Scoliosis

Introduction

When the body is viewed from behind, a normal spine appears straight without much deviation from side-to-side. If the spine is observed to have a lateral or side-to-side curvature, the person might have a condition called scoliosis. This disorder often gives the appearance of the person leaning to one side though it
should not be confused with poor posture. Scoliosis is a complicated deformity that is characterized by both lateral curvature and rotation of the vertebra often causing a characteristic rib hump in the mid or thoracic spine. The
vertebrae in the area of the major curve rotating toward the concavity and pushing their attached ribs posterior cause this. If the thoracic curve and rib rotation is severe, greater than 70 degrees, pulmonary and cardiac function can
be impeded. This amount of curve and subsequent cardiac and pulmonary changes are often seen later in life in untreated, severe idiopathic infantile and juvenile scoliosis patients and present a threat to life.

Anatomy

If one is to observe the trunk from a side view, the spine will demonstrate four normal curves, the cervical, thoracic, lumbar and sacral. The thoracic or chest area has a normal round back called a kyphosis, while in the lower spine there is a swayback, or lordosis. Increased kyphosis in the thoracic area is correctly called hyperkyphosis while increased swayback is termed hyperlordosis. Changes from normal on a side view frequently accompany scoliosis changes. Some round back deformities are simply due to bad posture can often being corrected with postural exercises. A small percentage of patients with kyphosis have more rigid deformities than the postural type, which are associated with vertebral deformity.

A layman can even help to identify a child or person with scoliosis by simply observing the person in the standing position, preferably without a shirt and in their underpants, and observing the following:

One shoulder may be higher than the other.
One scapula (shoulder blade) may be higher or more prominent than the other.
With the arms hanging loosely at the side, there may be more space between the arm and the body on one side.
One hip may appear to be higher or more prominent than the other.
The head is not centered over the pelvis.
When the patient is examined from the rear and asked to bend forward until the spine is horizontal, one side of the back appears higher than the other.

Once identified, the child should be sent to a health-care professional such as a Doctor of Chiropractic for further evaluation.

There are many different causes and varieties of scoliosis but by far the most common is idiopathic scoliosis. This type of scoliosis has no known cause and accounts for about 85 percent of all cases. Idiopathic scoliosis is seen with equal frequency in boys and girls in the mild or low curve magnitudes. This disorder can be sub classified into infantile, juvenile and adolescent types, depending upon the age of onset. Idiopathic scoliosis frequently runs in families and may be due to genetic or hereditary influences. However, girls, for unknown reasons, are five to eight times more likely than boys to have their curves increase in size and require treatment. The most frequent time for the development of idiopathic scoliosis is during adolescence when children are completing the last major growth spurt. It is very important to have this age group examined on a regular basis.

If a scoliotic curve is found in the growing adolescent, it is very important that the curves be monitored for change by periodic examination and some times standing X-rays. In 90 percent of cases, the scoliosis are mild and do not require active treatment. Iincreases in spinal deformity require evaluation to determine if brace or other treatment is required. In a small number of patients, surgical treatment may be needed.

Brace Treatment

Brace treatment (orthosis) is recommended for both juvenile and adolescent children observed to be increasing with their scoliosis or kyphosis and newly identified cases of moderate scoliosis or abnormal kyphosis. There are many types of braces, all designed to prevent curves from increasing by acting as a buttress for the spine to prevent the curve from increasing during active skeletal growth. Braces will not usually make the spine perfectly straight, and cannot always keep a curve from increasing. However, bracing is effective in halting curve progression in a significant percentage of skeletally immature adolescents.

There is no simple solution for scoliosis. The majority of cases, though often monitored, are not actively treated. The standard medical treatment for moderate cases is a brace where the severe cases are sometimes corrected surgically.

Besides bracing many other methods have been used including specialized exercise, electric stimulation of spinal muscles, nutritional programs, and chiropractic treatments. It seems that the best results have been maintained with a multifactor approach to the management of this condition.

If you would like to speak with one of our doctors regarding this problem, please do not hesitate to call our office today. We have treated many children and adults with scoliosis and most with good clinical outcomes.


