Scoliosis can develop at any time during childhood and adolescence. It is more common in girls than boys, most commonly occurring at the start of adolescence. Scoliosis is rarely present at birth however it can develop in infancy or early childhood. The reason may be unknown or may be caused by a rare childhood disorder.

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DESCRIPTION:

:

As the curve progresses, the vertebrae rotate toward the concave part of the curve. This causes the ribs to crowd together on the concave side while they are widely separate and project more posteriorly on the convex side. Most noticeable is the rotational chest asymmetry which can be best seen when the affected individual bends forward to touch their toes. When viewed from the side, most patients with scoliosis have fairly normal back contour with a tendency to have a flatter or less rounded back appearance with relatively normal lumbar lordosis (swayback). The curvature may force the spaces between the spinal disks to become asymmetric, while the vertebrae grow thicker on the outer convex side of the curve. Usually the disc spaces between the vertebrae, though asymmetric, do not degenerate in adolescence.

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Scoliosis: Words to Know:

Cobb angle: A measure of the curvature of the spine, determined from measurements made on X-ray photographs.

Magnetic Resonance Imaging (MRI): A procedure that uses electromagnets and radio waves to produce images of a patient's internal tissue and organs. These images are not blocked by bones, and can be useful in diagnosing brain and spinal disorders and other diseases.

Scoliometer: A tool for measuring the amount of curvature in a person's spine.

Spondylosis: Arthritis of the spine.

SCOLIOSIS When viewed from the back, the spine usually appears perfectly straight. In some cases, however, the spine is curved rather than straight. In addition, the vertebrae (the bones that make up the spinal column) are twisted. This condition is known as scoliosis. A small degree of curving in the spine does not usually cause any medical problems. But larger curves can lead to certain disorders, such as posture imbalance, muscle fatigue, and back pain. Severe scoliosis can interfere with breathing and lead to spondylosis (arthritis of the spine; pronounced spon-dl-OH-siss). About 10 percent of all adolescents have some degree of scoliosis. Less than 1 percent, however, require medical attention other than careful observation of the problem. Scoliosis occurs in both sexes, but appears in girls about five times more often than in boys. Scoliosis appears most often in adolescents between the age of ten and thirteen. Add this page to your favorites

SCOLIOSIS

When viewed from the rear, the spine usually appears perfectly straight. Scoliosis is a lateral (side-to-side) curve in the spine, usually combined with a rotation of the vertebrae. (The lateral curvature of scoliosis should not be confused with the normal set of front-to-back spinal curves visible from the side.) While a small degree of lateral curvature does not cause any medical problems, larger curves can cause postural imbalance and lead to muscle fatigue and pain. More severe scoliosis can interfere with breathing and lead to arthritis of the spine (spondylosis).

WHAT DOES IT PROGRESS LIKE?

The onset of scoliosis may occur during infancy (birth to three years), the juvenile years (ages four to nine), or in the adolescent years (greater than or equal to 10). The infantile type more commonly affects males and is the least common of the three types. Spontaneous correction may occur, but in the typical case the curve progresses with growth. Occasionally abnormal development of one or more of the vertebrae (i.e., Hemivertebrae) occurs which may affect curve progression. Juvenile scoliosis first appears between three and 10 years of age when a thoracic curve begins to form causing chest asymmetry, prominence of a shoulder blade, vertical elevation of one shoulder, or asymmetric skin folds. Both boys and girls are relatively equally affected in juvenile scoliosis. Some cases of juvenile scoliosis may not be noticeable until the child reaches adolescence as the skeleton grows to maturity. The most common type is the adolescent type in which girls are affected at a ratio of 10:1 relative to boys.

SCOLIOSIS

As the curve progresses, the vertebrae rotate toward the concave part of the curve. This causes the ribs to crowd together on the concave side while they are widely separate and project more posteriorly on the convex side. Most noticeable is the rotational chest asymmetry which can be best seen when the affected individual bends forward to touch their toes. When viewed from the side, most patients with scoliosis have fairly normal back contour with a tendency to have a flatter or less rounded back appearance with relatively normal lumbar lordosis (swayback). The curvature may force the spaces between the spinal disks to become asymmetric, while the vertebrae grow thicker on the outer convex side of the curve. Usually the disc spaces between the vertebrae, though asymmetric, do not degenerate in adolescence.

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A very small number of cases result from leg-length discrepancy that is produced by one leg being shorter than the other, causing a tilted pelvis and tilted take-off of the spine (think Leaning Tower of Pisa). However, the majority of cases, regardless of age, have an unknown cause and are considered to be genetic in origin.

ADDITIONAL DESCRIPTIONS OF SCOLIOSIS

Scoliosis (medical condition): Sideways curvature of the spine

Scoliosis: an abnormal lateral curve to the vertebral column
Source: WordNet 2.1

Scoliosis: An appreciable lateral deviation in the normally straight vertical line of the spine. (Dorland, 27th ed)
Source: Diseases Database

Scoliosis : appreciable lateral deviation in the normally straight vertical line of the spine.
Source: CRISP

Scoliosis: Scoliosis is a musculoskeletal disorder in which there is a sideways curvature of the spine, or backbone. The bones that make up the spine are called vertebrae. Some people who have scoliosis require treatment. Other people, who have milder curves, may only need to visit their doctor for periodic observation. (Source: excerpt from Questions and Answers about Scoliosis in Children and Adolescents: NIAMS)

Scoliosis and Who Has It:

''Scoliosis is not that unusual, about 0.7% of the population have it!'' Scoliosis is a lateral (sideways) curvature of the spine, its name being Greek for curvature. It usually involves a twisting of the rib cage in thoracic (chest) curves or one hip being higher than the other in lumbar (lower) curves. This because as the spine bends to the side, the vertebrae become twisted and in the process they pull the ribs round. This curvature can be to the right (80% of cases) or to the left. It can develop anywhere along the spine, although the thoracic or lumbar regions are the most common.

