The word “idiopathic” defines the cause of a disease or condition as unknown. Adolescent idiopathic scoliosis affects children between 10 and 18 years old and is more common in girls than boys. In fact, girls are treated 10 times more often. There are many theories as to why this type of scoliosis develops, however, the root cause of the condition has yet to be discovered. Some of the theories include:
Once scoliosis is diagnosed, concern may arise whether the curves will continue to grow larger. There is no absolute way to tell, however, this much is known:
In many cases of adolescent scoliosis, the child will not even notice the problem. Because the majority of scoliosis patients do not suffer any physical pain from this disorder, it is often not discovered until the curves have progressed to become more obvious. In fact, if the child is suffering from severe back pain, a diagnosis other than idiopathic scoliosis must be considered.
Though the spine may curve sideways, in minor cases the curves are not obvious until the person bends over. Many schools currently screen young students for scoliosis. As a result, referrals often come from school health workers. Frequently, parents or physical education instructors notice the first signs of scoliosis in a child. Signs of scoliosis may include the following abnormalities in appearance:
The treatment chosen for an adolescent with idiopathic scoliosis will vary depending upon the severity of the curve, the age of the patient and how far along the child is in skeletal maturity.
If the patient’s curve is minor (less than 15-20 degrees), the doctor will likely choose to monitor the curve for progression. The patient will normally have X-rays taken every four to six months during rapid growth years and then once a year.
Physical Therapy and Exercise
Adolescents with scoliosis may work with a physical therapist. A well-rounded rehabilitation program assists in calming pain and inflammation, improving mobility and strength and helping with daily activities. Adolescents with idiopathic scoliosis should be encouraged to continue their normal activities, including sports.
Exercise has not proven helpful for changing the curves of scoliosis. However, it can be helpful in maintaining flexibility, especially in the hamstrings and low back. Therapy sessions may be scheduled each week for four to six weeks.
The goals of physical therapy are to help:
Bracing is usually considered with curves between 25 and 40 degrees. The curve is likely to get bigger if the patient is still growing. It is important that the patient wear the brace daily for the number of hours prescribed by the doctor. Scoliosis often affects more than one area of the spine. A brace can be used to support all the curved areas that need to be protected from progression.
Sometimes an adolescent might feel self-conscious about wearing a brace. Though the brace can help the curve from getting worse, it may take some time for the patient (and caregiver) to get used to it. Adults tend to be less concerned about what their peers think, but adolescence is a time when appearance is often of great importance. Listen to the child’s concerns and look for ways to help overcome feelings about appearance.
Surgery is generally only considered in patients who have continual pain, difficulty breathing, significant disfigurement, or a steadily worsening curve angle. After skeletal maturity occurs, curves that are less than 30 degrees tend not to progress and, therefore, do not require surgery. Curves above 100 degrees are rare, however, they can be life threatening if the spine twists the body enough to put pressure on the heart and lungs.
If a curve is 45 degrees or more, surgery is more likely to be considered. The main surgery for scoliosis is spinal fusion with instrumentation. Most surgical procedures will use rods in order to help straighten the spine.
An orthopedic spinal surgeon may use a posterior approach, which involves going into the spine through the back, or an anterior approach, which is performed from the front or side. The operation can be performed from both the front and the back (a combined approach). The choice depends upon the flexibility of the spine, the location and degree of the curve and whether there is pressure on any of the nerve roots. The age of the patient is a factor in deciding which type of surgery is used. Patients whose spines are immature are more likely to require combined anterior and posterior fusion (see below).
An incision is made in the chest or flank and the intervertebral discs are removed in the area of the curve to make it flexible. Screws can be placed in the vertebrae and then connected by a metal rod. A bone graft is put in place of the discs that were removed so that the vertebra sitting next to each other will fuse together. The screws attaching the metal rod are tightened down, straightening the curve.
This approach is done through the back. Anchors are attached to the spine in the form of hooks, screws, or wires. These anchors are attached to spinal rods that straighten the spine. Bone grafting is done to fuse all instrumented vertebrae.
Combined Anterior/Posterior Approach
This surgery is actually two operations-one through the front and the other through the back. The two operations may be staged on separate days or as part of one longer surgery. Staged procedures require one to two additional days in the hospital compared to a single surgical procedure.
Even though it is recommended to them, a patient may choose not to have surgery because of the risks. There are also risks of leaving large curves untreated: