SCOLIOSIS FOUNDATION

 

 

Description

• Scoliosis is an abnormal curving of the spine that makes the spine look more like an "S" or "C" than a straight "I". Your spine is your backbone.
• Scoliosis can cause the bones of the spine to turn (rotate) so that one shoulder, scapula (shoulder blade), or hip appears higher than the other.

It runs straight down your back. Everyone’s spine naturally curves a tiny bit. But people with scoliosis have a spine that curves too much. The spine might look like the letter “C” or “S.”

Causes, incidence, and risk factors

Most of the time, the cause of scoliosis is unknown. This is called idiopathic scoliosis. It is the most common type. It is grouped by age.

• In children age 3 and younger, it is called infantile scoliosis.
• In kids age 4 - 10, it is called juvenile scoliosis.
• In older kids age 11 - 18, it is called adolescent scoliosis.

 Scoliosis most often affects girls. Some people are just more likely to have curving of the spine. Curving generally gets worse during a growth spurt.

Other types of scoliosis are:

• Congenital scoliosis: This type of scoliosis is present at birth. It occurs when the baby’s ribs or spine bones do not form properly.
• Neuromuscular scoliosis: This type is caused by a nervous system problem that affects your muscles, such as cerebral palsy, muscular dystrophy, spina bifida, and polio.

A study was conducted in nine secondary schools in Ibadan, the largest and the third most-populated city in Nigeria. They were 999 students (514 boys, 485 girls) aged 10-20 years sampled from nine purposively selected secondary schools in Ibadan.

All the students had an initial visual screening of the spine but those who demonstrated visually recognizable lateral deviation of the spine also had secondary screening to ascertain the presence of rib hump, shoulder elevation, trunk decompensation and location of the scoliosis curve.

Fifty-three (5.3%) of the subjects had visually recognizable scoliosis. The male to female prevalence ratio was 1.5:1. All but one subject with scoliosis were right handed while 26 (51%), 23 (49%) and 4 (7.5%) of them had right thoracic, left thoracic and left lumbar scoliosis respectively. Twenty five subjects (2.5%) were twins but 3 (12.0%) of them had scoliosis.

The prevalence of idiopathic scoliosis among adolescents in this study is similar to rates reported among similar age groups in other parts of the world. The finding suggests a need for a national survey of idiopathic scoliosis and institutionalization of the school screening program in Nigeria.

 

Symptoms

Usually there are no symptoms. But symptoms can include:

• Backache or low-back pain
• Tired feeling in the spine after sitting or standing for a long time
• Uneven hips or shoulders (one shoulder may be higher than the other)
• Spine curves more to one side

Signs and tests

The health care provider will perform a physical exam. You will be asked to bend forward. This makes your spine easier to see. It may be hard to see changes in the early stages of scoliosis.

The exam may show:

• One shoulder is higher than the other
• The pelvis is tilted

X-rays of the spine are done. It is important to have x-rays, because the actual curving of the spine may be worse than what your doctor can see during an exam.

Other tests may include:

• Spinal curve measurement (scoliometer screening)
• MRI of the spine

Treatment

Treatment depends on many things:

• The cause of scoliosis
• Where the curve is in your spine
• How big the curve is
• If your body is still growing

Physiotherapy has been very effective in treating scoliosis using specified exercises, muscle stimulator, and braces.

If you are still growing, your doctor might recommend a back brace. A back brace prevents further curving. There are many different types of braces. What kind you get depends on the size and location of your curve. Your health care provider will pick the best one for you and show you how to use it. Back braces can be adjusted as you grow.

Back braces work best in people over age 10. Braces do not work for those with congenital or neuromuscular scoliosis.

Sometimes, surgery is needed.

• Scoliosis surgery involves correcting the curve as much as possible.
• The spine bones are held in place with one or two metal rods, which are held down with hooks and screws until the bone heals together.
• Surgery may be done with a cut through the back, belly area, or beneath the ribs.

After surgery, you may need to wear a brace for a little while to keep the spine still.