SCOLIOSIS DESCRIPTION:

Scoliosis is a sideways curvature of the spine that causes the rib cage to become tilted. It is not a disease, and you cannot catch scoliosis from someone else who has it. Abnormal curvature in the spine runs in families, but in most cases the cause of the curvature is not known. Although scoliosis is a disorder that usually starts in childhood, it is usually discovered only during the teenage years, and the cause of this type of scoliosis is unknown. Scoliosis is about eight times more common in girls than in boys. Description and causes Normally, the spine curves in a front to back direction. In scoliosis, the spine also bends from side to side. Over 90% of the curves in scoliosis curve to the right. On an X-ray, the spine of an individual with scoliosis looks more like an S or a C than a straight line (refer to Figure 1). The usual scoliosis curve is a thoracic curve (i.e., at the level of the chest), instead of lumbar (level of lower back).

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• THE BONES
• Some of the bones in a scoliotic spine also may have rotated slightly, making the person's waist or shoulders appear uneven. The spine and rib cage are inter-connected, hence a severe scoliosis which affects the position of the ribs can affect surrounding organs as well. Severe scoliosis not only hurts the individual's appearance, but it can also affect his or her health and ability to function.
  

Scoliosis And Asymmetry

Scoliosis causes a noticeable asymmetry in the torso when viewed from the front or back. The first sign of scoliosis is often seen when a child is wearing a bathing suit or underwear. A child may appear to be standing with one shoulder higher than the other, or to have a tilt in the waistline. One shoulder blade may appear more prominent than the other due to rotation. In girls, one breast may appear higher than the other, or larger if rotation pushes that side forward.

Scoliosis can be categorized into four main types:

#1 Congenital scoliosis is present from birth, and involves actual malformation of the vertebrae (backbone) themselves. Surgery is the only effective form of treatment for this type of scoliosis. #2 Scoliosis due to neuromuscular disease may be caused by polio, cerebral palsy, spina bifida, muscular dystrophy, or other such disorders. Its treatment accordingly follows the treatment for the causative disease. Add this page to your favorites

#3 Idiopathic scoliosis (meaning that the cause is unknown) occurs either in infancy, childhood or adolescence in one or two out of every 100 children, the majority of them being girls. This deformity of the back may result in gradual collapse and twisting of the spinal column. This type of idiopathic scoliosis is the most common form of scoliosis amongst the four types, and it classically occurs in adolescents during their rapid growth spurt. Most of the time, it is relatively mild, but if it is accompanied by significant rotation of the spine, it can become life-threatening due to compression of the chest cavity and interference with the growth of the heart and lungs.

#4 Postural scoliosis is a scoliosis caused by postural misalignment, and can be corrected by postural alignment therapy. It is extremely common. A curve in the lower back is usually caused by a pelvis that is tilted to one side; a curve in the upper back is usually caused by a tilting of the shoulder girdle. It differs from the other three types of scoliosis in that postural scoliosis does not have an actual malformation in the structure of the backbone, and can be corrected by the patient's efforts.

EARLY DETECTION OF SCOLIOSIS

School students should be screened for scoliosis, especially when there is a case of diagnosed scoliosis in a family member. If someone in a family has scoliosis, the likelihood of an incidence is much higher - approximately 20 percent.

What About Scoliosis In Adults?

Scoliosis can also occur in adults. Adult scoliosis may represent the progression of a condition that actually began in childhood, but which was undiagnosed or untreated while the person was still growing. In other instances, adult scoliosis can be caused by degenerative changes of the spine. Other spinal deformities such as kyphosis (hunch/round back) are associated with the common problem of osteoporosis (bone softening) involving the elderly. If allowed to progress, severe cases of adult scoliosis can lead to chronic severe back pain, deformity, and difficulty in breathing. Add this page to your favorites

The Curve of Scoliosis:

Scoliosis is an abnormal curvature of the spine. Instead of going from top to bottom in a relatively straight line, a spine with scoliosis may appear to have a side-to-side S-shaped or C-shaped curve. Mild degrees of scoliosis wont cause you any problems. However, more severe cases of scoliosis can result in pain, weakness, and low self-esteem because of obvious cosmetic deformity. Very severe scoliosis may cause heart and lung problems if those organs are overly cramped in an abnormally shaped chest cavity.

Scoliosis is usually classified by the age at which it appears to have begun: Infantile: between birth and age 3 (very rare) Juvenile: from age 3 to age 10 Adolescent: over age 10 (most common) Most cases of scoliosis begin when a child is around 8 or 10 years old, and may progress as the child continues to grow.

Risk Factors For Scoliosis:

A risk factor is something that increases your likelihood of getting a disease or condition. Risk factors for Scoliosis are factors that do not seem to be a direct cause of the disease, but seem to be associated in some way. Having a risk factor for Scoliosis makes the chances of getting a condition higher but does not always lead to Scoliosis. Also, the absence of any risk factors or having a protective factor does not necessarily guard you against getting Scoliosis. It is possible to develop scoliosis with or without the risk factors listed below. However, the more risk factors you have, the greater your likelihood of developing scoliosis. If you have a number of risk factors, ask your healthcare provider what you can do to reduce your risk.

