Scoliosis
Scoliosis is abnormal curvature of the spine.
See the figure Scoliosis: A Curved Spine.
Scoliosis is very common, especially among girls. Scoliosis may result from a birth defect or develop later in life, most often in adolescence. Usually, the cause cannot be found. The spine usually bulges toward the right when the curvature is in the upper back and to the left when it is in the lower back. The result is that the right shoulder is usually higher than the left. One hip may be higher than the other. Scoliosis often develops in children with kyphosis (kyphoscoliosis).
Symptoms and Diagnosis
Mild scoliosis usually produces no symptoms. Sometimes the back becomes sore or stiff after the child sits or stands for a long period of time. Mild or more severe pain may eventually follow.
Mild scoliosis may be discovered during a routine physical examination. A parent, teacher, or doctor may suspect scoliosis when one of the child's shoulders seems higher than the other or when the child's clothes do not hang straight.
In about half of affected children, scoliosis is likely to worsen. The more severe the curve, the greater the likelihood of it worsening. Likewise, the more symptoms that develop, the greater the likelihood that scoliosis will worsen.
Because scoliosis tends to worsen when the child reaches puberty, the earlier it develops, the longer it has to worsen. Thus, a small curve in a 10-year-old is of much greater concern than that same curve in a 16-year-old. Worsening scoliosis may eventually cause permanent problems, such as noticeable deformities or chronic pain. Severe scoliosis may even affect internal organs, for example, deforming and damaging the lungs. Sometimes, scoliosis can worsen even if symptoms have not developed.
To diagnose the condition, a doctor asks the child to bend forward and views the spine from behind, because the abnormal spinal curve can be seen more easily in this position. X-rays show the precise angles of curvature. If doctors think scoliosis may worsen, they may examine the child several times a year. Special devices may be used to more precisely measure the curve of the spine.
Prognosis and Treatment
In the vast majority of children who have scoliosis, the curvature will not progress more but rather remain small. However, it needs to be followed by a doctor regularly. Scoliosis that causes symptoms, is worsening, or is severe may need to be treated. The earlier treatment is begun, the better the chance of preventing a severe deformity.
A brace or object fashioned to hold the spine (orthosis) may be worn to keep the spine straight. In the most severe cases, the vertebrae need to be bonded together surgically; a metal rod may be inserted during surgery to keep the spine straight until the vertebrae have bonded permanently.
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