Scoliosis

Who Develops Scoliosis?

Types of Scoliosis

• Adolescent idiopathic scoliosis (scoliosis of unknown cause) is the most common type and occurs after the age of 10. Girls are more likely than boys to have this type of scoliosis. Since scoliosis can run in families, a child who has a parent or sibling with idiopathic scoliosis should be checked regularly for scoliosis. Idiopathic scoliosis can also occur in children younger than 10 years of age, but is very rare.
• Early onset or infantile idiopathic scoliosis occurs in children less than three years of age.
• Juvenile idiopathic scoliosis occurs in children between the ages of three and 10.

What Causes Scoliosis?

• Nonstructural (postural) scoliosis— A structurally normal spine which appears curved. This is a temporary, changing curve. It is caused by an underlying condition such as a difference in leg length or muscle spasms. Doctors treat this type of scoliosis by correcting the underlying problem.
• Structural scoliosis— A fixed curve which doctors treat case by case. Sometimes structural scoliosis is one part of a syndrome or disease, such as Marfan's syndrome, an inherited connective tissue disorder. In other cases, it occurs by itself. Structural scoliosis can be caused by neuromuscular disorders such as cerebral palsy, spina bifida, muscular dystrophy or spinal cord injuries. Birth defects such as hemivertebra, in which one side of a vertebra fails to form normally before birth is called congenital scoliosis. Still other causes of a structural scoliosis include injury, certain infections or tumors such as those caused by neurofibromatosis, a birth defect sometimes associated with benign tumors on the spinal column; metabolic diseases, connective tissue disorders, rheumatic diseases, or unknown factors (idiopathic scoliosis).

How Does the Doctor Diagnose Scoliosis?

• Medical history: The doctor will speak with the patient and parents and review the patient's records to look for medical problems that might be causing the spine to curve, such as birth defects, syndromes, or other disorders that can be associated with scoliosis. The doctor will ask about  muscle weakness, numbness, tingling, pain, or problems controlling your bowel or bladder.
• Physical examination: The doctor will look at the patient's back, chest, pelvis, legs, feet, and skin. The doctor will check if the patient's shoulders are level, whether the head is centered, and whether opposite sides of the body look level. The doctor will also examine the back muscles while the patient is bending forward to see if one side of the rib cage is higher than the other. If there is a significant asymmetry (difference between opposite sides of the body), the doctor will  order an X-ray evaluation.
• X-ray evaluation: Patients whose medical history or physical exam suggests possible scoliosis, will have  to have two X-rays taken: one from the back and one from the side. Each X-ray is of the entire spine with the patient standing, whenever possible. Occasionally, doctors ask for more tests to see if there are other problems.
• Curve measurement: The doctor will measure the curve on the X-ray image. Curves that are greater than 20 degrees require treatment. Doctors group curves of the spine by location, shape, pattern and cause. This information is used to decide how best to treat the condition.
• Location: To identify a curve's location, the doctor will find the apex of the curve (the vertebra within the curve that is the most off-center).  A thoracic curve has its apex in the thoracic area (the part of the spine to which the ribs attach). A lumbar curve has its apex in the lower back. A thoracolumbar curve has its apex where the thoracic and lumbar vertebrae join. Some patients have more than one curve.
• Shape: A curve is usually C-shaped (one curve) or S-shaped (2 or more curves).
• Pattern: Curves frequently follow patterns that have been studied in previous patients. The larger the curve is, the more likely it will progress (depending on the amount of growth remaining). Curves in the thoracic area often make the shoulders and scapula (wingbones of the upper back) look uneven. Curves in the lumbar area may make one hip stick out more than the other or even make a skirt hem or pant legs appear crooked.