Medical Conditions

A number of medical conditions predispose children to scoliosis, including:

* Turner’s syndrome
* Muscular dystrophy
* Polio
* Cerebral palsy
* Marfan syndrome
* Friedreich’s ataxia
* Rheumatoid arthritis
* Osteogenesis imperfecta
* Spina bifida
* Myelomeningocele

Following is a list of underlying conditions that could possibly cause Scoliosis (includes conditions that may underly Nonstructural scoliosis):

o Leg length

o Muscle spasms

o Appendicitis

o Marfan's syndrome - Marfan may cause structural scoliosis.

o Neuromuscular diseases

o Cerebral palsy

o Poliomyelitis

o Muscular dystrophy

o Birth defects

o Hemivertebra

o Spinal injury

o Certain infections

o Spinal cord tumors

o Neurofibromatosis

o Certain metabolic diseases

o Certain connective tissue disorders

o Certain rheumatic diseases

o Certain hip conditions

o Certain pelvis conditions

o Certain vertebral conditions

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Other conditions that might have Scoliosis as a complication may, potentially, be an underlying cause of Scoliosis:

* Friedreich's ataxia
* Osteogenesis imperfecta

WHO GETS SCOLIOSIS?

Risk Factors for Scoliosis
General Risk Factors for Idiopathic Scoliosis. Idiopathic scoliosis, the most common form, nearly always occurs during the growth spurt right before and during adolescence. It can also develop in young children and even in infants. About 2% to 3% of adolescents develop curvature of 10 degrees or more, but only about 0.3% to 0.5% have curves greater than 20 degrees. Mild curvature occurs about equally in girls and boys, but curve progression is 10 times more likely to occur in girls.

Medical Risk Factors. People with certain medical conditions that affect the joints and muscles are at higher risk for scoliosis. [ See What Causes Scoliosis? .]

Young Athletes. A 2000 study reported that young girls engaged in rhythmic gymnastics had a 10 fold increased risk for scoliosis. This higher risk is possibly due to three coinciding factors:

* Imbalance in the weight on the spine.

* Loosening of the joints.

* Delay in the onset of puberty.

Curve Progression in Children and Adolescents with Scoliosis

Once a mild curve has been observed, the next step is more difficult, predicting whether the curve will progress into a more serious condition. Although as many as three in every 100 teenagers have a condition serious enough to need at least observation, the potential for severity may be significantly lower or higher than average depending on other factors.

* Being female, particularly if taller than average.

* Being younger at the onset of scoliosis.

* Having a greater angle of curvature. For example, at 20 degrees, only about 20% of curves progress. Young people diagnosed with a 30-degree curve, however, have a risk for progression of 60%; with a curve of 50 degrees, the risk is 90%.

* Curvatures that have been caused by congenital scoliosis (spinal problems present at birth). These may progress rapidly.

* Treatment with growth hormone.

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spine, speiegn, spiegn, spin, spein, spyn, speigne, speeign, speign, spiegne, speen, spyne, sp1ne, spime, spien, spnie, sipne, psine

These are some ways the SPINE is misspelled.

SCOLIOSIS SYMPTOMS

These symptoms are only those associated with the spine being curved:

* Your head may be off center.

* One hip or shoulder may be higher than the other.

* You may walk with a rolling gait.

* The opposite sides of the body may not appear level.

* You may experience back pain or tire easily during activities that require excessive trunk (chest and belly) movement.

From the book "Teaching English Pronunciation"
by Joanne Kenworthy, (Longman Handbooks for Language Teachers), Longman Publishing, 1987

MORE Symptoms

There are several different "warning signs" to look for to help determine if you or someone you love has scoliosis. Should you notice any one or more of these signs, you should schedule an exam with a doctor.

* Shoulders are different heights – one shoulder blade is more prominent than the other
* Head is not centered directly above the pelvis
* Appearance of a raised, prominent hip
* Rib cages are at different heights
* Uneven waist
* Changes in look or texture of skin overlying the spine (dimples, hairy patches, color changes)
* Leaning of entire body to one side

A standard exam that is often used by pediatricians and in initial school screenings is called the Adam's Forward Bend Test. Most schools test children in the fifth or sixth grade, and the Adam's Forward Bend Test can be administered easily by school nurses or parent volunteers. For this test, the patient is asked to lean forward with his or her feet together and bend 90 degrees at the waist. The examiner can then easily view from this angle any asymmetry of the trunk or any abnormal spinal curvatures. It should be noted that this is a simple screening test that can detect potential problems, but cannot determine accurately the exact severity of the deformity.

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Leaning Forward Standing Up

Once suspected, scoliosis is usually confirmed with an x-ray, spinal radiograph, CT scan, MRI or bone scan of the spine. The curve is then measured by the Cobb Method and is discussed in terms of degrees. Generally speaking, a curve is considered significant if it is greater than 25 to 30 degrees. Curves exceeding 45 to 50 degrees are considered severe and often require more aggressive treatment.

Most schools test children in the fifth or sixth grade, and the Adam's Forward Bend Test can be administered easily by school nurses or parent volunteers. For this test, the patient is asked to lean forward with his or her feet together and bend 90 degrees at the waist. The examiner can then easily view from this angle any asymmetry of the trunk or any abnormal spinal curvatures. It should be noted that this is a simple screening test that can detect potential problems, but cannot determine accurately the exact severity of the deformity.

* Shoulders are different heights – one shoulder blade is more prominent than the other
* Head is not centered directly above the pelvis
* Appearance of a raised, prominent hip
* Rib cages are at different heights
* Uneven waist
* Changes in look or texture of skin overlying the spine (dimples, hairy patches, color changes)
* Leaning of entire body to one side

A standard exam that is often used by pediatricians and in initial school screenings is called the Adam's Forward Bend Test.

FIRST GET SCOLIOSIS CONFIRMED!

"Once suspected, scoliosis is usually confirmed with an x-ray, spinal radiograph, CT scan, MRI or bone scan of the spine. The curve is then measured by the Cobb Method and is discussed in terms of degrees. Generally speaking, a curve is considered significant if it is greater than 25 to 30 degrees. Curves exceeding 45 to 50 degrees are considered severe and often require more aggressive treatment.

