Scoliosis & Spinal Deformity

Most cases of scoliosis are mild, and the curves can remain stable. But sometimes the degree of the curve may progress with time and some children may develop spine deformities that continue to get more severe as they grow.

An especially severe spinal curve can reduce the amount of space within the chest, which can lead to diminished lung capacity, pressure exerted on the heart, and restricted physical activities.

The cause of most cases is unknown but is believed to involve a combination of genetic predisposition and environmental factors. Other possible contributors to scoliosis may be birth defects, injuries or infections which affect the development of the bones of the spine. Other health conditions such as muscles spasms, cerebral palsy, Marfan syndrome, and tumors such as neurofibromatosis may impact spinal growth and curvature.

Scoliosis occurs in about 3% of people. Girls typically are more severely affected than boys. It usually appears between the ages of 10 and 15 but can be seen in much younger children. Scoliosis is often noticed during or after the growth spurt just before puberty.

Even when untreated, mortality rates are similar to the general population. However, there are new therapies and treatments that can help improve the quality of life and relieve the pain attributed to scoliosis.

Signs and symptoms of scoliosis may include:

• Uneven shoulders, hips, arms, or leg lengths
• One shoulder blade that appears more prominent than the other
• Uneven waist
• One hip higher than the other
• Pain in the back, shoulders, and neck and buttocks nearest the bottom of the back
• Constipation due to curvature causing "tightening" of stomach, intestines, etc.
• Limited mobility secondary to pain or functional limitation in adults
• Uneven musculature on one side of the spine
• Slow nerve action
• Respiratory and /or cardiac problems in severe cases

Mild curves, however, can develop without the parent or child knowing it because they appear gradually and usually don't cause pain. Pediatricians may check for scoliosis at a routine well-child visit. Occasionally, teachers, friends and sports teammates are the first to notice a child's scoliosis.

It’s time to make an appointment with a physician if you notice any of the above signs or symptoms.

In diagnosing scoliosis, the physicians at Semmes Murphey Clinic will conduct a detailed medical history interview, and perform a physical examination including several widely-accepted tests for scoliosis.

If scoliosis is suspected, the doctor will usually order X-rays of the entire spine from the neck to the pelvis. The doctor will also measure the spine’s curves to determine the actual degree of the curvature to help describe the scoliosis and develop a treatment plan. An MRI may be ordered to evaluate any other issues around the spine.

Treatment options depend upon the degree of curve, location, and cause. They may include:

• Monitoring of the curvature: Children who have scoliosis are monitored closely, usually with X-rays, and routinely, usually every four to six months, to watch for any worsening of their curve.
• Physical therapy: The physical therapists at Semmes Murphey can develop a variety of exercises to help improve and maintain comfort and ability.
• Braces: If the bones are still growing, the doctor may recommend a brace. Wearing a brace won't cure scoliosis or reverse the curve, but it usually stabilizes the spine and prevents further progression of the curve. The brace must be fitted to the person and is usually worn daily. Some braces are equipped to “grow” with the child.
• Medications: For adults, both over-the-counter and prescription painkillers may be an option. Consult with your physician about which are best for you.
• Surgery: Patients with major curves causing discomfort or other health problems will be evaluated for surgery to help straighten and/or prevent worsening and minimalize the effect on other organs and body parts. To completely straighten a scoliotic spine is rare, but significant corrections are achieved in most cases.
• The most common type of scoliosis surgery is spinal fusion. In spinal fusion, surgeons connect two or more of the bones in the spine (vertebrae) together, so they can't move independently. Pieces of bone or bone-like material are placed between the vertebrae. Metal rods, hooks, screws or wires typically hold that part of the spine straight and still while the old and new bone material fuses together.
• Another option to consider if the scoliosis is progressing rapidly at a young age is to install a rod that can adjust in length as the child grows. This growing rod is attached to the top and bottom sections of the spinal curvature and is usually lengthened every six months.

As with any surgery, you will need to fully understand the options, likely outcomes, and any complications as well as the patient’s readiness before deciding on this option.

This information was provided by the specialists at Semmes Murphey Clinic. Readers are encouraged to research trustworthy organizations for information. Please talk with your physician for websites and sources that will enhance your knowledge and understanding of this issue and its treatments.