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Scoliosis is a lateral deviation of the spine of more than 10 degrees. Minor curves are present in about 1 in 100 people, but more significant curves develop in 1 in a 1,000.
Even though scoliosis is measured as a side-to-side curve, there is always a three-dimensional or twisting component to the deformity as well. It is often that twisting, or rotation, that can be seen by bending a child forward and looking for a prominence of the ribs or lumbar musculature. This is commonly done in pediatric or school screenings.
As curves become more obvious, asymmetric shoulder height or scapular prominence can be seen.
Although pain can be associated with some forms of scoliosis, it is not typically a presenting sign of scoliosis.
The short answer is that we do not know. Some forms of scoliosis are related to specific neurologic problems, but the vast majority of cases are “idiopathic,” meaning we do not know the cause. Most theories about the cause of scoliosis have to do with asymmetric growth of the spine and a hereditary component. Scoliosis is not caused by backpacks, sports injuries, or bad posture.
Curve “progression” is what happens when a curve increases in size over time. The risk of curve progression is the main concern we have when seeing a patient with scoliosis for the first time. Growth is the main driver of curve progression. A minor curve can progress and become a significant issue in a young growing child, whereas even a moderate curve in a mature young person is less concerning. Larger curves, however, can progress even once a child is done growing.
Minor curves are generally watched and require no specific treatment. Moderate curves in growing children have the potential to progress or get worse. These curves are treated by brace wear. Recent studies have confirmed that brace wear can be effective in preventing worsening of a scoliosis.
Physical therapy (the Schroth Method) and some forms of chiropractic manipulations have been proposed to help control scoliosis as well. However, they lack scientific proof for effectiveness.
Surgery is indicated for a spinal deformity that disrupts a patient’s spinal balance causing functional and cosmetic issues or that is likely to do so in the future. These types of curves are generally in excess of 40 degrees. How significantly the curve affects the child varies from person to person and this is often a challenging decision.
Spinal deformity is most commonly treated by posterior spinal fusion with instrumentation. The deformed part of the spine is surgically loosened to allow improvement of the spinal alignment and then held in place with metal implants affixed to rods. This part of the spine becomes solidly fused to remain stable throughout the patient’s lifetime.
If your child or teenager has been diagnosed with scoliosis and you would like to schedule an appointment or consultation with a specialist, please contact the Division of Orthopaedic Surgery at Children’s Hospital of Pittsburgh of UPMC at 412-692-5530 Option #1.
Created: October 2015
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Pittsburgh, PA 15224
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