Scoliosis

Scoliosis is defined as an abnormal curve in the frontal plane (seen from behind) which exceeds 10 degrees. The incidence of curves between 10 and 25 degrees is equal in boys and girls at about 25 in 1000 (2.5%). Curves greater than 25 degrees are seven times more frequent in girls at 3-5 per 1000 (0.5%). The existence of a someone in you family with scoliosis increases the odds of another occurrence within your family by four times.

85% of all curves are idiopathic which is to say they are not associated with other disease process. Scoliosis is associated with spinal trauma, neuromuscular disease, severe spinal arthritis and degenerative disc disease in the elderly. In children treatment is based upon early recognition of curves before they become severe. Curves can be present at birth (congenital form), caused by spinal malformations such as incomplete separations of the vertebrae, or develop in early infancy due to growth of the spine and a bony bar that anchors the spine on one side while it grows on the other, causing a curve to develop. It can develop in early childhood (juvenile form), or just prior to the prepubertal growth spurt (adolescent form). Preteen adolescent scoliosis is by far the most common. Curves under 20 degrees are watched for progression. Curves over 20 degrees are braced, and curves over 45 degrees are surgically stabilized. Risk of progression is proportional to skeletal maturity (the greater the skeletal maturity the less likely the curve is to progress), and the growth rate of the child (children undergoing a growth spurt are morel likely to progress).

Exercises, medications, chiropractic are not effective in controlling a scoliotic curve.

Bracing if properly applied and worn at least 16 hours per day has been shown to sometimes limit progression but not correct a scoliotic curve. Some curves progress regardless of what conservative treatment is applied. Some curve do not progress regardless of what treatment is applied.

Surgical fusion can correct much of the deformity, but seldom all of it. The degree of correction is dependent upon the flexibility of the curve and the age of the patient. Very young patients often require anterior discectomy and posterior fusion in order to prevent "crankshafting" a twisting which occurs with active growth of the front of the spine after fusing the back. It has become clear that correction of the lack of sagital curves (sway back in the low back and roundedness between the shoulders is almost as important for long term success as  the correction of the side to side scoliosis curve. The newest surgical paradigm is to use pedicle screws to control all three spinal columns during the reduction process. This leads to the greatest correction and best clinical outcomes.

Smaller degenerative curves in the elderly spine are usually best handled through interbody spacers and pedicle screws (see minimal access fusion).

For more information about scoliosis please go to www.esurgeon.com/epratt and follow the links to www.iscoliosis.com.

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                                                    Last modified: 04/04/06