Scoliosis: Treatment, symptoms, and causes

Scoliosis causes the spine to curve to one side. It can affect any part of the spine, but the most common regions are at the level of the chest and the lower back.

It often appears in children. In most cases, treatment is not needed, as the curve corrects itself with growth. However, based on the degree of curvature and the age of the child, a combination of bracing and physical therapy is often recommended.

A very small number of patients with scoliosis may require surgery. Complications of scoliosis include chronic pain, respiratory deficiencies, and decreased exercise capacity.

Fast facts on scoliosis

Here are some key points about scoliosis. More detail is in the main article.

Often, the causes of scoliosis are not known.

A few people with scoliosis need surgery.

Symptoms in infants include a bulge on one side of the chest.

It is more common in females than in males

What is scoliosis?

A person with scoliosis will have a C- or S-shaped curve in their spine.

It can appear at any age, but it often presents from the age of 10 to 12 years, or during the teens, but infants can sometimres have symptoms.

The reasons for the change in shape are not usually known, but some cases are linked to cerebral palsy, muscular dystrophy, spina bifida, or a birth defect.

A structural curve is permanent, and may be due to another condition. A nonstructural curve is temporary and it is likely to diseappear with time.

Treatment

Most children with scoliosis have a mild curve that does not need treatment.

The doctor will recommend following up every 4 to 6 months to monitor the curve of the spine in clinic and periodically with X-rays.

The following factors will be considered by the doctor when deciding on treatment options:

Sex: Females are more likely than males to have scoliosis that gradually gets worse.

Severity of the curve: The larger the curve, the greater the risk of it worsening over time. S-shaped curves, also called “double curves,” tend to worsen over time. C-shaped curves are less likely to worsen.

Curve position: A curve that is is located in the center part of the spine is more likely to get worse compared with curves in the lower or upper section.

Bone maturity: The risk of worsening is lower if the person’s bones have stopped growing. Braces are more effective while bones are still growing.

Casting

Casting instead of bracing is sometimes used for infantile scoliosis to help the infant’s spine to go back to its normal position as it grows. This can be done with a cast made of plaster of Paris.

The cast is attached to the outside of the patient’s body and will be worn at all times. Because the infant is growing rapidly, the cast is changed regularly.

Braces

If the patient has moderate scoliosis and the bones are still growing, the doctor may recommend a brace. This will prevent further curvature, but will not cure or reverse it. Braces are usually worn all the time, even at night. The more hours per day the patient wears the brace, the more effective it tends to be.

The brace does not normally restrict what the child can do. If the child wishes to take part in physical activity, the braces can be taken off.

When the bones stop growing, braces are no longer used. There are two types of braces:

Thoracolumbosacral orthosis (TLSO) – the TLSO is made of plastic and designed to fit neatly around the body’s curves. It is not usually visible under clothing.

Milwaukee brace – this is a full-torso brace and has a neck ring with rests for the chin and the back of the head. This type of brace is only used when the TLSO is not possible or not effective.

One study found that when bracing is used on 10-15 year olds with idiopathic scoliosis, it reduces the risk of the condition getting worse or needing surgery.

[Scoliosis spine]
Often, the clothes of patients with scoliosis do not hang properly.

The most common form of scoliosis appears in adolescent. It is known as adolescent idiopathic scoliosis. It can affect children from the age of 10 years.

Idiopathic means that there is no known cause. Symptoms can include:

the head is slightly off center

the ribcage is not symmetrical – the ribs may be at different heights

one hip is more prominent than the other

clothes do not hang properly

one shoulder, or shoulder blade, is higher than the other

the individual may lean to one side

uneven leg lengths

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