Scoliosis
When examining teenage girls for sports physicals, I often note a slight curve to the spine. If further examination is needed, I will order x-rays to determine how much curve there is.
As soon as I mention the word "scoliosis" the family has a million questions. Particularly, they’re worried about how severe it will be and if surgery will be needed.
Dr. Robert Fitch, an orthopaedic surgeon at Duke, gives us insight into scoliosis and what steps may need to be taken.
-- Dennis Clements MD, PhD, MPH
What Is Scoliosis?
Robert D. Fitch, MDSimply put, scoliosis is an abnormal curvature of the spine that exceeds 10 degrees when measured on an x-ray. This curve is seen when observing the spinal column from behind.
This is differentiated from normal "postural" curves that should be present when viewing the spinal column from the side. In fact, scoliosis is a three-dimensional deformity that occurs as the spinal column bends and twists.
As scoliosis progresses, shoulder and waist asymmetry can be noted as well as rib or muscle prominence on the side that the curve is deflected. Postural curves can become flattened or exaggerated.
This radiograph demonstrates how the surgeon measures the size of the curve to determine appropriate treatment
(Click image to enlarge.)Scoliosis can be associated with many disorders. The most common type is idiopathic scoliosis. "Idiopathic" is a medical term that means no known cause, and is seen in otherwise well individuals. The incidence of this condition in the general population is approximately 2 percent.
However, the vast majorities of curves are mild and will not progress to cause significant deformity or disability, and therefore do not require treatment. Less than 10 percent of those diagnosed with scoliosis will progress to require treatment -- either bracing or surgery.
What You Need to Know about Treatment
- A patient's age, gender, and the size of the curve measured from a standing x-ray most influence treatment. While the incidence of scoliosis in boys and girls is nearly equal, girls are six times more likely to have the curves increase. The younger the age and the larger the curve is at the time of diagnosis, the more likely there will be progression.
- Children with curves that measure less than 25 degrees generally will not undergo treatment, but will need to be followed by a physician until spinal growth is completed (usually age 14 for girls, age 16 for boys). The interval for follow-up visits is generally every four to six months.
Brace Treatment
Scoliosis patients who show progression of the curve to 25 degrees or present with curves of 30-40 degrees are considered for brace management if there is significant growth remaining.
The goal of bracing is to prevent progression of the scoliosis during this growth period. Bracing has been shown to be successful treatment in approximately 80 percent of patients.
Surgery
.jpg "Preoperative radiograph of a patient with idiopathic scoliosis")
Preoperative radiograph of a patient with idiopathic scoliosis
(Click image to enlarge.)
.jpg "Postoperative radiograph of a patient with idiopathic scoliosis")
Postoperative radiograph of a patient with idiopathic scoliosis
(Click image to enlarge.)
If the scoliosis has reached 45-50 degrees, surgery will likely be recommended since further progression of the curve is probable. A rapid increase in the deformity will usually occur if there is significant spinal growth remaining.
In patients whose growth is complete, curve progression is expected but is likely to occur much more slowly, generally about 1 degree per year. Eventually a severe curve will develop and cause health concerns.
The goals of surgery are twofold:- Correct the curve and hold the spine in its corrected position. This is done by inserting stainless steel or titanium rods adjacent to the spine. The rods are secured to the vertebrae with hooks, wires, or screws.
- Obtain a fusion (make the vertebrae heal together). Rods by themselves are not sufficient. If the vertebrae are not joined together, the rods will eventually break from the stress of every day activities.
-- Robert D. Fitch, MD, is an orthopaedic surgeon at Duke specializing in scoliosis.
-- Dennis Clements, MD, PhD, MPH, is the chief of primary care pediatrics at Duke Children's Hospital.
