Scoliosis

The symptoms of scoliosis can vary depending on the severity of the curvature and the age of the individual. Common signs and symptoms include:

• Uneven shoulders or shoulder blades
• Asymmetrical waist or hips
• One shoulder blade protrudes more than the other
• Rib prominence or a noticeable hump on one side when bending forward
• Back pain, particularly in adults
• Fatigue after prolonged sitting or standing
• In severe cases, scoliosis can lead to respiratory and cardiovascular issues due to the restricted space within the chest cavity.

There are four types:

Adolescent Idiopathic scoliosis is the most common type, accounting for 80% of cases with no known specific cause. It is an abnormal curvature that appears during a growth spurt in late childhood or adolescence, typically between the ages of 10 and 18. It is estimated to affect

1-3% of children in their teen years prefer girls. 30% of cases have a family history of scoliosis. This type is generally mild.

Neuromuscular scoliosis is caused by diseases of the nerves and muscles that cause trunk imbalance. It includes muscular dystrophy, cerebral palsy, Marfan’s syndrome, and multiple other conditions.

Congenital scoliosis is caused by abnormal development in the womb, leading to vertebral malformations. It may only become noticeable when the child goes through a growth spurt around age two and between 8 and 13.

Degenerative scoliosis is usually found after age 40 due to age-related changes such as degenerative disc disease, spinal arthritis, and osteoporosis.

Spine surgeon Dr. Mathew Cyriac will take a detailed medical history, ask about your child’s growth patterns, and conduct a physical exam, which may also include testing for muscle weakness, numbness, and abnormal reflexes. The Adams forward bend test is a common initial screening tool where the patient bends forward at the waist, allowing the physician to observe any asymmetry or rib hump. He will order X-rays to confirm the diagnosis and may order advanced imaging studies to assess the spinal cord, nerves, or underlying structural abnormalities.

Treatment options will depend on the degree of curvature, the curve pattern, location, and the child’s maturity. Generally, treatment options include:

Observation: For mild curves (less than 20 degrees), especially in growing children, regular monitoring every 4-6 months may be sufficient to track progression.

Bracing: Bracing prevents further progression in moderate curves (20-40 degrees) in growing children and adolescents. The type and duration of bracing depend on the location and severity of the curve.

Physical Therapy: Exercises and stretches are designed to improve posture, strengthen muscles, and maintain spinal flexibility. While physical therapy does not correct the curvature, it can help manage symptoms and improve overall function.

Surgery: Surgery may be recommended for severe curves (greater than 40-50 degrees) or cases where conservative treatments fail. The most common surgical procedure is spinal fusion, which involves correcting the curvature and fusing the affected vertebrae using metal rods, screws, and bone grafts.

In addition to these treatments, pain management strategies, such as medications or spinal injections, may be used to alleviate discomfort, particularly in adults with degenerative scoliosis.

Scoliosis is a complex condition requiring a personalized approach to management. Early detection and appropriate intervention are crucial in preventing complications and improving the quality of life for affected individuals.