Scoliosis

ScoliosisEveryone's spine has natural curves. These curves round our shoulders and make our lower back curve slightly inward. However, some people have spines that also curve from side to side and rotate; this condition is called scoliosis. The abnormal curves occur most often during the growth spurt just before puberty.

Scoliosis is diagnosed as one of three types:

  • Idiopathic, which means of unknown origin. More than 80 percent of scoliosis cases are idiopathic.
  • Congenital, in which the bones are asymmetrical at birth.
  • Neuromuscular, in which the scoliosis is symptomatic of a systemic condition, such as cerebral palsy, muscular dystrophy or paralysis.
DIAGNOSIS

After a physical examination, scoliosis can be confirmed with a diagnostic exam such as an X-ray. ln rare instances, magnetic resonance imaging (MRI) of the spine is used for diagnosis if spinal injury is suspected. The curve is then measured and discussed in terms of degrees. Generally, a curve is considered significant if it is greater than 25 to 30 degrees. Curves exceeding 45 to 50 degrees are considered more severe.

The standard radiography (i.e. x-ray) measurement technique for all forms of scoliosis is the ‘Cobb angle’, in which the curve is measured from the most tilted vertebrae in a standing radiograph.

TREATMENT

Treating scoliosis depends on the curve, the age of the patient, and other factors. Observation may be an appropriate treatment option for small spinal curves. Follow-up visits are recommended every 4, 6, 9, or 12 months, depending on the patient's age, the degree of the curve and the characteristics of the clinical deformity.

If the curve needs to be corrected (> 25°), a brace is usually the first option. Most scoliosis curves never progress to the point where surgery is necessary.

Spinal fusion is the most common surgery to correct severe scoliosis. lt is typically used to correct curves in the spine that are greater than 45 degrees or spinal curves that have not responded to bracing. Spinal fusion will connect two or more of the affected vertebrae permanently. Surgeons insert pieces of bone between the vertebrae and then fasten the vertebrae together with metal rods and screws until the spine heals together in a corrected position.

The two goals for scoliosis surgery are to stop a curve from worsening and to correct spinal deformities.

Kyphosis

kyphosis pediatricA normal thoracic spine extends from the first to the twelfth thoracic vertebrae, which are attached to the ribs, and should have a slight kyphosis ranging from 20 to 45 degrees. When the "roundness" of the upper spine increases past 45 degrees, it is called "hyperkyphosis". Adolescent (Scheuermann's) kyphosis is the most classic form of hyperkyphosis and is the result of wedged vertebrae that may develop during adolescence. The cause is not currently known and the condition appears to be multi-factorial. lt is seen more frequently in males than females.

DIAGNOSIS

After a physical examination, the doctor may ask for imaging support such as an X-ray. Plain X-rays are used to determine the degree of curvature and can detect deformities of the vertebrae, which help identify the type of kyphosis. If more detail is required, the doctor might order a CT scan to see the internal structures. 

TREATMENT

Kyphosis treatment depends on the cause of the condition and the signs and symptoms that are present. Some types of kyphosis can be helped by exercising and bracing.

If the kyphosis curve is very severe or if the curve is pinching the spinal cord or nerve roots, the doctor might suggest surgery to reduce the degree of curvature. The most common procedure, called spinal fusion, connects two or more of the affected vertebrae permanently. Surgeons insert pieces of bone between the vertebrae and then fasten the vertebrae together with metal rods and screws until the spine heals together in a corrected position.

 

Spondylolysis

Spondylolysis pediatricThe pars interarticularis is a portion of the lumbar spine that joins the upper and lower joints together. After approximately 8 years of age, some people begin to experience abnormal growth and development of this particular region in the bone. If the pars separates or fractures, the condition is called Spondylolysis.

DIAGNOSIS

The doctor will begin by performing a physical examination and may order X-ray studies of the spine. However, sometimes it is difficult to see a crack and/or slippage on an X-ray image, so additional tests may be needed.

A computed tomography (CT) scan can show a crack or defect in the bone more clearly.

A magnetic resonance imaging (MRI) scan may be ordered to clearly show the soft tissue structures of the spine (including the nerves and discs between the vertebrae) and their relationship to the cracked vertebra and any slippage. lt will also show whether any of the nearby discs have suffered any wear and tear because of the spondylolisthesis (slippage).

TREATMENT

The recommended treatment program for active spondylolysis is usually a combination of medication, bracing and exercises.

With a spondylolisthesis, doctors will first try non-surgical treatment, such as medication, bracing, physical therapy or others. If the pain cannot be relieved by nonsurgical treatment methods, surgery may be an option.

The pain may be caused by a pinched nerve, movement of the unstable cracked vertebra, or nearby affected discs, which need to be repaired with a surgery.