There are several types of structural scoliosis. In this video, Dr. Joseph will discuss the most common type of scoliosis, review symptoms and outline treatment options available for patients. Idiopathic scoliosis accounts for about 8 in 10 cases of scoliosis. This type of scoliosis typically presents during adolescence, but it can also start earlier in childhood or infancy. What causes idiopathic scoliosis is currently unknown. Researchers discovered a gene that is believed to be associated with adolescent idiopathic scoliosis only a few years ago. Adolescent idiopathic scoliosis is an abnormal C-shaped or S-shaped curvature of the spine. The curvature of the spine is measured by the Cobb angle. A Cobb angle greater than 15° is considered scoliosis.
Symptoms of adolescent idiopathic scoliosis include back pain, unequal leg lengths, uneven hips, uneven shoulders (one shoulder appears higher than the other), abnormal gait, as well as breathing difficulties when the rib cage puts pressure on the lungs. When left untreated, the deformity might progress significantly. For milder cases, your doctor may recommend nonsurgical treatment such as bracing. Braces are usually worn for several hours daily. This can be effective if the child is still growing and has a Cobb angle between 25° and 45°. In progressive cases, or when the Cobb angle is greater than 45°, your doctor may recommend surgery to straighten and fixate the spine, by placing implants such as screws, rods, hooks, and wires in and along the spine. Surgery treats but does not cure scoliosis. It corrects the abnormal curvature and prevents further progression of the disease.
The degree of curvature is measured on x-rays by what is known as the Cobb method, and this is accurate to within 3 to 5 degrees.
In cases of curves that are less than 10 degrees, there is very little chance of the condition getting any worse. In fact, this is not even considered to be scoliosis, but instead spinal asymmetry. Most of the time these cases will not require any treatment, but at regular physician checkups throughout childhood, the physician should determine whether or not the curvature has progressed at all.
Curves that are 20 to 30 degrees in a growing child should be checked every 4 to 6 months to see if they are worsening. Any curves over 30 degrees in a growing child will require treatment, usually in the form of a back brace. Using a brace is intended to stop the growth of a curve, but will not correct the degree of curvature that already exists. The use of the brace is discontinued when the child stops growing.
Patients with curves of greater than 50 degrees sometimes continue to progress after the child’s growth has stopped. Therefore the objective of any treatment is to get the child into adulthood with less than a 50-degree curvature.
There are two types of commonly used braces. One is worn almost all day and night but can be taken off for swimming or playing sports. This brace applies three-point pressure and prevents the progression of the curvature. The other applies more pressure and bends the child against the curve. It is worn only at night while the child is sleeping.
Unfortunately, some curves continue to progress even with appropriate bracing. This may lead to the child needing more aggressive, surgical treatment. In some cases the physician will continue bracing the spine for a period of time, to allow the child to grow more before moving to the surgery option, which fuses the spine.
For patients with a 40 to 45-degree curve that is still progressing, or a curve of 50 degrees or more, surgery will likely be recommended. The objective is to fuse the spine in a more corrected position so that the curve will not continue to progress into adulthood. In addition to preventing further curvature, scoliosis surgery can also reduce the amount of deformity. Rods, cables, screws and hooks are used to move the spine back into the proper position, and when the spine fuses with the bone grafts it no longer moves out of place. Although the rods can be removed once the spine has fused, there is usually no reason to do so. Typically a correction of about 50% can be obtained with this method.
Patients should be regularly monitored for the first year or two. Once the bone is solidly fused there is no need for further treatment. In general, patients undergoing this surgery can return to a normal lifestyle and activity level.