Scoliosis

Overview

Scoliosis is a condition in which the spine shows an abnormal sideways "S" or "C" curvature. It is seen in 2-3% of adolescents; it is 4 times more common in females. Most cases are mild and do not require treatment; however, progressive cases require intervention.

It is most commonly noticed during rapid growth between ages 10-14.

Types

1. Idiopathic scoliosis (most common):

• Cause unknown
• Starts in adolescence

2. Congenital scoliosis:

• Birth defect of the spine

3. Neuromuscular scoliosis:

• Cerebral palsy, muscular dystrophy

4. Degenerative scoliosis:

• Spine wear in the elderly

5. Syndromic scoliosis:

• Associated with genetic syndromes (Marfan, Down)

Symptoms

There are usually no symptoms in early stages. In prominent cases:

• Shoulders at different heights
• Asymmetry of the waistline
• One hip higher than the other
• A hump in the back when bending forward ("rib hump")
• Back pain (in adults)
• Difficulty breathing (in advanced cases)
• Fatigue
• Visible asymmetry (especially noticed in swimming, swimsuit photos)

Causes

• Genetics (family history)
• Congenital spinal developmental disorders
• Neuromuscular diseases
• Trauma
• After spine surgery at a young age
• Tumor (rare)

Risk Factors

• Family history
• Age (10-14, pre-adolescent growth period)
• Being female (4 times)
• Some genetic syndromes

Complications

• Back and low back pain (in adulthood)
• Respiratory problems (in severe curves, >70°)
• Cardiac complications (in very severe)
• Cosmetic, psychological effects
• Lung infections (in advanced cases)
• Progressive curvature in adulthood

When to See a Doctor

• If your child has back or shoulder asymmetry
• Suspected scoliosis at school screenings
• Back or low back pain (in adults)
• If you notice curvature (especially at ages 10-14)
• If family history exists
• Shortness of breath, chest problems

Screening recommendation: 10-year-old girls and 13-year-old boys should definitely be evaluated at school examinations.

Diagnosis and Treatment

Diagnosis:

• Physical examination
• Adam's forward bend test
• Spinal X-ray: Cobb angle measurement
  • <10°: Normal variant
  • 10-25°: Mild (observation)
  • 25-45°: Moderate (brace)

  • 45-50°: Severe (surgery)

• MRI (nerve involvement, unclear cases)
• CT
• Pulmonary function test

Treatment (according to curve angle and age):

1. Observation (mild cases):

• Curves below 25°
• Check-up every 4-6 months
• Until growth is complete

2. Bracing:

• Curves of 25-45°
• Children still growing
• Worn 16-23 hours a day
• To stop the progression of the curve
• Boston, Milwaukee, TLSO models

3. Physical therapy and exercise:

• Schroth method
• Muscle strengthening
• Stretching
• Applied alongside bracing

4. Surgery:

Indications:

• Curve >45-50°
• Progressive curve
• Pain or respiratory problem
• Aesthetic concern (advanced cases)

Method:

• Spinal fusion: Correction and fusion of the spine with screws and rods
• Vertebral body tethering (VBT) — new technique (growth is preserved)
• Some methods are still debated

Prevention and Lifestyle

Idiopathic scoliosis cannot be prevented; however:

• Regular spine examinations (especially ages 10-14)
• Pay attention to school screenings for early diagnosis
• Regular follow-up if family history exists
• Refer your child to a pediatric orthopedist
• Exercises that strengthen back muscles
• Maintain proper posture
• Carry backpack on both shoulders
• Healthy weight, regular exercise

In bracing treatment:

• Provide moral support to your child
• Monitor regular use
• Skin care
• Psychological support (if needed)

In adults:

• Regular exercise (swimming very beneficial)
• Strengthen core muscles
• Ergonomic work environment
• Proper lifting techniques
• Pain management