SCOLIOSIS

What’s Scoliosis?

The medical term “Scoliosis” refers to the abnormal sideways curvature of the spine. Physicians mostly diagnose this condition in childhood or early adolescence (Janicki & Frcsc, 2007). Scoliosis forms “S”- or “C”-shaped curve over 3 dimensions. In some cases, the degree of curvature remains constant over time, whereas in others, it rises. While mild scoliosis seldom causes difficulties, more severe forms can impair breathing and mobility. People with scoliosis suffer from pain that gets worse with age. Scoliosis can develop in adults who have cerebral palsy or muscular dystrophy, although the etiology of most childhood scoliosis remains unclear. Scoliosis in childhood remains mild, although certain curvature will increase as children grow older. This debilitating condition can reduce the amount of room in the chest in a very severe spinal curvature, making it harder for the lungs to function correctly. 

Neurosurgeons regularly monitor mild scoliosis in children with X-rays to assess the condition of the curvature. Many scoliosis cases require no need for treatment. To prevent the curvature from deepening, some children will need to wear a brace. Others may require surgery to correct extreme curvature. In the United States, scoliosis affects 2% to 3% of the population, or around six to nine million individuals (Doi et al., 2021). While Scoliosis can occur throughout childhood or infancy, Scoliosis usually starts between the ages of 10 and 15, and affects both men and women equally. Scoliosis patients visit over 600,000 private physician offices each year, with an estimated 30,000 youngsters receiving a brace and 38,000 patients undergoing spinal fusion surgery (Hawary et al., 2019).

What’s the common symptoms and causes of Scoliosis?

 Signs and symptoms of scoliosis in patients include uneven waist, shoulders, and hips, visual curve in the back, bulging of ribs, uneven posture, slow nerve action, prominent shoulder blade, etc. In most cases of scoliosis, the spine twists or rotates in addition to bending side to side. As a result, the ribs or muscles on one side of the body protrude further than those on the other. Additional symptoms of scoliosis may include lower back pain, stiffness in the back, cardiac and respiratory problems, muscular fatigue, constipation due to tightening of the stomach or intestine, etc. 

Based on etiology, spinal specialists classified scoliosis into 4 different types, such as idiopathic, congenital, degenerative, and neuromuscular (Shakil, Iqbal, & Al-Ghadir, 2014). Idiopathic scoliosis comprises almost 80% of all cases and adolescent idiopathic scoliosis refers to the most common type of scoliosis. Congenital scoliosis occurs due to the embryological abnormality of one or more vertebrae, and it can affect any part of the spine. Neuromuscular scoliosis occurs due to neurological or muscular problems. Examples of neuromuscular scoliosis include cerebral palsy, spinal cord damage, muscular dystrophy, spinal muscular atrophy, and spina bifida. Degenerative scoliosis usually develops in the lower back as the disks and joints of the spine begin to wear out as patients age.

How do Spinal Specialists Diagnose Scoliosis?

 To check for scoliosis, neurosurgeons ask patients to bend over from the waist to observe any curve in their spine. Neurosurgeons will access the person’s gait and a thorough neurological examination such as the skin for café au lait spots that indicate neurofibromatosis and the feet for cavovarus deformity, and muscle tone for spasticity. Later, neurosurgeons perform various imaging tests such as X-rays to see whether patients’ backs present as curved (Karimi & Rabczuk, 2018). Neurosurgeons also suggest performing an MRI to rule out the possibility of a malignancy causing the patient’s spine to bend. Spinal specialists also perform a standard method for quantifying the curvature, known as Cobb’s angle, that measures the angle formed by two lines drawn perpendicular to the top endplate of the uppermost vertebra involved and the lower endplate of the lowest vertebrae involved.

How do Neurosurgeons treat Scoliosis?

After confirmation of scoliosis, neurosurgeons assess several issues, such as spinal maturity, location of curve, degree and extent of curvature, curve progression, etc. to determine the treatment procedures. After assessment, neurosurgeons suggest 3 most feasible options, such as observation, bracing, physical therapy, and surgery for treatment. 

1.     Observation: Mild scoliosis case requires no treatment in children. Therefore, neurosurgeons observe the condition of the patient for at least 6 months before making any decision. For adults, neurosurgeons suggest performing X-rays every 5 years to see the progression.

2.     Bracing: Neurosurgeons recommend bracing for patients with immature skeletons such as children. Bracing helps to prevent the curve from progressing.

3.     Spinal fusion surgery: Neurosurgeons perform this surgery to stop the curve from progressing during adulthood and to diminish spinal deformity. This surgery helps to lessen the curve of the spine and restores the previous state of spine. 

Besides these, neurosurgeons also suggest patients perform specific exercises to prevent the progression of the curve along with possible bracing and surgery avoidance. For any information, please contact us.

If you or someone you know want to talk to a Fort Worth Brain and Spine Specialist, please call (682) 33-SPINE to schedule a consultation with one of our Neurosurgical Specialists.

References

Doi, T., Watanabe, K., Doi, T., Inoue, H., Sugawara, R., Arai, Y., … Takeshita, K. (2021). Associations between curve severity and revised Scoliosis Research Society-22 and scoliosis Japanese Questionnaire-27 scores in female patients with adolescent idiopathic scoliosis: a multicenter, cross-sectional study. BMC Musculoskeletal Disorders, 22(1), 1–7. https://doi.org/10.1186/s12891-021-04189-6

Hawary, R. El, Zaaroor-Regev, D., Floman, Y., Lonner, B. S., Alkhalife, Y. I., & Betz, R. R. (2019). Brace treatment in adolescent idiopathic scoliosis: risk factors for failure—a literature review. Spine Journal, 19(12), 1917–1925. https://doi.org/10.1016/j.spinee.2019.07.008

Janicki, J. A., & Frcsc, B. A. (2007). joseph A janicki. Scoliosis Review of diagnosis and treatment. Paedriatric Child Health, 12(9), 771–776.

Karimi, M., & Rabczuk, T. (2018). Scoliosis conservative treatment: A review of literature. Journal of Craniovertebral Junction and Spine, 9(1), 3–8. https://doi.org/10.4103/jcvjs.JCVJS_39_17

Shakil, H., Iqbal, Z. A., & Al-Ghadir, A. H. (2014). Scoliosis: Review of types of curves, etiological theories and conservative treatment. Journal of Back and Musculoskeletal Rehabilitation, 27(2), 111–115. https://doi.org/10.3233/BMR-130438