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.
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