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Comprehensive Guide to Scoliosis: Types, Causes, Diagnosis, and Treatment

Introduction to Types and Causes of Scoliosis

Types of Scoliosis

There are different types and causes of scoliosis: idiopathic, congenital, syndromal, neuromuscular and degenerative. All ages can be affected by scoliosis, for example, idiopathic scoliosis can be early onset, age six years or less, or late onset after the age of six years, whereas degenerative scoliosis can occur in those usually over the age of 60 years.

Adolescent idiopathic scoliosis

The spinal column has a three-dimensional shape. From the front, it looks straight; from the side, there are normal curves. Scoliosis is an abnormal curving and twisting of the spine.

Who gets adolescent idiopathic scoliosis and what causes this?

Adolescent idiopathic scoliosis can occur in any young person. It is more common in girls than boys. It will often be first noticed during the rapid growth around the time of puberty. If the cause of the scoliosis is not known, it is called ‘idiopathic’. At present, there is some evidence that there is a genetic component to it and there is a family history in some cases. Identical twins have identical curves usually.

Diagnosing Scoliosis: Symptoms, Signs and Tests

Symptoms and Signs of Scoliosis

Scoliosis is usually noticed by a change of appearance of the back. There may be a visible curve in the spine. The ribs may be more prominent on one side producing a rib hump. One shoulder may be higher than the other, or the shoulder blade more prominent. Sometimes one hip may be more prominent.

Back pain is not usually a big part of childhood scoliosis.

Examination will often include the ‘forward bend test’ which helps the doctor to determine if the scoliosis is significant.

A careful examination of the nerves, muscles and skin will often exclude other causes of scoliosis.

Diagnostic Tests for Scoliosis

It is usual for x-rays to be taken when seeing a specialist. This is to make sure the correct x-rays are taken reducing the exposure to radiation that can occur with x-rays. MRI scans are not always required. A specialist opinion from a doctor treating scoliosis is recommended and usually a patient will be assessed and followed up until they have stopped growing. Growth is usually complete at about two years after puberty.

Treatment Options for Scoliosis: Bracing, Surgery and Prognosis

Non-Surgical Treatment for Scoliosis

Treatment may be simply to assess, review, and reassure if the curve is mild and non-progressive. A spinal curve after the age of eight does not affect internal organs or restrict heart and lung function. Participation in fitness activities and sports should not be restricted at all. A curve in the spine is not a ‘weakness’ and should not be viewed as a disability.

In young people that are still growing, the use of a spinal brace may reduce the possibility of the curve getting worse. After spinal growth is complete, the clinical effectiveness of a brace is low.

Surgical Treatment for Scoliosis

Spinal surgery is a very effective treatment for larger curves; the main advantage is an improvement in body shape and the knowledge that the curve will be stabilised after surgery. The surgery involved in scoliosis correction will vary according to the curve magnitude and the surgical specifics of the spinal curve. Most operations for scoliosis involve correcting the curve (within the limits of safety) and fusing the segment into one rigid bone. This is not a problem when the scoliosis just involves the chest area but can sometimes be a problem when the operation also involves the lower back (lumbar area). The risks of surgery should be carefully explained and balanced against the benefits of surgery. This process of consent is one of shared decision-making between the doctor and the patient and family.

Prognosis and Recovery from Scoliosis Treatment

Most patients who undergo scoliosis treatment, whether non-surgical or surgical, experience an improvement in their symptoms and quality of life. Recovery time and the long-term prognosis depend on the individual, the severity of the scoliosis, and the chosen treatment method. Regular follow-up appointments with the specialist are crucial for monitoring progress and ensuring the best possible outcome.

EUROSPINE is a society of spine specialists of various disciplines with a large knowledge of spine pathologies. All well-known and accepted treatment modalities for spine pathologies are represented by the members of the society. However, the Society cannot accept any responsibility for the use of the information provided; the user and their health care professionals must retain responsibility for their health care management.

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