Introduction
Cause
Symptoms
Diagnosis
Treatments
Treatment
Prevention
Rehabilitation
Introduction
Scoliosis, or the sideway curvature of the spine, is usually found in girls aged between 10 and 15.
Cause
The most common spinal curvature belongs to the “idiopathic” type, which means the cause is unknown. When scoliosis occurs in children below 10 years old, it is more likely to be congenital or caused by diseases in the central nervous system or musculo-skeletal system.
In general, idiopathic scoliosis is not related to poor posture or the carrying of heavy bags or backpacks by children.
Symptoms
Scoliosis does not usually give rise to any symptoms. It is most often noticed by parents or friends or is picked by school physicians during regular medical checkups.
The most common type of scoliosis involves the bending of the upper back. It causes the rib cage to rotate and change shape while the upper back bends forward. Female patients might find their breasts at different levels.
The curvature of the spine in idiopathic scoliosis usually progresses as the child grows. This trend would slow down or even stop as she approaches puberty at around 15 to 16. In most cases, scoliosis would not progress significantly after 25 years of age.
Diagnosis
Ask the patient to bend forward and observe from behind. See if the two sides of the back are asymmetrical or if one side is higher than the other.
If the curvature occurs in the cervical or upper thoracic spine, the patient’s shoulders will be asymmetrical, meaning, one shoulder will appear higher than the other.
Unless the lateral curvature of thoracic spine is more than 60-70 degrees, idiopathic scoliosis would not usually affect the heart and lungs.
If scoliosis occurs along the lumbar spine (lower back), there will still be asymmetry from the back but it will not be as obvious to the naked eye.
In more serious cases of scoliosis, one side of the body is shifted so much that the trunk is set off from the centre of gravity. A plumb line dropping from the nape will be able to demonstrate the shifting of the body away from the center of the pelvis.
Treatments
The treatment plan depends on the following factors:
1. The location of the curvature: Scoliosis in the thoracic spine is more obvious and easily noticed, hence more justified for treatment.
2. The severity of curvature: Surgical treatment is recommended if the arch is more than 45 to 50 degrees. For curvature between 20 and 40 degrees, conservative treatment with orthotics and body braces should be worn to control and slow down the progression of the spinal curvature. If it is less than 20 degrees, close follow-ups to monitor the curve progression is necessary.
3. The stage of bone development: When a girl starts to have menstruation, her bone development is almost complete. The closer she is toward maturity, the less likely the spinal curvature will progress, and the lateral arch would become stabilised. On the other hand, the younger a child is, the longer the window is for the spinal curvature to progress, hence the higher the chance of having an increased degree of spinal curvature.
Treatment
Regular check-ups, X-rays, X-rays of the hand for detecting bone age, and height measurements are necessary to help determine a child’s bone development.
If wearing a brace is necessary, then it should be worn for a long period of time in order for it to be effective. Twenty-three hours a day is recommended, with one hour’s break for taking showers. This treatment should last until the bone development is complete – usually at the age of 17 for most children.
While wearing the brace, the patient might experience skin irritation or discomfort. However, parents should co-operate with the doctor in encouraging their kids to wear the brace while continuing to rest and engage in everyday activities as usual.
For most idiopathic adolescent scoliosis, the main purpose of surgical treatment is for cosmetic purpose. Fusion of segments of the affected spine supplemented with the insertion of metal rods and screws will help control the progression of the spinal curvature. It is a major surgery that should not to be taken lightly.
Prevention
Up to now, there is no medical evidence that suggests that poor posture and the carrying of heavy backpacks will lead to the development of idiopathic scoliosis. However, these could well be the cause of back pain and muscular strains even for children with a straight spine. So children should be taught to maintain a healthy posture from early on and to avoid wearing heavy backpacks.
Rehabilitation
Post-operatively, the child should receive follow-up examinations and undergo a rehabilitation programme. In Hong Kong, specialised centers have been set up to receive and manage patients with this deformity.
While children with scoliosis need to be closely monitored for mild spinal curvatures, may have to wear a brace to control the progression of the curvature or undergo surgical treatments to correct more genuine curvatures, they should take up regular exercises to strengthen the spinal and abdominal muscles and to maintain the suppleness and flexibility of the spine to lead a normal lifestyle.
Dr. NGAI, Wai-kit
