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    Scoliosis, Is It In You?

    8 important facts you should know about scoliosis.

    Personal Message

    I chose this topic because I am one of three sisters all diagnosed with idiopathic scoliosis. By the time of diagnosis; the oldest sister had a curvature of 41 degrees requiring extensive surgery with 2 rods and 12 screws inserted into her spine. Although she now stands straighter and has less pain, an earlier diagnosis could have prevented this surgery. The other sister had to wear a brace to prevent the progression of the scoliosis, while the curve of my own spine was minuscule enough to require observation only.

    Our primary doctor seemed to have missed the signs of this condition throughout our regular checkups. This is why I feel it is important that the general public is better educated about scoliosis.

    Most of the below images and x-rays are of my sisters' cases.

    1. What it is:

    Generally speaking, scoliosis is a progressive lateral curvature of the spine, forming a "S" shape. There are many different types of scoliosis, the most common being neuromuscular and idiopathic. Neuromuscular scoliosis is caused by abnormal muscles or nerves and is common in individuals with Spina bifida or Cerebral Palsy.

    The most prevalent type of scoliosis, making up 80-85% of cases is idiopathic. Idiopathic scoliosis arises in individuals after 10 years of age, particularly during their growth spurt.

    2. Symptoms and Signs:

    Although most individuals with scoliosis are initially asymptomatic, there are physical signs that can arise. These include: uneven shoulders, a prominent shoulder blade, an uneven waist with one hip higher or slight leaning to one side.

    If a scoliosis curve worsens, a "rib hump" may arise in which the spine rotates in addition to curving. This causes the ribs to stick out farther on one side of the torso. As one can conclude, the more severe the curve, the higher the pain.

    In an especially severe case of scoliosis difficulty breathing can arise. This is due to the reduced amount of space within the individual's chest for proper lung function.

    3. Who's at Risk:

    Fact: "Approximately 2 to 3% of Americans at age 16 have scoliosis." However, less than 0.1% has curves severe enough to require surgery.

    Risk factors for an affected individual:

    -Age is a major risk factor due to idiopathic scoliosis arising just prior to a major growth spurt, affecting adolescences from 9 to 16 years of age.

    -It has been proven that females are more likely to be affected by the condition than males. They also have a much higher risk of the curve worsening over time.

    -Scoliosis has been known to run in some families. Children, especially daughters of affected women, are at an increased risk for the condition.

    4. Theory of its Inheritance:

    jbjs.org

    While scoliosis can be caused by certain conditions such as cerebral palsy and muscular dystrophy, the cause of most cases like that of idiopathic scoliosis is still under investigation.

    N. H. Miller conducted a study on the genetic analysis of structural elastic fiber and collagen genes in familial adolescent idiopathic scoliosis. The goal of his study was to use a “candidate gene" approach in order to potentially link a gene or genetic locus to the condition. This approach was used in hopes of being able to predict genotypes of future individuals. Genes encoding for elastin, FBN1, and one polypeptide of type-I collagen were selected as candidate genes.

    -Results showed a proportion of the families being linked to one disease gene and other families being linked to one or more alternative genes. Additional families may not be linked to any gene at all and may have non-genetic scoliosis. This suggests that multiple factors may be acting dependently or independently in scoliosis’ pathogenesis.

    -Continued work with an expanded population and consisting of other major structural genes of the ECM is essential in furthering knowledge of scoliosis’ genetic inheritance.

    5. Medical Testing:

    A forward bend test is performed to check for visible signs of scoliosis. This is when an individual bends forward from the waist, leaving their arms hanging loosely. This is done to see if one side of the rib cage is more prominent than the other that would be caused by the spine’s curve.

    X-rays may be taken if there are distinct visible signs of scoliosis in an individual. An x-ray of the spine will show the magnitude of its curve. The measurement is taken in degrees measuring the lateral curvature of the spine.

    An x-ray of the affected individual’s growth plate is a useful tool in determining the risk of the curve worsening. If growth plates have not yet fused, an individual still has growing to do, thus enhancing the risk of their curve worsening. This procedure is important when determining a treatment method.

    6. Treating and preventing its progression:

    There are currently three recommended treatments and preventions for scoliosis dependent on factors of the affected individual (age, type, maturity, and curve degree).

    For curves measuring less than 25 degrees, regular checkups are recommended especially if the individual is still growing. A suggested time schedule is a checkup with a medical professional every 4 to six months. These checkups include a physical exam along with a possible low-radiation x-ray to reaffirm the degree of curvature.

    For curves measuring between 25-40 degrees a bracing treatment is highly recommended in patients whose bones are still developing. This type of treatment only prevents the curve from worsening, overall preventing the need for surgery. However, it does not correct the curve. Most braces are required to be worn both during day and night. The brace can then be eliminated after the bones are confirmed to be done growing, or fusion of the growth plates has occurred.

    There are two types of braces:

    -An “underarm or low-profile” brace is contoured to form to an individual’s body. These braces are not useful for curves that are in the upper spine or neck.

    -On the other hand, the “Milwaukee” brace is a full torso brace that contains a neck ring. These braces are usually only worn in situations where an underarm brace would not be sufficient help prevent the curve from worsening.

    Overall, bracing appears to prevent about 20-40% of curves from progressing more than 6 degrees.

    Cases with curves measuring close to or greater than 40 degrees are considered for surgical intervention. Scoliosis surgery has two goals: to prevent curve progression and to obtain some curve correction. “Scoliosis surgery is one of the most demanding surgical procedures in spine surgery.” Because of this, it is only considered in cases where there is continuous pain, difficulty breathing, significant disfigurement, or continued progression.

    -The most common type of scoliosis surgery is called spinal fusion. This consists of joining the vertebrae together permanently. Pieces of bone or bone-like material are placed between the vertebrae. Metal rods, hooks, screws or wires hold the effected part of the spine straight while old and new bone materials fuse together.

    To aid in the decision making as regards to treatment options, a study by Weinstein and Ponseti on “Curve Progression After Skeletal Maturity” was performed.

    -The patients were evaluated as a group and by curve pattern (thoracic, lumbar, thoracolumbar, and combined).

    -After following the patients for 40.5 years, results showed that “in general, curves that were less than 30 degrees at skeletal maturity tended not to progress regardless of their curve pattern.”

    -On the other hand, curves measuring between 50 and 75 degrees at skeletal maturity were shown to progress, particularly thoracic curves.

    For cases that progress rapidly at a young age, a new treatment method has recently been developed. Two adjusting rods with an external remote control can be surgically placed along the young patient’s spine. The rods can then be lengthened along with the child’s development every six months and prevent further curve progression.

    7. Common scoliosis myths:

    Scoliosis is caused by activities such as carrying heavy loads, poor posture, or minor lower limb length inequality.

    Corrective exercises, physical therapy, yoga, chiropractic manipulation, electrical stimulation of muscles are alternative treatments to prevent curve progression.

    Scoliosis increases mortality rate

    8. The Do’s and Don’ts of scoliosis:

    Do:

    -Ask for frequent scoliosis screenings at your doctor's office. Especially when your child is at or near the age of puberty.

    -Get a second opinion to consider your options

    Don't:

    -Ignore any sign of scoliosis

    -Wait and see if the curve will progress before seeking medical advice.

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