X-ray of Lateral Curve

The following is a list of questions your physician/orthopaedic specialist may ask:

* At what age was the spinal deformity first noted? This information is important in determining the prognosis and severity of the scoliosis.
* Who first noted the problem? Parent? Teacher? Physician?
* What is the patient's prenatal history? Did the child experience any problems while still in his or her mother's womb? Was there anything unusual about the pregnancy?
*
Did the patient meet normal developmental milestones? Walking? Talking?
*
Is there a family history of scoliosis or other spinal problems? You are 20 percent more likely to develop scoliosis if someone in your family also has scoliosis.
*
Is the patient experiencing any back pain? Generally speaking, scoliosis in children and adolescents is not painful. If pain exists, further tests should be conducted for tumors, herniated discs or other abnormalities.

The doctor may also conduct exams to test reflexes, motor and sensory functions, and breathing ability. After a diagnosis is made, your doctor will suggest a treatment plan. Find out more about treatment options for scoliosis.

.

Types of Scoliosis:

There are many types of scoliosis, and people of all ages can be affected by scoliosis. In adults, scoliosis can result from several conditions, but most types fall into two different categories. In the first category is a person who had a scoliosis as a child/adolescent and the abnormal spine curve has increased into adult life or is becoming painful with aging. The second category of adult scoliosis is seen in patients who have never had a scoliosis as a child but begin to develop an abnormal curvature with aging. The spinal deformity in degenerative scoliosis is usually a mild side curvature involving predominantly the lower levels of the spine.

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HOW TO LOOK AT SCOLIOSIS SYMPTOMS

Symptoms related to adult scoliosis are mostly due to degeneration (wear and tear) of structures that support the spine. These changes which are often called arthritis of the spine can occur at all levels of the back (neck, upper back and lower back). With aging and arthritis, a gradual narrowing of the discspaces between vertebrae, wearing out of the joints, as well as narrowing of the space available for the nerves (a condition known as stenosis) can develop. Although degeneration of the spine is part of the normal aging process in all people, it appears that in most people the spine becomes stiffer with age but does not develop a lot of abnormal curvature and causes only minimal or no pain. In other people the spine loses its structural stability with aging and gradually develops abnormal curvatures that can be painful and lead to symptoms including back pain, stooped posture, leg problems (numbness, heaviness, tingling, pain and weakness) and progressive difficulty in walking which requires frequent rests and activity limitation.

What are the signs of scoliosis?

1. Scoliosis usually doesn't cause pain or limit a child's movements, so it is easily overlooked. Most children receive a diagnosis during a routine physical. Still, alert parents can often spot early warning signs: A child's shoulders may be uneven, one or both shoulder blades may stick out, the waist may be lopsided, the hips may seem unusually high, or the child may lean to one side. Parents should be especially watchful for these problems if someone else in the immediate family already has scoliosis. If you notice asymmetry, it's a good idea to have the doctor check it out. In adults, severe cases of scoliosis that are left untreated may cause pain, deformity, or breathing problems down the road.
2. Adolescents rarely have symptoms of pain or discomfort. Back pain in children and adolescents can be a sign of something more ominous than scoliosis, such as infection or tumor, and should be investigated. Young children with scoliosis can have spinal cord involvement, which may manifest itself as difficulty walking, stumbling, and spasms. Patients with neuromuscular scoliosis may develop progressive loss of balance while standing and sitting; they can also have progressive difficulty with walking. Adults can experience back pain, fatigue, sciatica, decreased walking tolerance, loss of height and leaning forward or to one side. Progression Mild scoliosis may be asymptomatic- adolescents will usually present with a cosmetic deformity only, but as a curve worsens they may experience back pain or fatigue, often activity related. Patients with neuromuscular scoliosis may develop progressive difficulty with walking, and may have problems maintaining and upright posture either sitting or standing. As adult scoliosis worsens, patients can suffer from increasing pain and fatigue, which can lead to increasing difficulty with activities of daily living.

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GET COMFORTABLE BY TREATING SCOLIOSIS RIGHT

Everyone's spine has curves. These curves produce the normal rounding of the shoulder and the sway of the lower back.

A spine with scoliosis has abnormal curves with a rotational deformity. This means that the spine turns on its axis like a corkscrew. Compare the more subtle curve of the normal spine to the severe curvature of the scoliotic spine.

The vertebrae, or bones that form the spine, are usually aligned straight when viewed from behind. In scoliosis, the spine is bent to the side. The spine can sometimes rotate, causing an uneven rib cage. If this happens, the ribs in the back will be prominent on one side. Scoliosis is sometimes associated with excess bending forward of the spine, called kyphosis. It may also be seen with excess bending backward of the spine, called lordosis. The curve of the spine may vary from a C-shaped to a S-shaped pattern.

Orthopedic surgeons are qualified to evaluate and treat deforming spinal conditions like scoliosis. However, a good resource for further information is:

The National Scoliosis Foundation
5 Cabot Place
Stoughton, MA 02072
Phone: (617) 341-6333
Fax: (617) 341-8333
Email:scoliosis@aol.com

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A SERIES OF PICTURES OF SCOLIOSIS

WHY GET SCOLIOSIS TREATED WITH SURGERY?

Surgical treatment of scoliosis may be indicated for any of the following reasons:

1. To prevent further progression of the curve.
2. To control the curve when brace treatment has failed.
3. To improve an undesired cosmetic appearance.
4. For reasons of discomfort or postural fatigue.

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SCOLIOSIS TREATMENT

The treatment and management of scoliosis involves bracing or surgery. Scoliosis is monitored regularly and carefully to evaluate progression of the curvature. Treatment is usually reserved for curvatures greater than 20 degrees. Surgery is usually recommended for curvatures greater than 50 degrees.

