Scoliosis causes the spine to curve in the wrong direction. It causes sideways curves, and those are different from the spine’s normal curves.
If you were to look at your spine from the side, you’d see that it curves out at your neck (cervical spine), in at your mid-back (thoracic spine), and out again at your low back (lumbar spine). Your back is supposed to have those curves.
However, if you look at your spine from behind, you shouldn’t see any curves at all. When there are sideways curves in the spine from this view, that’s scoliosis. The curves can look like an ‘S’ or a ‘C.’
Because there are different types of scoliosis, there are different causes. The types of scoliosis are:
• Idiopathic Scoliosis: This is the most common type. 80% of scoliosis cases are idiopathic, which means “occurring without a known cause.”
• Congenital Scoliosis: With congenital scoliosis, there is a malformation of the spine in utero, so a child is born with this type of scoliosis.
• Neuromuscular Scoliosis: Children with a neurological system disorder, like muscular dystrophy, can develop neuromuscular scoliosis. Because they have a weak trunk and can’t support the weight of their body, the spine starts to curve, generally into a long, c-shaped curve.
• Adult or Degenerative Scoliosis: Sometimes, scoliosis goes unnoticed-or untreated-during childhood. In that case, scoliosis can cause problems later in adult life. Degenerative, or age-related, changes to the spine can also cause scoliosis in adults. Osteoporosis, disc degeneration, a spinal compression fracture, or a combination of these problems can contribute to the development of adult scoliosis.
Although scoliosis is most commonly associated with children, adults can develop it, too. In some cases, they have actually had it their whole lives, but it has gone unnoticed or untreated until it started to cause pain or other problems. In other cases, age-related changes in the spine, such as disc degeneration, lead to scoliosis.
For children with scoliosis, there are two main non-surgical options: observation of the curve and bracing.
The doctor will develop a treatment plan that considers the patient’s age, a number of growing years that remain, curve pattern, curve size, likely rate of curve progression, and appearance. He or she will then recommend observation or bracing.
Most young patients with idiopathic scoliosis will see their doctor every 3 to 4 months so that the doctor can monitor if the curve is getting worse.
Bracing is the usual treatment for adolescents with curves greater than 20° and at least two years of growth remaining. Bracing is used to slow or stop the curve from getting larger and to improve spinal deformity.
For adults with scoliosis, the non-surgical treatment options are slightly different. Because bracing won’t help stop the curve in adults and because it usually doesn’t control pain, adults generally do not have to wear braces. Instead, they can try moist heat, medication for inflammation and pain, and exercise.
Doctors recommend surgery for children if they have progressive scoliotic curves greater than 50°. The goal of spine surgery for scoliosis is to stop the curve from getting worse, restore the spine to more normal alignment and appearance, and also to address any back pain or heart or lung function problems caused by scoliosis.
For scoliosis, spinal fusion using spinal instrumentation is the most common surgical procedure. Using a combination of rods, hooks, cables, screws, and cages, the surgeon very carefully moves the spine back into more normal alignment. Then the surgeon puts in the bone graft (usually using bone from the patient’s body) or a biological substance (which will stimulate bone growth) to help the bones in the spine fuse together over time.
Adults with scoliosis may also have surgery, but it will be for different reasons. Unlike scoliosis surgery for children, correcting the curve isn’t the most important goal of surgery. Instead, trying to stop the curve from getting worse later is the main goal.
HOD & Consultant – Spine Surgery, Manipal Spine Care Center
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