News from Sierra Nevada Memorial Hospital and Hospital Foundation
At the end of high school, one of my closest friends shared that she had scoliosis. That summer she had surgery and was put in a full body cast. I remember thinking how sad it was that she couldn’t enjoy the summer after graduation and visited her often as she recovered.
Initial signs of scoliosis generally become apparent in children and teenagers. Scoliosis is a sideways curve off the backbone or spine that affects about 2 to 3% of the population or 6 to 9 million people. There are over 600,000 physician visits with an estimated 30,000 children fitted with a brace and 38,000 patients undergoing spinal fusion surgery each year.
Normal spinal curves occur at the cervical, thoracic, and lumbar regions in what is known as the sagittal plane. Sagittal is a vertical anatomical plane dividing the body into left and right parts where the coronal plane is a vertical plane from head to foot and parallel to the shoulders, dividing the body into the anterior (front) and posterior (back) sections. These natural curves position the head over the pelvis and work as shock absorbers to distribute stress during movement.
The spinal curve angle may be large or small. Anything measuring over 10 degrees on an x-ray is considered scoliosis. Many cases are mild, but severe scoliosis can be disabling. A severe spinal curve may reduce space in the chest making it difficult for the lungs to function properly.
Several signs indicate scoliosis. A head that is not centered above the pelvis, uneven shoulder blades, one or both hips that are raised unusually high, uneven rib cage or waist, or the entire body leaning to one side or the other.
There are three types of scoliosis: idiopathic, congenital, and neuromuscular. Idiopathic is diagnosed when all other causes are excluded and accounts for about 80% of cases. Congenital scoliosis results from embryological malformation of one or more vertebrates when one area of the spinal column lengthens at a slower rate than the rest.
Neuromuscular scoliosis is related to neurological or muscular disease. Examples include cerebral palsy, spinal cord trauma, muscular dystrophy, spinal muscular atrophy and spina bifida. This scoliosis generally progresses the fastest and often requires surgical treatment.
When scoliosis is diagnosed in adulthood, treatment often differs because the patient has reached skeletal maturity. These adult patients were either not surgically treated as adolescents, did not receive treatment when they were young, or were diagnosed with degenerative scoliosis.
Degenerative scoliosis most frequently occurs in persons over 65 in the lumbar spine (lower back). It’s often accompanied by spinal stenosis, or narrowing of the spinal canal, which pinches the spinal nerves and makes it difficult for them to function normally.
With a confirmed diagnosis, the physician will determine if observation, bracing, or surgery are needed. Most cases can be treated with one of the first two options. Although a significant number of scoliosis patients benefit from surgery, there is no guarantee it will stop curve progression and symptoms.
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