Scoliosis

Scoliosis, an exaggerated sideways curvature of the spine, comes from the Greek term for curved or askew. Very few people have perfectly straight spines, but to qualify as scoliosis, the curvature must be more than 10 degrees. The abnormality often affects the symmetry of the shoulders, hips, or rib cage. but in some cases, double curves may balance each other without affecting the shoulders or hips.

This structural defect most often becomes apparent during an adolescent growth spurt, and girls are affected more often than boys. Possible early signs include a shoulder blade or hip that is more prominent than the other, uneven hip and shoulder levels, and clothes that hang unevenly.

In 80 to 90 percent of all cases, the cause is unknown, although the condition appears to run in families. Complications of severe scoliosis depend upon the site of the curvature. For example, if the upper spine is involved, heart and lungs may be compressed.

Diagnostic Studies and Procedures

A home test can help detect scoliosis, but a medical evaluation, preferably by an orthopedist, is needed to assess the severity. It begins with a careful physical examination that includes studying the symmetry of shoulders, arms, and hips, and measuring the length of each leg. X-rays are taken, and the degree of spinal rotation, is determined. A curvature of 20 degrees or less is considered mild, more than 25 degrees, moderate to severe.

Medical Treatments

Only 2 to 3 percent of scoliosis cases require treatment, but all should be checked periodically to monitor any progression, which occurs mostly during periods of growth. Instead of taking X-rays each time, a doctor may use an OSI Scoliometer to measure any significant changes in the curve.

When treatment is necessary, it usually entails wearing a rigid brace that exerts pressure on the apex of the curve to achieve a more normal alignment. Typically, a brace is worn 18 hours a day, but at the end of treatment, it may be needed only at night.

In about one case in a thousand, surgical correction will be needed. The operation may involve insertion of metal rods to hold the vertebrae in proper alignment. Usually, some of the vertebrae are fused in order to prevent further progression of the curvature.

Although the chances of arresting or even reversing scoliosis are greatest with early treatment, braces or surgery also may be recommended for an adult, especially someone who suffers from chronic back pain or spinal arthritis, or is experiencing breathing or heart problems related to scoliosis.

Alternative Therapies

Alexander Technique. Practitioners believe they can help mild scoliosis by analyzing body movements and then increasing the person's awareness of how to achieve better posture.

Chiropractic. Manipulation is advocated by some chiropractors as the way to prevent mild curvature from becoming more pronounced. Orthopedists discount its benefits.

Electro-stimulation. This approach, which uses low-voltage electrical stimulation, was once hailed as a promising new treatment. However, studies indicate that it is of little or no value.

Physical Therapy. A therapist can design an exercise program suitable for the person's age and extent of curvature to help maintain good muscle tone and strength while the torso is immobilized in a brace. Patients who do not require a brace are encouraged to pursue activities such as swimming or horseback riding that strengthen muscles and encourage good posture.

Self-Treatment

Scoliosis can be difficult for adolescents because it comes at a time when they want to be like their peers. Fortunately, there are braces that can be worn under clothing, and those patients who must have surgery usually do not require the bulky body casts used in the past. Still, joining a scoliosis support group may be helpful in dealing with emotional problems related to the condition.

Other Causes of Spinal Curvatures

Congenital anomalies, cerebral palsy, muscular dystrophy, spinal fracture, or advanced osteoporosis are among the disorders that can cause spinal curvatures. Degenerative scoliosis may be caused by osteoarthritis.