Scoliosis

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[edit] Scoliosis

This condition is often congenital (called "idiopathic scoliosis"), but comes out only during the growth spurts between age 10 and 16. In this age group about 2% to 3% develop scoliosis and about 70% of them are girls (Ref.3). Scoliosis is a sidewards curvature of the spine with a degree of rotation as well. This leads to an abnormal posture of the ribs with a chest hump, which is most visible with forward flexion of the spine (see below). As we do not know the exact reason why some children get scoliosis compared to others, it is called "idiopathic" scoliosis meaning "we don't know" the reason. These cases are the most common ones. The other cases are called "acquired scoliosis" as they occur following back injuries.

Scoliosis may be entirely without symptoms. It presents by physical appearance in that one shoulder is carried higher than the other. Or the clothes do not fall straight due to the reverse S curve of the spinal column. With forward bending a shoulder hump is visible as the upper rib cage and shoulder blade sticks out more on one side than the other. Orthopedic surgeons have classified scoliosis into various degrees of severity, which can be determined with X-ray examinations.

Mild cases are left alone, moderate cases are treated with bracing and severe cases can be treated with corrective surgery. Untreated severe scloiosis can seriously affect circulation through the lungs and lead to congestive heart failure. The exercise tolerance would be severely affected in these patients. However, with the introduction of Harrington rods and spinal fusion surgery techniques, also called ankylosis, things have changed considerably.

Harrington rods are steel rods that are inserted paralell to the spine.

Although this has been useful in the past, it was found subsequently that perhaps this surgical procedure was too heroic and unnecessarily stiffened the spine too much. Since then King has classified idiopathic scoliosis into 5 types and a more conservative approach with limited fusion surgery in the thoracic spine has been introduced (see Ref.4 and 5). Only a minority of patients have to have this surgery done. The majority can be observed or treated with bracing.

References:

1. ABC of rheumatology, second edition, edited by Michael L. Snaith , M.D., BMJ Books, 1999.

2. The Merck Manual, 7^th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 52.

3. The Merck Manual, 7^th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 275,p.2429.

4. HA King Orthop Clin North Am 1988 Apr;19(2):247-255.

5. HA King Orthop Clin North Am 1999 Jul;30(3):467-474, ix.

6. The Merck Manual, 7^th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 59.

7. JA Smith Orthop Clin North Am Jul 1999; 30(3): 487-499.