You may need surgery if the spine curve is severe or getting worse very quickly. The surgeon may want to wait until all your bones stop growing, but this isn’t always possible.

Scoliosis treatment may also include:

• Emotional support. Some kids, especially teens, may be self-conscious when using a back brace
• Physical therapy and other specialists to help explain the treatments and make sure the brace fits correctly.

Expectations (prognosis)

How well you do depends on the type, cause, and severity of the curve. The more severe the curving, the more likely it will get worse after you stop growing.

People with mild scoliosis do very well with  physiotherapy braces. They usually do not have long-term problems. However, scoliosis can make you more likely to have back pain when you get older.

The outlook for those with neuromuscular or congenital scoliosis varies. Patients with neuromuscular scoliosis have another serious disorder (like cerebral palsy or muscular dystrophy) so their goals are much different. Often the goal of surgery is simply to allow a child to be able to sit upright in a wheelchair.

Congenital scoliosis is difficult to treat and usually requires many surgeries.

Complications

Complications of scoliosis can include:

• Breathing problems (in severe scoliosis)
• Low back pain
• Lower self-esteem
• Persistent pain if there is wear and tear of the spine bones
• Spinal infection after surgery
• Spine or nerve damage from an uncorrected curve or spinal surgery

Prevention

The Scoliosis Foundation  plans a routine scoliosis screening is junior and senior high schools. Screening will help detect early scoliosis in many kids.

 

Statistics

• Frequency of scoliosis:
• Scoliosis curves measuring at least 10° occur in 1.5% to 3.0% of the population
• Curves exceeding 20° occur in 0.3% to 0.5% of the population
• Curves exceeding 30° occur in 0.2% to 0.3% of the population
• Small spinal curves occur with similar frequency in boys and girls, but girls are more likely to have a progressively larger scoliotic curve that will require treatment.

Cause

·       In most cases of scoliosis, the exact cause is not known (idiopathic). However, scoliosis can occur in several people within a family. When it does, there is probably a genetic component to its cause.

Classification

·       Scoliosis can occur at any age.

o      Adolescent idiopathic scoliosis occurs after the age of 10 years. It is the most common type.

o      Infantile scoliosis occurs in children less than 3 years old. It may result from abnormally shaped vertebrae at birth (congenital), various syndromes, neurologic disorders, or unknown reasons (idiopathic).

o      Juvenile scoliosis occurs in children between the ages of 3 and 10 years. It is not common

Symptoms

·       Scoliosis does not usually cause any pain, neurological dysfunction, or respiratory problems. The concern over the cosmetic appearance of the back often is the primary concern of the patient and parents.

Examination, Signs

·       The doctor will ask your child to bend forward, which will show any deformities (see the image above). This is called the "Adam's forward bend test." He or she will also check for any limb-length discrepancies, abnormal neurological findings, or other potential causes.

Investigations, Tests

Many schools regularly conduct scoliosis screenings of students. These screenings usually occur during the middle school years. Your child may receive a referral for scoliosis to a doctor based on the results of a school screening.

Scoliosis is confirmed with an x-ray of the spine. Your doctor will measure the degree of the curve, as shown in the accompanying x-ray.

This x-ray of a patient's scoliosis measures 82° in the upper curve, and 75° in the lower curve.

 

Natural History

If left untreated, curves exceeding 50° can lead to problems in the long term. Progressive deterioration of the scoliotic curve can occur, which in some patients can lead to diminished lung capacity and the development of restrictive lung disease. Cosmetic concerns are significant to many patients. The incidence of back pain among patients with scoliosis is similar to that of the general population.

 

 

 

Treatment - Indications

·       The type of treatment required depends on the kind and degree of the curve, the child's age, and the number of remaining growth years until the child reaches skeletal maturity.

 

Please if you notice any abnormal curve or should your child complain of back pain, you can visit our office for examination, and possible treatment of all back related problems.

@ No 9 Worluchor Street,

Rumukalagbor, Off Waterlines

Port Harcourt

08033930798