In many cases, a grandmother, grandfather or some other family member spots scoliosis. Because it is better to detect this condition early, all family members are urged to take notice of any abnormalities.
The literal translation of the word “orthopaedic” is “straight child”. Orthopaedic surgeons often treat a condition known as scoliosis, or curvature of the spine. Adolescent idiopathic scoliosis is the most common cause of spinal deformity. This condition and its treatments will be discussed.
The word idiopathic basically means that there is no definitive known cause of a disorder. Thus, by definition, adolescent idiopathic scoliosis means curvature of the spine in a teenager that has no known cause. There appears to be a genetic component, as it does seem to run in families. Females tend to have the more progressive type that worsens with time and requires treatment.
Onset of the curves usually begins at an early age, at around 10 or 11. At that point, the curves are usually very small and not easily detected. At puberty, an increase in the size of the curves occurs in certain patients. When the preteen or teen hits a “growth spurt”, we see a number of significant curves. Usually, these teens are very healthy and have no medical problems. Occasionally, other disorders can mimic the idiopathic form of scoliosis. These include problems with the spinal cord, tumors, and other disorders. These will occasionally cause pain. Any child with scoliosis should undergo a good history and physical with either a pediatrician or orthopaedic surgeon.
The natural history of adolescent idiopathic scoliosis is varied. There have been large studies done to try to determine who is at risk for having the curve worsen. Risk factors for the curve worsening include:
Treatment recommendations are based on the chance of the curve getting worse. The most important step in treatment is identifying the disorder. School screenings can be an effective way of identifying children with the curve. Astute pediatricians can also help identify possible curves. Parents, as well, should examine their children. Examine the child from behind. If there is any notice of the shoulders or pelvis being uneven, this can indicate a curve. Also, when the child bends to touch his/her toes, any asymmetry in the rib region may indicate a curve. Any child with a family history of scoliosis should be examined. Once a child with a potential curve has been identified, radiographs of the child should be performed. These should always be standing and display the whole spine. The orthopaedic surgeon will then make measurements on the x-rays, and look at indications of skeletal maturity.
Again, the treatment depends on the above-mentioned factors. If the curve is small, observation of the teen is advised, with repeat x-rays in 4 to 6 months. The parent should not let years lapse before returning, as the curve can progress significantly.
If the curve progresses, or starts out large, the surgeon may recommend one of a myriad of braces. The braces are meant to try to halt the progression of the curve, but do not correct any existing curve.
In the case of curve progression or growth, the surgeon may recommend surgery. There are numerous surgical techniques in the treatment of scoliosis, but all basically involve straightening the curve and then fusing the spine so that the bones do not move. If curves are left untreated, they can cause serious problems into adulthood.
In conclusion, the most important factor in the treatment of adolescent idiopathic scoliosis is the detection. With prompt diagnosis, the orthopaedic surgeon can help the child to keep a straighter spine and live a healthier life.