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Scoliosis



What Is Scoliosis?

Scoliosis is a musculoskeletal disorder in which there is a sideways curvature of the spine, or backbone. The bones that make up the spine are called vertebrae. Some people who have scoliosis require treatment. Other people, who have milder curves, may need to visit their doctor for periodic observation only.

Who Gets Scoliosis?

People of all ages can have scoliosis, but this publication focuses on children and adolescents. Adolescent idiopathic scoliosis (scoliosis of unknown cause) is the most common type and typically occurs after the age of 10. Girls are more likely than boys to have this type of scoliosis. Because scoliosis can run in families, a child who has a parent, brother, or sister with idiopathic scoliosis should be checked regularly for scoliosis by the family doctor.

What Causes Scoliosis?

In most cases, the cause of scoliosis is unknown; this is called idiopathic scoliosis. Before concluding that a person has idiopathic scoliosis, the doctor looks for other possible causes, such as injury or infection. Causes of curves are classified as either nonstructural or structural.

How Is Scoliosis Diagnosed?

Doctors take the following steps to evaluate patients for scoliosis:

Doctors group curves of the spine by their location, shape, pattern, and cause. They use this information to decide how best to treat the scoliosis.

Does Scoliosis Have to Be Treated? What Are the Treatments?

Many children who are sent to the doctor by a school scoliosis screening program have very mild spinal curves that do not need treatment. When treatment is needed, the doctor may send the child to an orthopaedic spine specialist.

The doctor will suggest the best treatment for each patient based on the patient's age, how much more he or she is likely to grow, the degree and pattern of the curve, and the type of scoliosis. The doctor may recommend observation, bracing, or surgery.

Are There Other Ways to Treat Scoliosis?

Some people have tried other ways to treat scoliosis, including manipulation by a chiropractor, electrical stimulation, dietary supplements, and exercise. However, studies of these treatments have not been shown to prevent curve progression, or worsening. Patients may wish to exercise for the effects on their general health and well-being.

What About Bracing?

The decision about which brace to wear depends on the type of curve and whether the patient will follow the doctor's directions about how many hours a day to wear the brace.

Braces must be selected for the specific curve problem and fitted to each patient. To have their intended effect (to keep a curve from getting worse), braces must be worn every day for the full number of hours prescribed by the doctor until the child stops growing.

If the Doctor Recommends Surgery, Which Procedure Is Best?

Many surgical techniques can be used to correct the curves of scoliosis. The main surgical procedure is correction, stabilization, and fusion of the curve. Fusion is the joining of two or more vertebrae. There are different ways to straighten the spine and different implants to keep the spine stable after surgery. (Implants are devices that remain in the patient after surgery to keep the spine aligned.) The decision about the type of implant will depend on the cost, the size of the implant, which depends on the size of the patient; the shape of the implant; its safety; and the experience of the surgeon. Each patient should discuss his or her options with at least two experienced surgeons.

Patients and parents who are thinking about surgery may want to ask the following questions:

Can People With Scoliosis Exercise?

Although exercise programs have not been shown to affect the natural history of scoliosis, exercise is encouraged in patients with scoliosis to minimize any potential decrease in functional ability over time. It is very important for all people, including those with scoliosis, to exercise and remain physically fit. Girls have a higher risk than boys of developing osteoporosis (a disorder that results in weak bones that can break easily) later in life. The risk of osteoporosis can be reduced in women who exercise regularly all their lives. Also, weight-bearing exercise, such as walking, running, soccer, and gymnastics, can increase bone density and help to prevent osteoporosis. For both boys and girls, exercising and participating in sports can also improve their general sense of well-being.

What Research Is Being Conducted on Scoliosis?

Researchers supported by the National Institutes of Health (NIH) are exploring genetic and neurological factors that may cause idiopathic scoliosis in an effort to identify targets for prevention and new treatments.

In one study, a randomized clinical trial, scientists are developing strategies to improve clinical decision making with respect to the nonoperative management (bracing versus watchful waiting) of idiopathic scoliosis in adolescents.

Researchers continue to examine how a variety of braces, surgical procedures, and surgical instruments can be used to straighten the spine or to prevent further curvature. They are also studying the long-term effects of both scoliosis fusion and the long-term effects of untreated scoliosis.

-NIH



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