	Gibsonia Office 5499 William Flynn Highway (Route 8) Gibsonia, PA 15044 724-443-8444	Brackenridge Office 825 10th Ave Brackenridge, PA 15014 724-224-2224	Monroeville Office 1 Racquet Lane Monroeville, PA 15146 412-372-3772

Scoliosis Introduction When the body is viewed from behind, a normal spine appears straight without much deviation from side-to-side. If the spine is observed to have a lateral or side-to-side curvature, the person might have a condition called scoliosis. This disorder often gives the appearance of the person leaning to one side though it should not be confused with poor posture. Scoliosis is a complicated deformity that is characterized by both lateral curvature and rotation of the vertebra often causing a characteristic rib hump in the mid or thoracic spine. The vertebrae in the area of the major curve rotating toward the concavity and pushing their attached ribs posterior cause this. If the thoracic curve and rib rotation is severe, greater than 70 degrees, pulmonary and cardiac function can be impeded. This amount of curve and subsequent cardiac and pulmonary changes are often seen later in life in untreated, severe idiopathic infantile and juvenile scoliosis patients and present a threat to life. Anatomy If one is to observe the trunk from a side view, the spine will demonstrate four normal curves, the cervical, thoracic, lumbar and sacral. The thoracic or chest area has a normal round back called a kyphosis, while in the lower spine there is a swayback, or lordosis. Increased kyphosis in the thoracic area is correctly called hyperkyphosis while increased swayback is termed hyperlordosis. Changes from normal on a side view frequently accompany scoliosis changes. Some round back deformities are simply due to bad posture can often being corrected with postural exercises. A small percentage of patients with kyphosis have more rigid deformities than the postural type, which are associated with vertebral deformity. A layman can even help to identify a child or person with scoliosis by simply observing the person in the standing position, preferably without a shirt and in their underpants, and observing the following: One shoulder may be higher than the other. One scapula (shoulder blade) may be higher or more prominent than the other. With the arms hanging loosely at the side, there may be more space between the arm and the body on one side. One hip may appear to be higher or more prominent than the other. The head is not centered over the pelvis. When the patient is examined from the rear and asked to bend forward until the spine is horizontal, one side of the back appears higher than the other. Once identified, the child should be sent to a health-care professional such as a Doctor of Chiropractic for further evaluation. There are many different causes and varieties of scoliosis but by far the most common is idiopathic scoliosis. This type of scoliosis has no known cause and accounts for about 85 percent of all cases. Idiopathic scoliosis is seen with equal frequency in boys and girls in the mild or low curve magnitudes. This disorder can be sub classified into infantile, juvenile and adolescent types, depending upon the age of onset. Idiopathic scoliosis frequently runs in families and may be due to genetic or hereditary influences. However, girls, for unknown reasons, are five to eight times more likely than boys to have their curves increase in size and require treatment. The most frequent time for the development of idiopathic scoliosis is during adolescence when children are completing the last major growth spurt. It is very important to have this age group examined on a regular basis. If a scoliotic curve is found in the growing adolescent, it is very important that the curves be monitored for change by periodic examination and some times standing X-rays. In 90 percent of cases, the scoliosis are mild and do not require active treatment. Iincreases in spinal deformity require evaluation to determine if brace or other treatment is required. In a small number of patients, surgical treatment may be needed. Brace Treatment Brace treatment (orthosis) is recommended for both juvenile and adolescent children observed to be increasing with their scoliosis or kyphosis and newly identified cases of moderate scoliosis or abnormal kyphosis. There are many types of braces, all designed to prevent curves from increasing by acting as a buttress for the spine to prevent the curve from increasing during active skeletal growth. Braces will not usually make the spine perfectly straight, and cannot always keep a curve from increasing. However, bracing is effective in halting curve progression in a significant percentage of skeletally immature adolescents. There is no simple solution for scoliosis. The majority of cases, though often monitored, are not actively treated. The standard medical treatment for moderate cases is a brace where the severe cases are sometimes corrected surgically. Besides bracing many other methods have been used including specialized exercise, electric stimulation of spinal muscles, nutritional programs, and chiropractic treatments. It seems that the best results have been maintained with a multifactor approach to the management of this condition. If you would like to speak with one of our doctors regarding this problem, please do not hesitate to call our office today. We have treated many children and adults with scoliosis and most with good clinical outcomes.