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Mystery of the Spine: Scoliosis
Do you know what your back looks like? Did you know that not all spines look alike and some are curves? It’s curved because of a spinal disorder called Scoliosis. Adolescent Idiopathic Scoliosis is the most common form of Scoliosis, especially among young, tall, skinny girls.
What is Scoliosis? It is defined as a side-to-side curvature of the spine (encyclopedia). In most cases, scoliosis is idiopathic, but there are other causes. Before the cause is identified, signs must be recognized first.
Most of the time people do not show signs. Signs can include obviously a curve in the spine, one shoulder or hip is higher than the other, flat waistline, or a rib looks higher on one side (Mayoclinic). Another sign can be the head appearing off-centered (medicine). There are many causes of scoliosis but the cause also classifies the kind of curve.
There are four main types of scoliosis which are idiopathic, congenital, neuromuscular, and syndromic (Lincoln). Idiopathic means there is no known cause. Experts do believe there are genetic connections. Congenital is cause by a birth defect, such as Spina Bifia (WebMD). Neuromuscular is caused by abnormal neurologic function such as in such as Cerebral Palsy (nlm). Last but not least, syndromic is associated with genetic and chromosomal abnormalities such as Neurofibromatosis (Martin).
Then it is classified by age, Infantile, Juvenile, and Adolescent (Stopping Scoliosis). Infantile occurs form ages zero to three, and it most often occurs in boys. Juvenile occurs from ages four to ten and occurs about the same in boys and girls. Adolescent occurs from ages eleven to eighteen (nlm), most of the time in girls.
The last classification is location. Locations can include cervical or neck thoracic or upper back, lumbar or lower back or combination of them all (Lincoln). They can be shaped like an “S” or “C”. There are nearly a dozen curve patterns but the most common are shown above.
Curves usually begin in the thoracic or T vertebrae, and end in the Lumbar or L vertebrae. A thoracic curve begins at T4, T5, or T6 and ends at T11, T12, or L1. Thoracolumbar starts at T4, T5, or T6 and end at L2, L3, or L4. Lumbar begins at T11 or T12, and end at L5. A Double Major Curve is formed at both the Thoracic and Lumbar regions (Stopping Scoliosis).
Ten in every hundred kids are diagnosed and require treatment. Thirty in one hundred, with scoliosis has a family member with it. One in every hundred people of the general population has some form of it (WebMD). 2-3% has curves over 10°, 0.3-0.5% has curves over 20°, and 0.2-0.3% has curves bigger that 30° (Lincoln). With bigger curves, girls get it more than boys. When left untreated, visible cosmetic deformities become more apparent. When a curve is over 100°, it can become life threatening.
Children with scoliosis can have emotional problems (encyclopedia) from either having an untreated curve, wearing a brace, or a surgery gone wrong. Some problems that can be caused by scoliosis are respiratory problems, lower back pain, spine cord or nerve damage, heart damage, and headache. In the USA and Canada, idiopathic scoliosis is the most common form, and usually occurring in adolescent girls (100 Q&A).After reading over the statistics most people would be surprise how common, but also the fact they may have never heard of it. 10% off all adolescents have some form of it, but only 1% gets treated beyond observation (encyclopedia).
When a person is screened for scoliosis they usually do the Adam’s bend forward test to see if the person has the curve, from there they are referred to an orthopedic, or spine specialist (medicinet).
When a person is diagnosed with scoliosis there are 3 steps of treatment, observation, bracing and surgery. If a curve is less than 25° or the person has reached bone maturity then no treatment is given (Lincoln). In observation you go to the orthopedic to check your sine, using the bend forward test and x-rays, every 4-6 months. Observation is also part of bracing. Bracing is only for idiopathic juvenile and adolescent curves. All other curves get surgery, and in most of those cases, it does not work.Bracing is for curves that are over 25-30°, a person has less than two years of growth left, or has not had their first period (Q&A). It is also used if the person is still growing and has an idiopathic curve between 20-29° and is getting worse.
There are 3 main types of braces. Nighttime, Dynamic, and Fulltime. Milwaukee and Boston are full-time, Providence and Charleston are nighttime, and SpineCor is “dynamic” (Lincoln). The Providence brace and Charleston Brace Bending brace, is used only at night for curves less than 20°. The SpineCor shown left, is “dynamic”, but there is mixed results of these braces actually working.
The Milwaukee brace is now primary used for kyphosis, which is an abnormally rounded upper back, but at one point the only brace used for scoliosis. It is also called a Cervico-Thoraco- Lumbo-Sacral- Orthosis or CTLSO brace.
The most common and main type is the TLSO or Thoracic- Lumbar-Sacral- Orthosis,(Lincoln) also called Boston brace. It was developed by Dr. John Hills and Bill Miller is “shockingly” Boston, MA. It is used on all types of curves and cost $1,000+ without medical insurance, and around $500 with it.
If bracing does not work than the last option is surgery. It is only used if the person is still growing and has a curve over 45° and is getting worse (Q&A). There are four goals of surgery. Correct the deformity, straighten and stabilized the spine, prevent further progression and alleviate pain. There are 2 types of surgery approaches. Anterior and Posterior the most common type is posterior and anterior is only used when needed. There are two explanations on what is done. One is more updated that the other but it depends on the hospital. Spinal Fusion is a major component of most scoliosis surgery.
In Stopping Scoliosis the is their explanations. The area is prepped for bone graft. They decorate the vertebra and hen the graft is inserted into he bone. After four to six months for adolescent, the fusion melds together into a piece of bone. Bone is usually taken from the ribs or hips.This is how Dr. Tod Lincoln MD does his. By the way the surgery is called a posterior instrumental spinal fusion. The back is straightned by placing some screws and 2 rods. About 70-80% of the curve can be corrected. Bone is then placed along the spine and the rods stay in the body for life.
Martin Poles is the only person one has met with scoliosis, yet one has met atleast 3 females with it. Even Dr.Lincoln says “you fit the description, young,tall and skinny.” Most stories online are of girls. Even the braces are fit for girls. The ration to girls to boys in adolescent is 4 to 1.Some people go their whole life without knowing they have it. 1 in 100 kids, have scoliosis and require treatment, think how many have it and don’t require treatment. Have you have your back x-rayed? Do you know what your spine looks like, do you know if you are one of the 10%.