Scoliosis - Diagnosis & Treatment Options
Report #24 - Being Proactive in Preventing Scoliosis in Children
In a recent series of reports, we explored Scoliosis and why surgery should be your last treatment option. In this “Prequel,” we’ll summarize how this disease of the spine occurs, who it most often strikes, how it progresses, and the best treatment options.
To recap a previous report, Scoliosis is a medical condition that causes an abnormal curvature of the spine. It is usually diagnosed by measuring the degree of the scoliotic curve, also known as the Cobb angle. Diagnosis involves physical examination, imaging tests such as X-ray or MRI scans, and sometimes a nerve conduction study to determine if there are any neurological problems associated with the condition. Treatment options for scoliosis include bracing, physical therapy, and in some cases, surgery. Bracing helps to reduce pain and slow down the progression of the disease, while physical therapy can help improve posture and strength in order to reduce pain and improve mobility. Surgery may be necessary in more severe cases when other treatments have failed or if there is a risk of spinal cord damage due to severe curvature.
Symptoms
The most common symptoms of scoliosis include:
One shoulder blade appears more prominent than the other
Shoulders are unequal
An irregular-looking waist
One hip higher than the other
Ribs or muscles on one side of the body protrude farther than those on the other side when bending forward
Scoliosis also causes the spine to twist, rotate, and curve sideways. This makes one side of the back look more prominent when someone with scoliosis leans forward or simply stands upright. In my case, I developed a highly noticeable, extremely large “hump” of muscle on my right side as my body tried to compensate for my spine’s slowly growing curvature to the left.
Causes of Scoliosis
The cause of the most common form of scoliosis is unknown, which is referred to as “Adolescent Idiopathic (unknown) Scoliosis,” or “A.I.S.” for short, and it generally develops in childhood and adolescence, which accounts for 90% of all cases. It is believed to have a hereditary component as well, as scoliosis can run in families. The less common types of scoliosis can be attributed to certain neurological conditions, like cerebral palsy and muscular dystrophy, as well as birth defects, chest wall surgery, injuries or infections to the spine, and abnormalities in the spinal cord.
Potential Risks
Scoliosis usually has a mild impact but can bring about some complications, including:
Respiratory issues. Severe cases of scoliosis could lead to the rib cage putting pressure on the lungs, making it harder to breathe.
Backache. Adults who had scoliosis when they were younger are more likely to struggle with chronic backache if their unusual curvature was left untreated or is particularly pronounced.
Appearance. If scoliosis worsens, it can be visible in the individual’s posture and form.
Treatments
Mild Cases
Treatment for mild cases of AIS (less than 20° Cobb angle) usually consists of regular physical check-ups done in a clinical environment to monitor the deformity; the purpose of these check-ups is to be able to detect possible progression of the deformity early on to have it properly treated as well as the use of other methods such as Schroth's method and stretching exercises.
Moderate Cases
Treatment for moderate cases of AIS (between 20 and 40° Cobb angle) usually consists of bracing of the spine; rather than correcting the deformity, it simply prevents it from progressing any further (that is, progressing into a severe case of scoliosis).
Severe Cases
Treatment for severe cases of AIS (more than 40° Cobb angle) consists of corrective surgery, which usually involves bone grafts and the insertion of spinal instrumentation (hardware) into the spine. Surgical methods have high post-surgical complication rates, which is something you can read more about in my report for 03-07-23.
The Importance of Constantly Monitoring Children for Scoliosis
The best way to avoid spine and chronic pain problems in adults due to scoliosis is to constantly monitor the condition as your child grows. Parents should examine their children’s spine at least once or twice a year to determine if there is any curvature.
An easy way to make comparisons is to photograph the child’s back every six months, then print and save the images to a three-ring notebook, centering the image on the page and notating the date of the image. Then, using a ruler, draw a thin line on the printout down the center of the page both vertically and horizontally with a sharp pencil. Use a ruler, straightedge, or square, and make sure both the lines are at a 90-degree angle. Then draw another straight line that follows the spine, but use a broad pen or marker that makes it easy to see and stand out. Once you have at least a year’s images (2), you can easily begin to monitor any curvature in your child’s spine by calculating any degree of difference using a compass and protractor. If you notice that the line over the spine differs from the underlying cross on the page, measure the angle of difference. If there is a noticeable difference, then it’s time to take your child to your family doctor to get a professional opinion. Although this takes a little time and work, it’s better to know whether there is a potential problem before it becomes a much bigger problem for your child as they age.
As Ben Franklin used to say, “An ounce of prevention is worth a pound of cure.” How true. As great and loving as my parents were in raising me, I wish they had known and heeded this advice before I became a teenager when my spine’s curvature was plainly noticeable to the eye, which was too late to begin bracing at that point. If they had, you probably wouldn’t be reading this report now, and I wouldn’t be sitting in pain writing it.
Take care, be proactive, and let me know if you have any questions, comments, or a personal story regarding scoliosis to share that might help others.
All the Best!
Franklin