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Scoliosis is defined as a lateral (side-to-side)
curvature of the spine. In reality, scoliosis is a three dimensional
deformity with vertebral rotation, in addition to side-to-side bending.
There are many known causes of scoliosis, including birth defects of the
spinal column (congenital scoliosis) and various neuromuscular disorders
such as cerebral palsy, muscular dystrophy, and spina bifida. There are
also unusual forms of scoliosis caused by injury, tumors, infection,
radiation, and metabolic disorders.
The most common type of scoliosis, however, is termed "idiopathic
scoliosis," which means there is no known cause. Idiopathic scoliosis
may develop at any age during childhood, but most commonly occurs just
prior to or during puberty.
With the exception of rare forms of scoliosis caused by tumor or
infection, scoliosis is not typically a painful condition. Scoliosis is
usually detected by school screening, routine physical exam, or by
parents. The prevalence of scoliosis (curves greater than 10 degrees) in
school screening studies is between 1.3 and 3.0%. Scoliosis curves are
measured in degrees, as determined on standing x-rays of the spine.
Once scoliosis has been detected, treatment options include observation,
bracing, and surgery. Fortunately, most patients with scoliosis require
no treatment other than periodic observation. Observation is usually
appropriate for curves up to 25 degrees. If a curve measures more than
25 degrees, but less than 40 degrees, and the child is still growing, a
brace is usually prescribed. Controlled studies have shown bracing to be
approximately 70% effective in preventing the scoliosis from getting
worse and requiring surgery.
The two most important factors that determine the risk for a curve
getting worse are: (1) the amount of growth remaining and (2) the
severity of the curvature. In others words, skeletally immature patients
are at a greater risk than more mature patients for curve progression
and larger curves are more likely to get worse than smaller curves.
Surgery is often necessary if the scoliosis is greater than 40 degrees
in a growing child. Modern surgical techniques allow for excellent
correction of the spinal deformity and rapid return to activities. With
recent surgical implant designs, most patients can be walking almost
immediately after surgery without a cast or brace. Return to full
activity, including sports, is often allowed at six to nine months after
surgery.
Extensive research is ongoing to determine the cause (or causes) of
idiopathic scoliosis. At the present time these is no known cause, hence
there is no cure or prevention. Treatment therefore hinges on early
detection and close monitoring so that small curves can be prevented
from becoming large curves that may require surgery.
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