest, called the thoracic spine, curves more than 90°, the volume of the chest can be reduced so much that the function of the heart and lungs may become compromised. The heart may have to work harder to pump the normal volume of blood, or the affected individual may have difficulty breathing.

Severe curvature of the lower half of the spine that connects the chest with the pelvis, known as the lumbar spine, may push the contents of the abdomen against the chest and in this way interfere with function of the heart and lungs indirectly. In addition, curvature of the lumbar spine may alter sitting balance and posture.

Severe curvature of the either the thoracic or the lumbar spine, or both, eventually will become visible to others. The resulting tilting and twisting of the back, shoulders and pelvis, and in turn can affect the individuals regarding appearance that the individual finds unacceptable. When one considers that the most common scenario for Idiopathic Scoliosis is a girl at around the time of puberty, when body image is developing hand in hand with self-esteem, this can pose significant psychological and emotional challenges.

There is no clear evidence that untreated Scoliosis, or Scoliosis treated with bracing or spinal fusion, will increase the risk of back pain or arthritis in the long term. Progression of spinal curvature is inversely related to maturity.

After maturity, curves under 50° will remain stable and stay that way, i.e. they do not progress. For this reason, the ultimate goal of Scoliosis management is to keep curves under 50° until maturity. Children with curves under 50° will grow up into adults who will have no significant problems related to their Scoliosis.

00°-10° Not Scoliosis

10°-25° Observation
Your Dr will first need to determine if the curvature is progressing/getting worse. Some children will have a curvature of their spine that is stable and unchanging, whereas other children will have a curve that relentlessly progresses. Observation is the first step in the treatment, your Dr will study the curve and order special tests to evaluate the condition. These tests could include X-Ray, MRI or CT scan. During the observation your child may be referred to other specialists, such as a geneticist, cardiologist, or pulmonologist to make sure there are no other problems in other parts of the body.

25º-40º Bracing the standard of care in the United States. The Scoliosis brace is known as a TLSO, which stands for Thoraco-Lumbar Spinal Orthotic. The idea behind bracing is to keep the progression of the curve stable so that it stays under 50º. An X-ray taken in a brace shows that the brace does straighten the spine, but at best the spine will return to its original curvature when the brace is removed. The 2 principal types used are the Milwaukee and Boston brace. (for more info on these braces use the search provided)

40º-50° Too high for brace but too low for surgery
It is also possible that if your curve is greater than 30° (some have said 40°) then it probably will continue to increase even after you're done growing. (we have a member on the group where this is relevant.) The point is that if you're at 40°, you will most likely get to the 50°+ category.

More than 50° Surgical Candidate
Beyond 50°, the spine loses its ability to compensate, and progression becomes inevitable even after the child is mature. The only way to stop progression at this stage is spinal fusion.

The spine can bend towards either side of the body at any place, in the chest area (thoracic scoliosis), in the lower part of the back (lumbar), or above and below these areas (thoracolumbar). It can even bend twice, causing an S-shaped curve. When the curve is S-shaped (double curvature) it is often not noticeable and the person can appear quite straight because the two curves counteract each other. If the curve is low down in the spine, the ribs will not be affected but one hip may be higher than the other.

Scoliosis is, surprisingly, quite common. About three or four children per thousand of the general population will need specialist supervision, and about one child in every thousand will need hospital treatment usually for major corrective surgery with the insertion of a metal rod, sometimes followed by a period in a plaster jacket or brace. Scoliosis can develop at any time during childhood and adolescence. It might develop in infancy, in which case there is a good chance of it resolving with growth. Progressive (worsening) early onset curvatures are potentially serious, and some of these may need surgical treatment. Late onset scoliosis is less serious, but some will need surgery and all need to be seen by a scoliosis specialist who can keep an eye on the situation and give some idea about the future. Severe deformity, which is uncommon nowadays because of modern treatment, can lead to damaged lung function, or disability in middle age. The lungs are usually affected only in people with untreated early onset thoracic scoliosis, when the upper (chest) part of the spine is curved.

A developmental disorder, Scoliosis is rarely present at birth (congenital Scoliosis). It can develop in infancy or early childhood and it is sometimes caused by rare childhood disorders. However, it is most common in early teenage years, when, especially at the start of the adolescent growth spurt, it can progress rapidly.

Treatment at this age is usually corrective surgery.

There is contradictory evidence as to whether early discovery and treatment of a curve improves the long-term outcome, but we know that if curves are discovered too late, when they are already severe, the results of surgery can be compromised. Therefore, awareness of scoliosis and what it can mean for an individual among General Practitioners and physical education teachers in schools is regarded as important, so that early referral to a specialist in scoliosis is achieved. Treatment in a scoliosis centre will usually prevent unsatisfactory long-term results.

Scoliosis has been recorded since the days of the ancient Greeks, but its cause is still unknown - Idiopathic Scoliosis. Orthopaedic surgeons specialising in scoliosis and scientists in many countries continue to research the cause, or causes, of the condition.