What is scoliosis?
The most common type of scoliosis in children is called “adolescent idiopathic scoliosis”. Idiopathic means “of unknown origin”. Although the exact underlying trigger is not known, we do know that as the spine grows, the bones change shape causing the curvature to worsen.
The most common type of scoliosis overall is in adults. This type of scoliosis is called degenerative De Novo scoliosis and is caused by asymmetrical wear and team (degeneration) of the spinal bones called vertebrae. Adults can also have pre-existing adolescent idiopathic scoliosis that can either be stable or progressive in adult life. Although adult scoliosis is the most common form of scoliosis, it is under-recognized.
More focus is usually placed on children with scoliosis because of how rapidly the scoliosis can progress during periods of spinal growth. If scoliosis progresses to a large degree, spinal fusion surgery may be required to stabilize the spine in an attempt to stop the progression of the curvature in adult life.
Idiopathic scoliosis is usually first seen in children between the ages of 10 and 12. However, it can occur in younger children aged 4 to 10 years (juvenile scoliosis) and in babies aged 0 to 3 years (infantile scoliosis). The effects of idiopathic scoliosis include poor posture, shoulder humping, and pain. In rare cases, untreated idiopathic scoliosis can lead to heart and lung problems.
If scoliosis is detected and treated early, patients can avoid these symptoms in many cases. If left untreated or treated incorrectly, scoliosis can sometimes require surgery. In surgical cases, the bones of the spine are sometimes fused together and metal rods are inserted to try to straighten the spine. In most cases, if the scoliosis is detected and treated early enough, bracing and scoliosis-specific exercise can be used to stop the scoliosis from worsening and help a patient avoid surgery.
In adults, pain and poor posture are the most common complaints. Sometimes ongoing progression can also be an issue. Often regularly prescribed treatments for the pain associated with adult scoliosis do not help or only help temporarily. Fortunately, new treatments such as the adult brace and intensive exercise rehabilitation offer these patients new hope.
How is scoliosis assessed?
Choosing the right treatment for scoliosis relies on first being able to accurately assess and measure it. Accurate assessment of scoliosis cases is one of the most important steps in achieving the best outcomes for a patient.
Assess Posture, Measure X-rays
Scoliosis can detected through postural assessment, but can only be accurately diagnosed and measured on an x-ray of the spine. Standing x-rays only should be used, as they show the true degree and alignment of the curve or curves while the patient is upright. Lying down x-rays are not as useful as the patient’s spine can be mispositioned and the true extent of the scoliosis minimised.
Once x-ray images have been taken, a type of measurement called the “Cobb angle” is used to assess the degree of the scoliosis. It is criticial that any health professional assessing scoliosis be familiar and accurate with this measurement, as it is then used to form recommendations for treatment options based on the degree of curve.
What scoliosis measurements mean
A scoliosis is a curve over 10 degrees Cobb angle, with visible rotation of the vertebrae. If no rotation is seen on x-ray, the curve is not a true scoliosis and may be postural or positional.
Many scoliosis surgeons recommend surgery when the curve is over 40 or 45 degrees and there is a high probability of progression.
ScoliCare’s approach to scoliosis treatment is to ensure each curve is accurately assessed from the outset and to provide appropriate non-surgical treatment options, tailored to each patient.
Types of scoliosis
Infantile scoliosis is most often seen in boys and accounts for less than 1% of idiopathic cases. The most common curve type is a left curve.
When a right curve is present, particularly in girls, this usually indicates a poorer prognosis. Sometimes these cases can resolve spontaneously, sometimes they can progress to a more severe scoliosis. Depending on the case, the treatment of infantile scoliosis may involve observation, physical therapy, bracing and as a last resort surgery.
Juvenile scoliosis is more often seen in girls than boys. In children between the ages of 4 to 6 years the rate is fairly equal between the two sexes. However between the ages of 6 to 10 years the rate is much higher among girls. It is seen more frequently than infantile idiopathic scoliosis, but it is less common than adolescent idiopathic scoliosis. Curves tend to bend to the right in children with juvenile scoliosis, however left curves tend to have a better prognosis.
Children with juvenile scoliosis generally have a high risk of progression of their curve. Seven out of ten children with this condition will worsenand require active treatment. Juvenile curves almost never resolve spontaneously. They usually require bracing, and many will go on to require surgery.
Like other types of scoliosis AIS is characterised by an abnormal sideways S or C curve of the spine. Children with AIS are generally otherwise healthy and normal. AIS is the most common type of scoliosis. Approximately 4% of all children between 10 and 18 years old will develop this type of scoliosis. AIS is more commonly seen in girls than boys – 90% of scoliosis cases are girls. AIS often begins to develop at the initial onset of puberty becoming more apparent as is worsens during growth spurts.
AIS has a better prognosis than juvenile scoliosis, but can still progress to become a significant deformity if it is not detected early and properly managed. It is not uncommon for adolescents with large curves or curves that progress quickly to develop some back pain. The most effective non surgical treatment is bracing but for curves under 25 degrees exercise may appropriate.
This is known as Degenerative De-Novo Scoliosis (DDS).
Adults with ASA may or may not have previously been diagnosed with adolescent scoliosis. ASA may be progressive or stable, depending on the individual case. In those with a previous diagnosis of AIS monitoring progression is easy as comparison of current x-rays to adolescent x-rays can be done. In those where the scoliosis is discovered in adulthood, determining if the scoliosis is a pre-existing adolescent condition or a new onset of degenerative scoliosis can be difﬁcult.
DDS usually develops in middle aged and older adults and is typically seen starting around 45 years of age onwards. Because DDS is a result of degenerative instability, it is almost always progressive. However the main complaint usually associated with DDS is lower back pain.