The term "scoliosis" involves lateral curvature and rotation of the spine. Although it can span all age groups, the deformity is most frequently seen in normal, rapidly growing, preadolescent or adolescent children. Because most of the serious consequences of scoliosis can be prevented, it is a deformity particularly amenable to early diagnosis and proper treatment. It is therefore important that the health care community and general public be knowledgeable about the deformity; that screening programs be promoted in every locality; and that pediatricians focus particular attention on the spine during the adolescent growth spurt.
There are several different "warning signs" to look for to help determine if you or someone you love has scoliosis. Should you notice any one or more of these signs, you should schedule an exam with a doctor.
Shoulders are different heights – one shoulder blade is more prominent than the other
Head is not centered directly above the pelvis
Appearance of a raised, prominent hip
Rib cages are at different heights
Uneven waist
Changes in look or texture of skin overlying the spine (dimples, hairy patches, color changes)
Leaning of entire body to one side
A standard exam that is often used by pediatricians and in initial school screenings is called the Adam's Forward Bend Test. Most schools test children in the fifth or sixth grade, and the Adam's Forward Bend Test can be administered easily by school nurses or parent volunteers. For this test, the patient is asked to lean forward with his or her feet together and bend 90 degrees at the waist. The examiner can then easily view from this angle any asymmetry of the trunk or any abnormal spinal curvatures. It should be noted that this is a simple screening test that can detect potential problems, but cannot determine accurately the exact severity of the deformity.
Once suspected, scoliosis is usually confirmed with an x-ray, spinal radiograph, CT scan, MRI or bone scan of the spine. The curve is then measured by the Cobb Method and is discussed in terms of degrees. Generally speaking, a curve is considered significant if it is greater than 25 to 30 degrees. Curves exceeding 45 to 50 degrees are considered severe and often require more aggressive treatment.
Once it has been determined that a patient has scoliosis, there are several things to take into consideration when discussing treatment options:
Spinal maturity – is the patient's spine still growing and changing?
Degree and extent of curvature – how severe is the curve and how does it affect the patient's lifestyle?
Location of curve – according to the Scoliosis Research Society, thoracic (upper spine) curves are more likely to progress than thoracolumbar (middle spine) or lumbar (lower spine) curves.
Potential for progression – patients who have large curves prior to their adolescent growth spurts are more likely to experience curve progression.
After this complex set of variables is
analyzed, treatment options are discussed. There are three basic types of
treatments for scoliosis: observation, bracing and surgery.
Observation
includes follow up x-rays 4-6 months after the first x-ray to measure any
changes. The greatest changes occur
during the growth spurt of puberty.
Bracing can be moderately effective
for a growing child with a spinal curvature between 25 and 40 degrees.
Plastic braces are worn at night for two to three years to prevent the
curve from worsening.
Surgery is recommended for curvatures over 45 degrees.
Southwest General offers a Scoliosis Treatment Program at Lifeworks, a health and fitness facility. Treatment is provided by a special team of physical therapists and physical therapist assistants with years of experience in spine, orthopedic and pediatric treatments. After an initial evaluation of the patient, a trained scoliosis therapist will develop an individualized plan of care. Treatment involves correction of posture based on the patient's spinal curve, corrective breathing and muscle strengthening. For more information, or to schedule an appointment, call 440-816-8010.