Overview Scoliosis is a disease characterized by an abnormal curvature to the
spine, in which the vertebrae twist like a bent corkscrew. In less
severe cases, scoliosis may cause the bones to twist slightly, making
the hips or ribs appear uneven. When this occurs, the problem is
more cosmetic and less of a health risk.
Scoliosis does present a health risk if bones are so severely twisted
that they compress vital organs, or if the spinal deformity is so severe
that spine health and posture is threatened. If this happens, surgery
may be necessary. If left untreated, severe cases of scoliosis can
shorten a person's life span.
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Causes The exact cause of scoliosis is unknown. Only 1-4 percent of the population
has this condition. It is more common in women than men and most
often affects adolescents between the ages of 10 and 18. A child's
likelihood to develop scoliosis is much higher if their parent or
a sibling has it. Scoliosis can also develop over time in mid- to
late childhood, usually before puberty. In other cases, the disease
is congenital, meaning a person is born with a vertebral abnormality
that causes it.
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Symptoms Sometimes, the symptoms of scoliosis are visible. For instance, the
child may have uneven shoulders, chest, hips, shoulder blades, waist,
or a child may have a tendency to lean to one side. In other cases,
there are no visible symptoms. To diagnose a child with scoliosis,
have them touch their toes. If either one or both shoulder blades
are prominent, the waist is shifted or ribs are uneven, scoliosis
may be present. For a child or teenager, your pediatrician often
screens for scoliosis. There are school screening programs as well.
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Diagnosis Outlined below are some of the diagnostic tools that your physician
may use to gain insight into your condition and determine the best
treatment plan for your condition.
Medical history: Conducting a detailed medical history
helps the doctor better understand the possible causes of your
back and neck pain which can help outline the most appropriate
treatment.
Physical exam: During the physical exam, your physician
will try to pinpoint the source of pain. Simple tests for flexibility
and muscle strength may also be conducted.
X-rays are usually the first step in diagnostic
testing methods. X-rays show bones and the space between bones.
They are of limited value, however, since they do not show muscles
and ligaments.
MRI (magnetic resonance imaging) uses a magnetic
field and radio waves to generate highly detailed pictures of the
inside of your body. Since X-rays only show bones, MRIs are needed
to visualize soft tissues like discs in the spine. This type of
imaging is very safe and usually pain-free.
CT scan/myelogram: A CT scan is similar to an MRI
in that it provides diagnostic information about the internal structures
of the spine. A myelogram is used to diagnose a bulging disc, tumor,
or changes in the bones surrounding the spinal cord or nerves.
A local anesthetic is injected into the low back to numb the area.
A lumbar puncture (spinal tap) is then performed. A dye is injected
into the spinal canal to reveal where problems lie.
Electrodiagnostics: Electrical testing of the nerves
and spinal cord may be performed as part of a diagnostic workup.
These tests, called electromyography (EMG) or somato sensory evoked
potentials (SSEP), assist your doctor in understanding how your
nerves or spinal cord are affected by your condition.
Bone scan: Bone imaging is used to detect infection,
malignancy, fractures and arthritis in any part of the skeleton.
Bone scans are also used for finding lesions for biopsy or excision.
Discography is used to determine the internal structure
of a disc. It is performed by using a local anesthetic and injecting
a dye into the disc under X-ray guidance. An X-ray and CT scan
are performed to view the disc composition to determine if its
structure is normal or abnormal. In addition to the disc appearance,
your doctor will note any pain associated with this injection.
The benefit of a discogram is that it enables the physician to
confirm the disc level that is causing your pain. This ensures
that surgery will be more successful and reduces the risk of operating
on the wrong disc.
Injections: Pain-relieving injections can relieve
back pain and give the physician important information about your
problem, as well as provide a bridge therapy.
Treatment There are roughly three tiers of treatment for adolescent scoliosis.
General scoliosis treatment options include observation, bracing,
and if the curve is large and progressive, surgery. Patients with
pain and function issues can be treated with therapy, as well as
physiatry (physical medicine and rehabilitation physician-supervised
programs). Sometimes, shoe inserts (orthotics) are prescribed for
those whose legs are uneven.
For adults, the emphasis is on function and movement. Bracing is used
only as a temporary pain relief measure; it cannot correct the curve
in an adult. Treatment focuses on medications and physical therapy.
If other problems exist that are caused by the scoliosis (sacroiliac
dysfunction, flatback, spinal stenosis, nerve root pinching), there
are many non-operative treatments for each of these issues.
Surgery may be required in order to correct the spinal curve. Surgery
is usually only recommended for large, progressive curves or in those
patients who have nerve pain that steadily worsens. These surgeries
can be extremely complicated, and a person should invest a great deal
of time in selecting a spine surgeon who subspecializes in using the
most current (fourth generation) corrective techniques. As with any
spine surgery, finding a doctor with experience in this specific type
of surgery is key.
As with any disease, the sooner the problem is discovered, the more
treatment options there are available to arrest the progress of the
condition.
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FAQs How can I tell if I have scoliosis? Your doctor will take X-rays of your spine which will reveal whether
or not scoliosis is present as well as how severe it may be.
When is scoliosis considered dangerous to my health? Scoliosis can be life-threatening when bones are so severely twisted
that they compress vital organs. Surgery is most likely the best
option in such cases. If left untreated, severe cases of scoliosis
can shorten a person's life span.
What are some of the nonsurgical ways to treat scoliosis? There are some nonsurgical ways to treat scoliosis such as physical
therapy, exercise, bracing, shoe inserts and medication. However,
only a spine surgeon can determine if any of these options might
apply to you.
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