The goals of treatment for scoliosis include:

* Good cosmetic outcome
* Avoidance of complications in adulthood, such as lung disease due to restriction in deformed chest cavity

TREAT IT RIGHT, HEAL IT RIGHT

1. The most common surgical treatment for scoliosis is a spine fusion using special stainless steel rods, hooks, and a bone graft. The rods are attached to the spine with hooks and the curved portion of the spine is carefully straightened. Then, small strips of bone graft are placed over the spine to fuse it in a straight position.

   As the bone graft heals over the next several months, the spine becomes solid and will not curve again. But the part of the spine that has not been fused will still be flexible, and allow nearly normal overall movement.

   .
2. Treatment list for Scoliosis:
   The list of treatments mentioned in various sources for Scoliosis includes the following list. Always seek professional medical advice about any treatment or change in treatment plans.

   * Watchful waiting - mild conditions may require no treatment other than monitoring for worsening.
   * Treatment of any underlying cause of scoliosis
   * Bracing
   o Spinal cast
   o Spinal brace
   o Milwaukee brace
   o Thoracolumbosacral orthosis (TLSO)
   * Surgery
   * Other treatments that have not been successful
   o Chiropractic manipulation
   o Electrical stimulation
   o Nutritional supplementation
   o Exercise - not successful in correcting scoliosis but desirable to maintain mobility.
   * Supportive treatments to cope with the spinal curvature:
   o Built-up shoe - if one leg is longer than the other
   

Milwaukee Brace

This brace covers the entire torso. It has a an area to rest the chin, and a headrest for the back of the head. One flat bar travels down the front, and two flat bars travel down the back. This type of brace is used for scoliosis occurring at any point along the spine.

Thoracolumbosacral Orthosis (TLSO) or Boston Brace

This brace is a bit less chunky and obvious than the Milwaukee brace. It doesn’t extend up under the chin or behind the head. Instead, it stays under your arms, and wraps around the back, rib cage, lower back, and hips.

Charleston Bending Brace

This is a brace that’s worn only at night. Questions remain about its effectiveness.

SpineCor

Researchers are still looking into this new type of brace that consists of a cotton vest and adjustable bands. Its effectiveness is still being evaluated.

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Goals

FOR UNDERSTANDING SURGERY

Surgery is usually reserved for severe cases of scoliosis with a degree of curvature over 40 to 50 degrees.

The goals of surgery are to:

* Stop the progression of scoliosis
* Improve cosmetic appearance
* Prevent further complications, such as eventual pressure on heart and lungs

Many types of techniques can be used for scoliosis. They all have the following in common:

* Efforts to restore symmetry to the torso and pelvic areas
* Fusing (permanently joining) the back bones (vertebrae) in the area of the curve
* Supporting the vertebrae with any of a number of devices, such as steel rods, screws, or hooks

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Scoliosis is, surprisingly, quite common. About three or four children per thousand of the general population will need specialist supervision, and about one child in every thousand will need hospital treatment usually for major corrective surgery with the insertion of a (permanent) metal rod, sometimes followed by a period in a plaster jacket or brace. Scoliosis can develop at any time during childhood and adolescence. It might develop in infancy, in which case there is a good chance of it resolving with growth. Progressive (worsening) early onset curvatures are potentially serious, and some of these may need surgical treatment. Late onset scoliosis is less serious, but some will need surgery and all need to be seen by a scoliosis specialist who can keep an eye on the situation and give some idea about the future. Severe deformity, which is uncommon nowadays because of modern treatment, can lead to damaged lung function, or disability in middle age. The lungs are usually affected only in people with untreated early onset thoracic scoliosis, when the upper (chest) part of the spine is curved.

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A child with a curve between 10 and 20 degrees should be examined periodically and treatment begun if the curve exceeds 20 degrees (or, depending on other factors, such as location, 25 degrees). Curves that are discovered when they exceed 20 degrees should get treated immediately, if there is still a potential for growth.

Treatment Options Treatment options include bracing and surgery. Bracing works well for curves of up to 45 degrees. The smaller the curve, the more effective the brace. Beyond 45 degrees, a brace will be ineffective, and surgery is the treatment of choice. Early detection and treatment with a brace may therefore prevent worsening that would require surgery. Because braces work so well if treatment is started early, early detection of curves should be a major objective. Medical doctors, especially orthopedic surgeons, have instituted aggressive educational campaigns to increase the likelihood that children with significant curvature will be found early.

The Scoliosis Research Society and the American Academy of Orthopaedic Surgeons have promoted these campaigns. Pediatricians now routinely screen children on a regular basis. School screening programs are almost universal across the United States. As these programs became more prevalent, the rates for surgery dropped dramatically. Surgery is reserved for those children whose curves were discovered when they were too large for a brace, or the approximately 10% of children who fail brace treatment. The medical profession would like to be able to offer a treatment that is easier and more pleasant than a brace. Much effort and research have been put into developing more comfortable and more effective braces, so that treatment is better tolerated and surgery can be avoided. Over the years many alternative treatments have been proposed. These include spinal manipulation, massage therapy, exercising, and electric stimulation. Unfortunately, when subjected to rigorous scientific testing, these approaches have been found to be either worthless or much less effective than bracing. Surgery is the only treatment method that can significantly lower the magnitude of a scoliotic curve.

The goal of brace management is to stop the curve from worsening. Remember that a patient with a curve maintained at a small degree is indistinguishable from a patient with no curve. For the majority of patients there is no advantage in lessening the magnitude of the curve. Curves of 60 degrees or more, which are rare, present a special problems. Even after the child finishes growing, there is a strong likelihood the curve will continue to progress. This leads to significant deformity of the chest and interference with the function of the heart and lungs. The muscles are displaced and can cause pain. With time, the unequal forces on the spine lead to arthritis. No treatment other than surgery has ever been shown to work for these patients. The Bottom Line The mainstay of scoliosis management is early detection. If the curve progresses to the point that treatment is needed, a brace is prescribed. In 90% of such cases, a brace will work very well. Scoliosis screening programs have drastically reduced the number of children who need surgery.

