Scoliosis Overview

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Phase II: Non-Operative

Phase III: Operative

Phase IV: Life After Surgery

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How to diagnosis Scoliosis?

Who might detect the presence of scoliosis in a child?

•  Pediatrician or family doctor during routine exam

•  School screening nurse

•  Athletic coach or P.E. teacher

•  Parents

•  The child her or himself

•  Other family members or friends

•  Incidentally, such as an x-ray done for another reason

What is School Screening?

Some states in the U.S. mandate that children in the public school system be screened for scoliosis in early adolescence. Typically, girls are evaluated in the 5th or 6th grade and boys in the 6th or 7th grade. This screening is usually performed by a school nurse.

 

What are they looking for?

There are a number of things that one might notice:

•  One shoulder higher than the other

•  One shoulder blade (scapula) more prominent

•  One hip higher than the other

•  One leg appears longer

•  Asymmetry of the waist

•  Trunk and ribcage shifted to one side

•  Head not centered over middle of hips

•  Clothing hangs unevenly

•  When child bends forward at the waist, one side appears higher

Some of these signs of scoliosis may be very hard to see, especially to the untrained observer. Scoliosis in the early stages does not cause pain.

 

What causes these changes in appearance?

Scoliosis is a 3-dimensional deformity. When a curve develops, the spine also twists, or rotates to the left or right. The amount and type of change in body shape can depend on the curve pattern, and there is variation among individuals because each person’s body responds a bit differently to the presence of scoliosis.

 

What we’re seeing might be scoliosis... How did we miss this?

It is not uncommon for someone other than a parent or a child to notice scoliosis. Changes to the body occur rapidly during pre-adolescence and adolescence. Children typically become more private about their bodies, so parents often don’t see their children in situations where it may be noticed. The early changes in body shape that are the result of scoliosis can be subtle.

 

What is the next step?

When there is concern for scoliosis, the first step is often an evaluation by your pediatrician or family doctor. He/She will do a complete exam and may refer you to a specialist with expertise in scoliosis.

An x-ray will be required to confirm the diagnosis of scoliosis. Ideally the x-ray views should be obtained at a facility that routinely screens for scoliosis.

 

What will happen at the visit to the specialist?

•  Gather child’s health history and family history of scoliosis

•  Measure child’s height

•  Do a physical examination

•  Perform Adam’s Forward Bend Test

•  Obtain x-rays of the spine

•  Review and explain the results of the exam and x-rays to you

•  Answer your questions

•  Recommend a treatment plan

 

What is Adam’s Forward Bend Test?

As a spinal curve develops, the spine also twists, creating asymmetry of the ribcage and/or waist. Using a scoliometer, the degree of rotation is measured as an angle, in degrees. This determination of trunk rotation is made with a person bent forward at the waist and is a reflection of the severity of scoliosis. A rotation greater than 5-7 degrees suggests scoliosis may exists.

 

What does scoliosis look like on an x-ray?

Scoliosis is defined by the region of the spine where the curve or curves develop (upper thoracic spine, thoracic spine or lumbar spine). Scoliosis may be present in one or more sections: single, double or triple curve. The direction of the curve may be to the right or left.

How is the size of the curve measured?

The size of the curve is measured on an x-ray as an angle, in degrees. This is called the Cobb Angle or Cobb Measurement.

 

When is an MRI or further diagnostic workup recommended?

In the presence of an unusual curve pattern (ex: left thoracic curve), or other symptoms, additional testing may be recommended. An MRI (magnetic resonance image) checks the spinal cord for problems.

 

Will the curve get bigger?

There isn’t always a way to know if scoliosis will continue to progress, though there are a number of factors that increase that risk. If scoliosis is going to progress, the time of greatest risk is during the adolescent “growth spurt” when curves can increase 1 – 2 degrees per month.

Two factors are most important in predicting progression:

1. Size of the curve
2. The amount of growth still to come

 

How is the potential for skeletal growth determined?

At each visit to the specialist, a height measurement will be taken. Two subsequent measurements (months apart) without a gain in height is the surest way to know that growth is complete.

In addition, a skeletal maturity marker on the pelvis, called the Risser Sign, is visible on x-ray.

Also taken into account is the presence of signs of puberty-in girls, onset of menstrual periods and breast development; and in boys, facial hair and voice changes.

 

What is the Risser Sign?

The Risser Sign is used to evaluate skeletal maturity. A “cap” of growth cartilage covers the top of the pelvic bone (iliac wing). The growth cartilage turns to bone (and becomes visible on x-ray) in a consistent manner during puberty. As the skeleton matures, a bony cap appears first at the outer edge (Risser 1) and grows over the iliac crest towards the spine. The stages of skeletal maturity are classified as Risser 0 – 5, with 0 being the time before the bone cap appears and 4 being complete coverage. Fusion of the growth cap to the iliac wing (Risser 5) signifies completion of spinal growth.

 

 

What will an x-ray of the hand and wrist show?

An x-ray of the hand and wrist will show the growth plates of the individual bones in the hand. These growth plates remain open during growth and have a pattern of closure with skeletal maturity that is actually more reliable than the Risser sign. Hand x-rays also allow the doctor to compare chronological age (years since birthday) with skeletal age (real bone age, which may or may not match up to one's chronological age). This can be helpful in determining how much skeletal growth remains.

 

It is scoliosis...what’s next?

Scoliosis is treated non-operatively either with observation of the curve for progression or by wearing a brace. Scoliosis can also be treated operatively if it progresses to the point where it will continue to progress even after growth is finished.

 

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