Scoliosis
What Is Scoliosis?
Scoliosis is a musculoskeletal disorder in which there is a sideways curvature of the spine, or backbone. The bones that make up the spine are called vertebrae. Some people who have scoliosis require treatment. Other people, who have milder curves, may only need to visit their doctor for periodic observation.
Who Gets Scoliosis?
People of all ages can have scoliosis, but this booklet focuses on children and adolescents. Of every 1,000 children, 3 to 5 develop spinal curves that are considered large enough to need treatment. Adolescent idiopathic scoliosis (scoliosis of unknown cause) is the most common type and occurs after the age of 10. Girls are more likely than boys to have this type of scoliosis. Since scoliosis can run in families, a child who has a parent, brother, or sister with idiopathic scoliosis should be checked regularly for scoliosis by the family physician. Idiopathic scoliosis can also occur in children younger than 10 years of age, but is very rare. Early onset or infantile idiopathic scoliosis occurs in children less than 3 years old. It is more common in Europe than in the United States. Juvenile idiopathic scoliosis occurs in children between the ages of 3 and 10.
What Causes Scoliosis?
In 80 to 85 percent of people, the cause of scoliosis is unknown; this is called idiopathic scoliosis. Before concluding that a person has idiopathic scoliosis, the doctor looks for other possible causes, such as injury or infection. Causes of curves are classified as either nonstructural or structural.
Nonstructural (functional) scoliosis--A structurally normal spine that appears curved. This is a temporary, changing curve. It is caused by an underlying condition such as a difference in leg length, muscle spasms, or inflammatory conditions such as appendicitis. Doctors treat this type of scoliosis by correcting the underlying problem.
Structural scoliosis--A fixed curve that doctors treat case by case. Sometimes structural scoliosis is one part of a syndrome or disease, such as Marfan's syndrome, an inherited connective tissue disorder. In other cases, it occurs by itself. Structural scoliosis can be caused by neuromuscular diseases (such as cerebral palsy, poliomyelitis, or muscular dystrophy), birth defects (such as hemivertebra, in which one side of a vertebra fails to form normally before birth), injury, certain infections, tumors (such as those caused by neurofibromatosis, a birth defect sometimes associated with benign tumors on the spinal column), metabolic diseases, connective tissue disorders, rheumatic diseases, or unknown factors (idiopathic scoliosis).
Does Scoliosis Have To Be Treated? What Are the Treatments?
Many children who are sent to the doctor by a school scoliosis screening program have very mild spinal curves that do not need treatment. When a child does need treatment, the doctor may send him or her to an orthopaedic spine specialist.
The doctor will suggest the best treatment for each patient based on the patient's age, how much more he or she is likely to grow, the degree and pattern of the curve, and the type of scoliosis. The doctor may recommend observation, bracing, or surgery.
Observation--Doctors follow patients without treatment and re-examine them every 4 to 6 months when the patient is still growing (is skeletally immature) and has an idiopathic curve of less than 25 degrees.
Bracing--Doctors advise patients to wear a brace to stop a curve from getting any worse when the patient:
- Is still growing and has an idiopathic curve that is more than 25 to 30 degrees;
- Has at least 2 years of growth remaining, has an idiopathic curve that is between 20 and 29 degrees, and, if a girl, has not had her first menstrual period; or
- Is still growing and has an idiopathic curve between 20 and 29 degrees that is getting worse.
Surgery--Doctors advise patients to have surgery to correct a curve or stop it from worsening when the patient is still growing, has a curve that is more than 45 degrees, and has a curve that is getting worse.
Credit: National Institute of Health.