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What About Surgery for Scoliosis?

1. Option 3. Surgery
   For those persons who already have a significant curve with a significant deformity surgery can reduce the curve and significantly reduce the deformity. Usually surgery is reserved for teen and pre-teens who already have a curve around 40 degrees or more. In our practice we tend to be more aggressive than many in doing surgery around 40 degrees while there are many excellent surgeons who defer to 45 or 50 degrees. In the adult age range the reasons for doing surgery are less well defined but include an increasing discomfort or pain in a curve that appears to have increased. For many women the deformity in the hip line and the increasing discomfort combine to make surgery a reasonable option. Many persons note the increasing deformity in the chest coupled with an increase in the rib hump. For those persons surgery can ( not always and certainly not guaranteed) reduce the deformity and the discomfort or pain.

   Surgery however is a big deal and not to be undertaken lightly. We invariably use metal rods or screws to help straighten and hold the spine in the corrected position.

2. The usual scoliosis curve is a thoracic curve ( i.e. at the level of the chest.) In these curves the procedure is a posterior spinal fusion. A fusion is a procedure where the individual bones are made solid each to the one above and below. Typically 10 or more segments are included. In order to first get as much correction of the curve, multiple hooks or wires are attached to the back of the individual vertebra and then these are connected to one or two metal rods which have been pre-bent to the desired contour. The correction is done and then little bits of bone are flaked off the back of the vertebra so that when healing occurs the flakes of bone cross and become solid. The metal rod hopefully holds the correction until it is solid approximately in one year.
3. Keeping adding a piece until you are saying the whole word or phrase.
   

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Scoliosis is a three dimensional problem. It is easy to think of the curves from looking at the back or the front; but the side view also must be considered. Flattening of the normal roundness to the side view of the back affects the general look of the back and the person. One of the aims of surgery is to try to restore the normal contour of the back from both the front view and the side view..

This method goes in through the chest using three or four small incisions to reach the front of the spine. Once inside the chest the spine is clearly visible and "soft" tissues can be cleaned off exposing the spine. The discs are easily seen and can be removed.

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A physical therapist said that several of his clients have reported improvements in their spinal curvature through therapy sessions with him. This is noteworthy because he does ergonomic consulting and specializes in repetitive stress injuries, not scoliosis. Interestingly, he and the other therapists in his clinic do focus a lot on posture and body alignment, the same techniques that were popular for scoliosis treatment in the U.S. earlier in the century.

The November, 1999 issue of Redbook magazine contains another example of someone who had success with an alternative treatment for scoliosis. In an interview with Laura Dern, the actress is quoted as saying that she had an extreme S curve in her spine when she was 9. She told the interviewer that all of the doctors and specialists she went to advised her and her mom that she had six months before she would have to be put in a brace from the neck down. According to Ms. Dern, they all said, "Forget it, there's no hope." Her mother refused to accept this diagnosis and took daughter to a "bunch of chiropractors and healers." Ms. Dern said the person who helped her the most was an osteopath. She is quoted in the article as stating, "My mom took me there twice a week, and within six months I was absolutely fine. I never had to wear a brace."

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SCOLIOSIS SURGERY TREATMENT

This was a teenager with an increasing curve out of balance. Note the return of the center of gravity.

SAY IT RIGHT, HEAR IT RIGHT

1. Dr. Hawes has written a book, inspired by her experience with spinal curvature, called Scoliosis and the Human Spine: A critical review of clinical approaches to the treatment of spinal deformity in the United States, and a proposal for change. The NSF site describes the book as " an exhaustive analysis of the peer-reviewed literature describing the history, biology, and clinical approach to treatment of spinal deformity, and includes a bibliography of more than 700 medical and scientific papers. (For an excerpt of this book, see my section on Scoliosis Treatment.)

   If your doctor has told you that you need surgery to correct your scoliosis or face dire health consequences, you might want to invest in buying this book first. It will give you some information on the dangers, potential complications and drawbacks of spinal surgery.

   .
2. "Not only had my curvature stabilized in childhood in correlation with daily strengthening exercises despite my surgeon's dire predictions (the magnitude of my curve was virtually unchanged three decades after diagnosis), but it had reversed in middle age with daily mobilization exercises despite the popular belief that adult scoliosis is untreatable except by surgery".
   (Emphasis added)

   Excerpt from Scoliosis and the Human Spine
   by Martha C. Hawes, PhD.

3. Another example came from a physical therapist in New Zealand. He argues that physical therapy is considered a medically approved scoliosis treatment option in New Zealand, and unlike the U.S., doctors there do routinely refer scoliosis patients for physical therapy. He reports that, in many cases, scoliosis "absolutely, absolutely" responds to treatment. He told me that he has had the greatest success in treating the milder curves.
   

Contrary to popular medical dogma that exercise therapy isn't effective for scoliosis, with the help of my physical therapist and some good books, I was able to reduce most of my scoliotic curves with exercises, trigger point therapy and yoga. Orthopedic surgeons of today often state that exercise and physical therapy can't help spinal curvature, but this wasn't always a commonly held belief by medical doctors.

In the early 1900s, a form of physical therapy referred to as "gymnastics" was often the treatment of choice for mild scoliosis. When they referred to gymnastics in those days, they didn't mean the kind of competitive gymnastics you see on ESPN or the Olympics. It was actually their term for what we would call physical therapy today. Therapeutic gymnastics from the early 1900's involved stretching, exercises and the use of traction from machines that had names like "trunk bending apparatus" and "shoulder pushing apparatus". The apparatus equipment of the early 20th century was similar to modern traction equipment.

