IDIOPATHIC SCOLIOSIS

Idiopathic Scoliosis

The word “idiopathic” means that the cause of this form of scoliosis is unknown. The adolescent form affects children between 10 and 18 years old. This form of scoliosis affects girls more than boys. In fact, girls are treated 10 times more often than boys. There are many theories as to why this type of scoliosis develops, but the root of the condition remains unknown.

Causes Include

• Genetics – Scoliosis appears to run in certain families because hereditary could cause the condition. In view of this, significant research continues in the field of genetics.
• Growth – Curves progress rapidly during growth spurts, perhaps showing a tie to hormonal causes.
• Structural Changes – Some studies have shown increased muscular activity around the spinal curves. Differences in leg lengths have also been noted in adolescents with this condition. But clear evidence does not exist that this type of change causes scoliosis. However, a relationship could exist.
• Central Nervous System Changes – Some forms of scoliosis are linked to central nervous system disorders. A lot of research has been focused on this topic. But so far such disorders have not been proven as the root of this condition.
• Equilibrium – If a child has problems with posture, balance, and body symmetry, it could affect the way the spine positions itself. If the problems are chronic, they may disrupt the way the spine and muscles develop.

Idiopathic Scoliosis gets classified by the age at which it occurs, falling into one of four categories:

• Infantile – Also known as early-onset scoliosis. Develops in children, mostly boys, under the age of 3.
• Juvenile – More common in girls, this kind of scoliosis occurs between the ages of 3 and 10.
• Adolescent – This type of scoliosis makes up the majority of cases. It’s most common in girls between the ages of 11 and 17. Adolescent idiopathic scoliosis refers to children and is the most common — representing nearly 90 percent of cases.
• Adult – This type refers to adults 18 years and older.

The curvature of idiopathic scoliosis (Infantile, Juvenile, and Adolescent) varies from person to person, with mild curves being more common than severe curves. In children and adolescents who are still growing, the curve can get worse rapidly during a growth spurt. While this type of scoliosis can develop in younger children, it most often begins during puberty for both boys and girls.  However, girls usually develop severe curves that require medical care.

Likelihood of Progression

Once scoliosis becomes diagnosed, the concern may arise whether the curves will continue to grow bigger. Doctors do not have the ability to determine if a curve will continue to grow, but the following is known:

• Curves in the thoracic spine are more likely to progress than lumbar curves.
• The likelihood of growing bigger depends on the size of the curve. Larger curves are more likely to get bigger.
• If the curves start at a young age or before a girl begins her period, they are more likely to progress.
• The higher the child’s Risser sign number at diagnosis, the less chance of progression. The Risser sign also measures skeletal maturity and is based on a 0 to 5 scale with 5 being full skeletal maturity.

Symptoms

In children and adolescents, small curves often go unnoticed until they hit a growth spurt during puberty and there are more obvious signs, such as:

• Tilted, uneven shoulders, with one shoulder blade protruding more than the other
• The prominence of the ribs on one side
• Uneven waistline
• One hip higher than the other
• Back pain
• Difficulty breathing

Adult Idiopathic Scoliosis

Adult idiopathic scoliosis refers to the continuation of the disease from childhood. Scoliosis may have started during your teenage years and gone unnoticed, not progressing until you reached adulthood. This form of scoliosis can affect both the thoracic and lumbar portions of the spine.

In adults, the symptoms are often more severe and may include:

• Spinal stenosis, an abnormal narrowing of the spinal canal that can cause back pain that’s worse when standing or walking.
• Nerves can sometimes become compressed and may cause radiating pain in the mid to lower back, as well as numbness, tingling, or weakness in the legs.
• In severe cases (generally in curves more than 90 degrees), scoliosis can result in diminished lung function.

Diagnosing

Idiopathic scoliosis gets diagnosed through a combination of physical examinations and specialized X-ray images. During the physical examination, one of our doctors, Richard Hostin, MD, Devesh Ramnath, MD, Ishaq Syed, MD, Shyam Kishan, MD, and Kathryn Wiesman, MD  will examine the curvature of the spine, looking closely at the degree of rotation in the spine. They will also note any secondary changes in other parts of the body.

X-ray images are important to pinpoint the shape and location of the curves, as well as for measuring the degree of the curvature for classification. Southwest Scoliosis and Spine Institute utilizes the revolutionary EOS 2D/3D X-ray imaging system, which allows us to quickly take full-body images of patients in standing or seated positions in just a few seconds while delivering the lowest possible dose of radiation.

Treating 

In many cases, doctors treat idiopathic scoliosis treatment through a combination of watching and bracing. However, in cases where the patient’s curve progresses to the point that it causes pain or causes difficulty breathing, the doctor may recommend surgery as the best option.

Observation

Your doctor will typically recommend watching a patient whose curves are not severe. Using our advanced in-house imaging system, doctors can get X-ray images of the spine every 4 to 6 months to determine if the curve continues to grow or not while the patient receives an extremely low dose of radiation. This low-dose imaging system protects children, from the effects of radiation.

Scoliosis brace

In (primarily adolescent) patients whose curve progresses past 20-25 degrees, the doctors often prescribe a back brace until the patient reaches full skeletal maturity. Though bracing cannot correct the curvature, in many cases it can stop it from getting bigger. For this reason, bracing should begin early in detection and be worn as prescribed.

Scoliosis surgery

If the curve grows beyond 40-50 degrees, the doctors may suggest surgery. The most common type of surgery to address this condition is spinal fusion, which involves inserting rods and screws into the vertebrae to prevent the spinal curvature from growing further.

Finally, surgeries to correct idiopathic scoliosis are complex, and multi-step procedures.  Our doctors are specially trained and have years of experience performing these types of spine surgeries.