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IDIOPATHIC SCOLIOSIS

Posted Mar 15 2010 12:00am
Mar
15

          The word scoliosis comes from a Greek word meaning crooked.  If you have scoliosis, you’re not alone.  About 3 out of every 100 people have some form of scoliosis, though for many of them it’s not much of a problem.  The spine, or backbone, helps hold the body upright.  Without its gentle curving down the back, we wouldn’t be able to balance, walk or move properly.  But the spine curves from side to side in people with the condition scoliosis, and sometimes this can cause problems.  To be more precise, scoliosis is a sideways curvature of the spine that makes the spine look more like an “S” or “C” than a straight “I”.  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 (as in the photograph shown).  Although small curves generally do not cause problems, if the curve gets severe it can be visible and cause discomfort.

          Scoliosis is sort of a medical mystery – no one knows for sure what causes the most common form of scoliosis, idiopathic scoliosis.  Idiopathic is a medical term that means it’s not known what causes the condition or disease.  Doctors do know that scoliosis can run in families, though.  So a person who has scoliosis may have family members who have it.  Most types of scoliosis are more common in girls than boys, and girls with scoliosis are more likely to need treatment.  If a curve gets really severe, it can even affect a person’s breathing and heart function and can lead to damage in the joints of the spine and pain in adulthood.  Because scoliosis can develop very gradually, in most cases it isn’t diagnosed until a person is between the ages of 10 and 14.  Physicians routinely check teens for scoliosis during regular physical exams.

          After examining you closely, the doctor will decide if further treatment is needed.  If he or she determines the curve isn’t a problem, you may not need any treatment, just regular checkups to make sure the curve doesn’t become larger.  To get a clearer view of your spine, the doctor might order X-rays.  If the exam or X-rays show a significant curvature, you’ll be referred to an orthopedist.  The orthopedist will examine you and study X-rays of your spine.  You may hear the orthopedist mention something called a Cobb angle.  The Cobb angle is a measure of the curvature of the spine in degrees, and the number of degrees helps the doctor decide what type of treatment is necessary.  A scoliosis curve of 10 to 15 degrees usually means that nothing needs to be done except for regular checkups until the person has gone through puberty and finished growing (the curvature of the spine usually doesn’t get worse after that point).  If the curve is 20 to 40 degrees, the orthopedist will generally suggest a back brace.  A Cobb angle of 40 or 50 degrees or more may mean that surgery is necessary.

          About 1 in 5 teenagers with scoliosis needs to wear a back brace.  Back braces today are much lighter and more comfortable than they used to be – and researchers are developing even better ones all the time.  There are several different types of braces. Some braces are worn for 18 to 20 hours a day, others only at nighttime.  Which one the orthopedist chooses depends on the person, where the curve is on his or her back, and how severe the curve is; the brace acts as a holding device that keeps the spine from developing more of a curve.  A brace won’t ever make the spine straight.  But if it does its job well, the curve won’t increase more than 5 or 10 degrees and may prevent the need for surgery.  Sometimes, even with a brace, someone with severe scoliosis will need surgery to correct the curve.  During the operation, the orthopedic surgeon does a procedure called a spinal fusion.  This causes some of the separate bones of the spine to link or “fuse” together, so that the spine can no longer continue to curve.  The surgeon also uses metal rods, hooks, screws and wires to correct the curve and hold everything in line until the bones heal.  The metal parts are placed deep under the spine muscles, and in most cases can’t be felt and do not hurt.

          An operation to correct scoliosis takes several hours, depending on how big the curve is and how many bones need to be fused.  Normally, the person will be able to get out of bed the next day and start to walk, and usually can go home in less than a week.  Teens who have had surgery to correct scoliosis usually go back to school about a month after surgery, then return to some activities in 3 or 4 months.  After about a year, the bones should have fully fused.  Although the metal rods are no longer needed, they are left in the patient’s back because they aren’t doing any harm and taking them out would involve another operation.  People with scoliosis can have active, normal lives.  Doctors don’t know of any activities (including things like sports or carrying a backpack) that make scoliosis worse.  So teens that have scoliosis should still be able to play their favorite sports and carry on as normal.

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