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Goals

FMORE ALTERNATIVE TREATMENT FOR SCOLIOSIS

Surgery is usually reserved for severe cases of scoliosis with a degree of curvature over 40 to 50 degrees.

.

Physical Therapy for Scoliosis

Scoliosis: Before and After Pictures from an early 20th Century Exercise Program

Left photo - Patient with left dorsal curve in 1900. Right photo - Same patient in 1905 after five years of exercise and stretching treatment from a technique that was advocated by orthopedic surgeons in the early 1900s but has unfortunately fallen out of favor in recent decades in favor of surgery and bracing.

Source: page 133, Lateral Curvature of the Spine and Round Shoulders, Robert W. Lovett, M.D., John B. and Buckminster Brown Professor of Orthopedic Surgery, Harvard Medical School. Published 1916, by P. Blakiston's Son & Co., Philadelphia. Third Edition.

Contrary to popular medical dogma that exercise therapy isn't effective for scoliosis, with the help of my physical therapist and some good books, I was able to reduce most of my scoliotic curves with exercises, trigger point therapy and yoga. Orthopedic surgeons of today often state that exercise and physical therapy can't help spinal curvature, but this wasn't always a commonly held belief by medical doctors.

In the early 1900s, a form of physical therapy referred to as "gymnastics" was often the treatment of choice for mild scoliosis. When they referred to gymnastics in those days, they didn't mean the kind of competitive gymnastics you see on ESPN or the Olympics. It was actually their term for what we would call physical therapy today. Therapeutic gymnastics from the early 1900's involved stretching, exercises and the use of traction from machines that had names like "trunk bending apparatus" and "shoulder pushing apparatus". The apparatus equipment of the early 20th century was similar to modern traction equipment.

On page 135 of Lateral Curvature of the Spine and Round Shoulders, published in 1916, the author, Dr. Robert W. Lovett writes that, "In mild structural scoliosis efficient gymnastics should constitute the sole treatment, and may be continued as the sole treatment so long as the improvement from one exercise period exists until the next one." (Emphasis added.) The before and after pictures shown above taken from the Lovett book illustrate a significantly reduced curve in a young woman after a number of years of gymnastic treatment.

Interestingly, many of the gymnastic stretching exercises illustrated in the Lovett book are similar to yoga poses that are often recommended today for back problems. The illustration below was taken from page 142 of the book. Note that the exercise is very similar to the cobra pose , a yoga posture commonly referred to as a back strengthener.

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Related Links:

Preoperative skeletal traction in scoliosis. - "Preoperative traction resulted in an average improvement of the curves of 34 degrees, or 41 per cent of the initial curve." from The Journal of Bone and Joint Surgery, 1975 Jul;57(5):616-9

Scoliosis treatment using a combination of manipulative and rehabilitative therapy: a retrospective case series - " The combined use of spinal manipulation and postural therapy appeared to significantly reduce the severity of the Cobb angle in all 19 subjects. These results warrant further testing of this protocol." - BMC Musculoskeletal Disorders 2004, 5:32

Treatment of adult lumbar scoliosis with axial spinal unloading using the LTX3000 Lumbar Rehabilitation System. - "Results from this study showed a significant decrease in Cobb angle measurements in the lumbar curvature during the intervention phase. Once the home intervention program was terminated, the lateral lumbar curvature reverted to baseline values (pre-intervention)." Spine. 2002 Feb 1;27(3):E71-9

Disclaimer: Statements and information regarding any products mentioned within this site have not been evaluated by the Food and Drug Administration and are not intended to diagnose, treat, cure, or prevent any disease or health condition. Any information on this site should be considered as general information only and should not be used to diagnose or treat any health condition.

See your health care provider for a diagnosis and treatment of any medical concerns you may have, and before implementing any diet, supplement, exercise or other lifestyle changes.

How This Book Specifically Helped One Person's Scoliosis

In order to correct her scoliosis, she had to use "reverse engineering." She had to figure out where her muscles were tight and where they were stretched out, and then try to strengthen the weak muscles and stretch out the tight muscles. The Backcare Basics book is good because it has sections on how to determine where your muscles are tight and then

Here's a picture she drew to illustrate what was wrong with her body when her scoliosis was at its worst. The big knotted muscles in my shoulder at point A and leg at points C and D were causing tension across her whole side and caused her spine to bend and buckle.

The shaded areas show where she had a lot of tension in her body. At point B, she developed a frozen shoulder. By the time she hit her thirties, her shoulder was simply under too much muscular stress to move freely. After relaxing the knotted muscles at points A and C, and loosening up and strengthening my right shoulder at point B, she's slowly getting her body to look more normal and her spine fairly straight.

SStructural Yoga Therapy

Structural Yoga Therapy: Adapting to the Individual

This is another excellent book on using yoga to correct specific postural and orthopedic problems, with a good deal of information specifically on scoliosis. I found this book after I'd corrected a lot of my own spinal curve, but it is interesting to note that many of the postures the author recommends are either the same, or very similar, to the postures I found on my own through trial and error. While my scoliosis probably improved 85% from when it was at it's worst, I'm using this book now to try to" fine tune" my body even more and eliminate the rest of my curve and other structural imbalances.

This book specifically has poses to do to not just for scoliosis but also many of the associated conditions such as one shoulder higher than the other, a tilted head, winged scapula, kyphosis, forward heard, high hips, round shoulders and many more.

It is much more detailed and comprehensive than the Back Care Basics book. If you have never tried yoga before you might want to start off with Back Care Basics. But if you are already sold on the benefits of yoga and want more detailed information on how to use yoga to solve your pain and structural problems, then this book might be a good one to read as well.

