Scoliosis

Scoliosis is an abnormal curvature of the spine. A certain degree of spinal curvature is often considered normal and usually requires no formal treatment. This may not be considered an abnormal finding in some cases.

Scoliosis has many causes and can be associated with:
• Neuromuscular disorders
• Bone disease
• Soft tissue disorders

Scoliosis can occur in infancy or during adolescence.
• Infantile scoliosis is rare and typically presents itself before the
age of three.
• Adolescent idiopathic scoliosis is the most common type of scoliosis. Females are affected eight times as frequent as males.

School screening programs have provided for earlier detection
and treatment of scoliosis, which has led to improved outcomes.
A careful spinal evaluation should be part of all orthopaedic examinations. The exam should also include a thorough neurological examination and inspection for skin lesions to
rule out non-idiopathic causes.

Diagnostic evaluation:
• X-rays of the cervical, thoracic and lumbar spine should be performed to measure the exact location and degree of curvature.
• Bone scans may be indicated.

Treatment varies based on criteria including:
• Location of curve
• Type of curve
• Degree of curvature
• Age
• Underlying condition(s)
• Skeletal maturity

In general, curves less than 20 degrees can be observed and followed every six months. Curves above 20 degrees typically require bracing.

Exercise is important for maintaining flexibility and strength of spinal muscles.
Surgery is performed if the curve continues to progress despite bracing, or if the curvature angle is too severe. Curves above 50 degrees have been shown to progress over the years, and progression of a thoracic curve above 60 degrees can impair heart and lung function. Surgical fusion is important in these cases to prevent further medical problems.