Scoliosis is a medical disorder which caused the spine to grow curved to the side. There are various types of scoliosis but the most commonly seen is the ‘idiopathic’ scoliosis which is so called because its cause cannot be identified or determined.
This scoliosis is the most common form of scoliosis seen in younger children and adolescents between 10-18 years of age. The curve in the spine caused by scoliosis is rarely painful and is often unnoticed till a regular health check-up with a pediatrician. In most idiopathic cases the degree of curve is insignificant and goes unnoticed and is asymptomatic as well, however, children with a larger degree of curve in the spine might require wearing a back-brace device for some time or can also have surgery to treat the abnormal curve in the spine.
Although idiopathic scoliosis’ cause is unknown it is believed to be strongly linked to hereditary factors such as certain genes.
Types of Idiopathic Scoliosis
Scoliosis mainly causes the vertebral bones in the spine to rotate, or twist, in such a manner that the spine is not normally aligned but is bent into a ‘C’ or an ‘S’ shape. This abnormal curve is noticed most often in the upper and middle back, or the thoracic, spine region. They rarely develop in the lower back as well as in both.
The degree of curve in idiopathic scoliosis caused in the spine varies in size with mild curves more commonly seen than more extreme curves in children. Scoliosis is known to worsen with time if the child going through a growth-spurt.
Other less common types of scoliosis are:
- Congenital scoliosis – In this, the deformity in the spine is developed in the fetal stage itself which can cause the spinal bone to be deformed or fused at birth.
- Neuromuscular scoliosis – Certain medical disorders of the muscles and nerves (cerebral palsy or muscular dystrophy) can also lead to scoliosis. These types of disorders cause the muscles in the spine to get imbalanced and weak.
Signs and Symptoms of Idiopathic Scoliosis
The Smaller degree of curves in the spine due to mild scoliosis may often go unnoticed, but as the child grows and reaches puberty the curve becomes larger and more noticeable as well as showing other visible signs such as:
- Uneven shoulders
- Uneven waistline
- Tilted, protruding shoulder on one side
- One hip higher than the other
It is highly advisable to consult a pediatric orthopedic surgeon or a spinal deformity surgeon for a complete evaluation and viable treatment plan.
Idiopathic Scoliosis Diagnosis
The pediatric orthopedic surgeon or the orthopedic specialist will initially conduct a thorough physical examination as well as check your medical history for any other related prevailing medical condition that might also be causing the bend in the spine.
- Physical Examination – This usually involves performing the ‘Adam’s Forward Bend Test’ in which the doctor will ask the child to bend forward with the feet placed together and the arms hanging free on the side. In the case of scoliosis, the doctor will be able to observe a difference in the ribs on either side and a spinal deformity is most visible in this position.
The doctor will also make the child stand straight and check the hips and shoulders for unevenness as well as to see whether the head is positioned in the center and is aligned with the spine. The range of movements of the spine can also be checked in this position. The doctor also checks for other causes that might be causing the spinal curve such as, limb-length discrepancy (LLD), abnormal neurological conditions as well as other physical deformity disorders.
- X-ray Tests – An x-ray test is most useful in viewing the child’s spine in the best way. This allows the doctor to observe the exact location and degree of the curve in the spine.
Idiopathic Scoliosis Treatment
There are various methods of treatment for idiopathic scoliosis. The type of treatment method best-suited for your child’s case will be decided by the doctor after taking into consideration certain factors, such as:
- Location of curve
- Severity of curve
- Child’s age
- Number of years left for complete physical growth and development
After considering these factors the doctor will be able to determine how much worse is the child’s spinal curve likely to get with time and suggest the best treatment method for them.
These are the common idiopathic scoliosis treatment methods:
- Observation – In case the degree of curvature of the child’s spine is less than 25 and there is less time left in complete physical development in the child the doctor might recommend observing the curve to ensure it does not worsen. A regular checkup around every 6-12 months is usually advised with x-ray tests till the child reaches adulthood.
- Bracing – If the degree of curve in the spine of the child is from 25-45 and the child is still in the development stage the doctor may advise using a bracing device. Although a brace is not useful in straightening the spinal curve it will stop it from getting worse and requiring surgery.
Surgical treatment for correcting idiopathic scoliosis in a child is advised in case the degree of curvature in the spine is from 45-50 and bracing has been unsuccessful in halting the curve earlier. Severely curved spines are known to affect lung functions if left untreated for long.
A surgical procedure known as a ‘spinal fusion’ surgery is useful in treating the curve by straightening the curve physically and then fusing the vertebras together in order to allow them to heal into a single and solid bone. This stops the growth of the spinal region that has been fused.
The procedure requires realigning the spinal vertebras and using small pieces of bones (bone grafts), sourced from your hips or another donor source, are used to be placed between the spaces in the vertebras to allow fusion (joining) of the vertebras together.
At times, medical-grade metal rods, screws, plates or pins are used to stabilize the fused vertebras until the natural fusion is complete. The severity of the spinal curve mainly decides the number of vertebras that require being fused together. The other (unaffected) vertebras are left alone to allow for free movement of the back (spine).
Risks and Complications of Idiopathic Scoliosis Treatment
As is seen in any major surgical procedure the surgical treatment for idiopathic scoliosis also entails certain risks and complications that are mostly related to the surgical process, such as:
- Anesthetic reaction
- Blood clot
- Nerve damage
The doctor will observe every possible precautionary measure to prevent any of these complications from arising.