Some yoga books that are supposedly for specific conditions are often in reality just pretty pictures of models doing yoga poses that involve the body part in question. Both the Back Care Basics and Structural Yoga Therapy books are different because they both have sections on how to determine where your muscles are unbalanced and then suggest specific poses based on individual issues.

If you understand what I'm saying about "reverse engineering your body" and correcting your postural imbalances, then these are both great books to get. Structural Yoga Therapy is especially very detailed and comprehensive. While it does have some basic routines that people that are helpful for people with scoliosis and other structural problems, the author really focuses on providing information charts and exercises to help people to understand where their muscles are tight and unbalanced and which specific exercises they should do for their individual orthopedic problems.

With scoliosis, I don't think there are many blanket exercises that people can do to correct their curves. Some people may have a double curve with even shoulders, some may have a single curve with a high left shoulder, some a high right shoulder, etc. Books and videos that do not show you how to develop an individualized, personalized routine just for your specific imbalances, are in my opinion, likely to be a waste of money.

Joint freeing series - especially good if you have scoliosis with tight shoulder muscles like I do. (Chapter 15)

Head to Knee Pose - I hold this pose longer when I'm stretching on the right (concave side) of my curve where the muscles are shorter and the hip is higher to try to get the paraspinal muscles on that side on my body even in length with my left side. I think over time this has helped my spine to become straighter by not being pulled out of alignment by tighter muscles on one side on my body.

Spinal and Abdominal Twists - When I do these I can feel the muscles in my high shoulder being stretched out and pulled down, which weakens them. In my case this is good because right now they are overly tight and overdeveloped, so I want to try to get the muscles in my left shoulder weaker and the muscles in my right shoulder stronger.

I do a lot of abdominal twists with my knes to the left to stretch out my high left shoulder. Then I do the extended triangle with my right hand up only to strengthen the muscles on the right shoulder, because there the shoulder muscles are weak and stretched out from years of being pulled down my tight leg muscles in my right leg.

IS THIS WHAT YOU WANT?

Tips and notes on trigger points and self-massage:

I tried acupuncture and it did not help me at all. In looking back it seems silly to think that putting needles in my arm was going to help me when the real problem was that one of my arms was hanging two inches lowers than the other. What really helped was stretching and massaging the trigger points in the tight areas of my body to bring my muscles and bones into better alignment.

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* Two rubber balls (similar to tennis balls) connected together. I don't know what the actual product name is. I roll on them with one ball on either side of your spine and it massages the trigger points along my spine. My friend has a homemade one that is two tennis balls taped together.
* Small, hard, back roller - this is about the size of a rolling pin. I roll on it on the floor and it helps stretch out my back. I use it for my legs, too.
*
I bought a trigger point tool for massaging my back.. This is a cane shaped tool with knobs all over it. The shape of the cane makes it easy to massage your own trigger points, especially in hard to reach places. It's expensive, but I found it worth it. I've know of several other people with back problems who thought these types of product were also effective.
* Massage balls - these are balls with bumps that massage my muscles when I roll on them. Tennis balls will work, too, but the massage balls are more effective. My yoga teacher recommended just rolling around on a tennis ball.
* "Ball on the Wall" - One of my physical therapists gave me this idea. He had me put a tennis ball in a sock. Then he had me sit up against that wall dangling the tennis ball behind me while at the same time massaging my back by rolling it on the tennis ball. Having the tennis ball in a sock makes it easy to move round to reach different parts of your back..

1. 21st Century Back Care
2. Advanced Biostructural Correction
3. Alternative Treatments
4. ASCO Scoliosis Treatment
5. Asklepios Katharina-Schroth-Klinik, Bad Sobernheim
6. Atlas Orthogonal
7. Biomechanical Analysis, Correction & Retraining
8. Bodyquake Clinic
9. Botulinum Toxin Injection
10. Botulinum Toxin Injection
11. Bowen Therapy
12. Bowen Therapy
13. Chronic Pain: When Surgery is not an Option
14. Copes Foundation - Northeast Treatment Center
15. Curve-Menders
16. Egoscue Method
17. Exercising with Scoliosis and Knee Problems
18. Hazuka Chiropractic and STRS Center
19. Healing of Movement Disabilities
20. Jin Shin Jyutsu
21. Katherina Schroth Treatment in Bad Salzungen, Germany
22. The Luklinski Back Pain Clinic - Free Online Diagnosis
23. Matrix Repatterning
24. Muscle Balance and Function Development
25. Myofascial Release
26. Neuroskeletal Dynamics: Non-Manipulative Skeletal Alignment
27. Network Spinal Analysis
28. Non-Surgical Scoliosis Treatment
29. Northpoint Natural Health
30. Pain & Posture Clinic
31. Pilates London
32. Pneumex
33. Prolotherapy
34. Prolotherapy: Scoliosis
35. Postural Alignment Therapy
36. Psoas Therapy: Unraveling Scoliosis
37. Raindrop Therapy
38. Raindrop Therapy and You
39. Raindrop Therapy: A Critical Look
40. Raindrop Therapy - White Paper
41. Reader's Email about Exercises instead of Bracing
42. Reader's Email about Scoliosis in Children
43. The Rolf Method of Structural Integration
44. Rolfing
45. Sacro Wedgy
46. Scoliosis: A Case Study of Deep Tissue Massage Therapy
47. Scoliosis and Proprioception (Rolfing)
48. Scoliosis and Rhythmic Gymnastics
49. Scoliosis in HCTDs and Idiopathic Scoliosis
50. Scoliosis Complex Program
51. Scoliosis Complex Program
52. Scoliosis Complex Program
53. Self Controlled Energo-Neuro Adaptive Regulator
54. Spinal Traction
55. Supplemental Treatments
56. Vivatek Healing Machine

 

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