Scoliosis refers to an abnormal side-to-side curvature of the spine (lateral curvature). About 1% to 3% of children between the ages of 10 and 16 have some degree of scoliosis. AIS typically starts in puberty or during an adolescent growth spurt. The spinal curvature in AIS may be to the right or left. AIS is progressive, meaning that it gets worse with time.
Causes
Current research suggests that there may be genetic factors involved in AIS. Girls are more likely than boys to have AIS.
Terminology
When the abnormal side-to-side curve occurs in children for unknown reasons, the condition is called adolescent idiopathic scoliosis (AIS). Idiopathic is a medical term that simply means “for unknown reasons” or “of unknown cause.”
Symptoms
Children with AIS may not experience any pain but may exhibit signs of having the condition. Among the most commonly reported signs and symptoms are:
- Legs of different length
- Abnormal gait
- One shoulder higher than the other
- A prominent shoulder blade or rib cage when bending forward
- Visible curvature of the spine to one side
- Uneven hips
- Hemlines or trouser lengths uneven
- Clothing does not fit correctly
Back pain, if it occurs, may range from mild to severe.
It is important to seek treatment for AIS because, left untreated, AIS can result in significant deformity. The deformity can cause marked psychological distress, especially among adolescents, and lead to permanent disability. AIS deformity can have lifelong physical consequences. As the vertebrae (spinal bones) rotate with scoliosis, the rib cage is affected, which, in turn, can restrict this area and cause heart and lung problems, a symptom of which is shortness of breath.
When progressive scoliosis affects the lumbar (low back) spine, the pain can be quite severe, even debilitating. Patients with AIS can expect pain levels to worsen as long as the condition is untreated.
Diagnosis
If scoliosis is suspected in anyone, particularly a child or adolescent, prompt and expert medical attention is required. At the Neuro Spinal Hospital, an accurate diagnosis is made, typically based on a medical history, physical examination, and neurological examination.
- Medical history will include the patient’s medical history, the medical history of the patient’s parents, and questions about symptoms. Female patients will be asked about their age at their first period. Skeletal maturity is an important consideration in the diagnosis. In some cases, skeletal maturity may cause scoliosis to stop (particularly if the curve is less than about 45 degrees). This is less likely in patients whose scoliosis curve is more than 45 degrees.
- During the physical and neurological examinations the doctor learns about the patient’s health and general fitness. Both exams provide the doctor with a baseline from which future curve progression can be estimated.
The table below describes some of the physical tests involved in an AIS diagnostic examination.
| Examination | Description |
|---|---|
| Physical assessment | The doctor looks for trunk asymmetry, such as uneven shoulders or hips, humpback, or listing to one side. |
| Cardiopulmonary | Testing heart and lung function. |
| Adam’s forward bending test | The patient bends forward at the waist, with arms extended forward. The doctor looks for asymmetric thoracic prominence, such as a shoulder blade, or a lumbar prominence. |
| Leg lenght | Both legs are measured to determine if they are of equal length. |
| Plumb line | A plumb line is suspended from the C7 vertebra (neck area) and allowed to hang below the buttocks. The plumb line does not hang between the buttocks if the patient has scoliosis. |
| Range of motion | The doctor evaluates the patient’s ability to perform flexion, extension, bending, and rotation movements. |
| Palpation | The doctor feels (“palpates”) the spine for abnormalities, in particular, if the ribs are more prominent on one side. |
| Neurological assessment | Reflexes are tested. The presence of pain, numbness, tingling, extremity weakness or sensation, muscle spasm, and bowel/bladder changes are noted. |
Other diagnostic tests are required to confirm and measure the extent of scoliosis. These are shown in the table below.
| Diagnostic Test | Description |
|---|---|
| Scoliometer | A scoliometer measures rib prominence while the patient bends forward at the waist. |
| X-rays (radiographs) | X-rays may include a standing side view (lateral) of the spine while the patient bends. |
| Cobb Angle Measurement | A full-length front-to-back (anterior-posterior) X-ray is taken to calculate the angle(s) of the curves. |
| Risser Sign | An x-ray test to measure skeletal maturity. The test evaluates the iliac crest growth plate in the pelvis; the crest fuses with the pelvis at physical maturity. |
| Nash-Moe | This test measures vertebral rotation. Rotation of the vertebral pedicle is measured by dividing the vertebral body into segments. |
| Classification | Doctors primarily use one of two classification schemes to describe scoliosis: King-Moe or Lenke. This rates the degree or severity of the scoliosis. |
Treatment
Some cases of AIS do not require spine surgery and are treated by bracing. In such cases, the patient should be closely monitored by expert physicians to assure progress and adjust therapy, as needed. In some cases, an individualised exercise or physical therapy programme may be recommended.
- Small curves (less than 15-20 degrees) are observed for possible progression over a period of time. At this stage, no specific treatment is needed.
- Larger curves (between 20-40 degrees) require bracing to prevent curve progression.
Some adolescents find wearing a brace 16 to 23 hours every day difficult. Braces can be uncomfortable, unattractive, hot, and make a young person feel self-conscious, even though the brace can be well-disguised under clothing. Despite these difficulties, bracing can be an effective treatment of scoliosis and may help to avoid surgery.
Unfortunately, some curves do not respond to bracing. As a rule of thumb, these curves are less likely to respond to bracing:
- Cervico-thoracic curves (those in the neck or the rib-level of the back)
- Curves greater than 40 degrees
- Curves, even less than 40 degrees, in children closer to skeletal maturity (older children)
In some cases, surgical intervention to treat AIS may be advisable. Scoliosis surgery usually involves spinal instrumentation (i.e. rods, screws) and fusion (bone graft). The goal of surgery is to realign and stabilize the spine. Instrumentation and fusion secure the spine to stop curve progression. Surgery does not cure scoliosis, but helps to correct and manage curve progression to prevent further deformity.
The surgeon may perform surgery through the front (anterior) or back (posterior) of the spine. There are different types of instrumentation, bone grafts and graft products, procedures, and minimally invasive techniques. The physicians at Neuro Spinal Hospital will discuss the latest treatment options with you, including surgery, if appropriate.
Prognosis
AIS can be effectively treated but requires expert medical intervention. Even relatively mild cases should be monitored to delay or prevent progression.
Risk Factors
There may be genetic factors involved in AIS.
Conclusion
Left untreated, AIS can lead to significant physical deformity, debilitating pain, and psychological distress. However, proper AIS treatment can help prevent curve progression and stabilize the spine while the child grows. Neuro Spinal Hospital physician can recommend the latest treatment options for AIS, which may alleviate symptoms and stop progression of the condition.
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