Scoliosis

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Scoliosis is an abnormal curve in the spine. There are several types of scoliosis based on the cause and age when the curve develops. Depending on the severity of the curve and the risk for it getting worse, scoliosis can be treated with observation, bracing, or surgery. Causes of Scoliosis Over 80 % of scoliosis is idiopathic, meaning they arise from an unknown cuase. It is subdivided into types based on the aged the defects develop. 1. 2. 3. 4. Infantile idiopathic scoliosis starts to appear in children less than three years old Juvenile idiopathic scoliosis starts to develop between 3 and 10 years old Adolescent idiopathic scoliosis starts to develop in people that are over 10 years of age Adult idiopathic scoliosis starts to develop in people who have reach their skeletal maturity (their bones are fully grown) Types of Scoliosis Congenital The term congenital means present at birth. Congenital scoliosis is the result of the malformation of part of the spine; this malformation happens sometime in the third to sixth weeks of pregnancy, when the spine is still forming to develop. Functional: In this type of scoliosis, the spine is normal, but an abnormal curve develops because of a problem somewhere else in the body. This could be caused by one leg being shorter than the other or by muscle spasms in the back. Neuromuscular: In this type of scoliosis, there is a problem when the bones of the spine are formed. Either the bones of the spine fail to form completely or they fail to separate from each other during fetal development. This type of scoliosis develops in people with other disorders, including defects, muscular, cerebral palsy, or Marfan's disease. People with these conditions often develop a long C-shaped curve and have weak muscles that are unable to hold them up straight. If the curve is present at birth, it is called congenital. This type of scoliosis is often much more severe and needs more aggressive treatment than other forms of scoliosis. Degenerative: Unlike the other forms of scoliosis that are found in children andteens, degenerative scoliosis occurs in older adults. It is caused by changes in the spine due to arthritis known as spondylosis. Weakening of the normal ligaments and other soft tissues of the spine combined with abnormal bone spurs can lead to an abnormal curvature of the spine. The spine can also be affected by osteoporosis, vertebral compression fractures, and disc degeneration.

Classification of Scoilisis y y y Mild - <25 curvature Moderate 25-40 curvature Severe - >40 curvature

Signs and Symptoms

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Lateral curvature of the spine 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. Diagnostic Test Adam's Forward Bend Test. The screening test used most often in schools and in the offices of pediatricians and primary care doctors is called the Adam's forward bend test. The child bends forward dangling the arms, with the feet together and knees straight. The curve of structural scoliosis is more apparent when bending over. In a child with scoliosis, the examiner may observe an imbalanced rib cage, with one side being higher than the other, or other deformities. The forward bend test is used most often in schools and doctor's offices to screen for scoliosis. During the test, the child bends forward with the feet together and knees straight while dangling the arms. Any imbalances in the rib cage or other deformities along the back could be a sign of scoliosis. The forward bend test, however, is not sensitive to abnormalities in the lower back, a very common site for scoliosis. Because the test misses about 15% of scoliosis cases, many experts do not recommend it as the sole method for screening for scoliosis. Other Physical Tests.
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The patient walks on the toes, then the heels, and then jumps up and down on one foot. Such activities indicate leg strength and balance.

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The doctor will check leg length and look for tight tendons in the back of the leg, which may cause an uneven leg length or other back problems. The doctor will also check for neurological impairment by testing reflexes, nerve sensation, and muscle function.

Identifying the Curvature Proper diagnosis is important. A misjudgment can lead to unnecessary x-rays and stressful treatments in children not actually at risk for progression. Unfortunately, although measurements of curves and rotation are useful, no test exists yet to determine whether a curve will progress. Inclinometer (Scoliometer). An inclinometer, also known as a scoliometer, measures distortions of the torso. The procedure is as follows:
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The patient bends over, arms dangling and palms pressed together, until a curve can be observed in the upper back (thoracic area). The Scoliometer is placed on the back and measures the apex (the highest point) of the upper back curve. The patient continues bending until the curve can be seen in the lower back (lumbar area). The apex of this curve is also measured. Measurements are repeated twice, with the patient returning to a standing position between repetitions. If results show a deformity, the patient will probably need x-rays to determine the extent of the problem.

X-Rays. If screening indicates scoliosis, the child may be sent to a specialist who takes an initial x-ray and monitors the child every few months using repeated x-rays. X-rays are essential for an accurate diagnosis of scoliosis:
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They reveal the degree and severity of scoliosis. They show other spinal abnormalities, including kyphosis (hunchback) and hyperlordosis (swayback). X-rays help the doctor determine whether skeletal growth has reached maturity. X-rays taken when patients are bending forward can also help differentiate between structural and nonstructural scoliosis. Structural curves persist when a person bends over, and nonstructural curves tend to disappear. (Muscle spasms or spinal growths may sometimes cause nonstructural scoliosis that shows a curve on bending.) Children and young adolescents who have mild curves, and older adolescents, who have more severe curvatures but whose growth has stopped or slowed, need x-rays every few months to detect increasing severity. Young people who are diagnosed with scoliosis should keep their x-rays indefinitely in case they develop back problems later in adulthood and need to be re-examined. Magnetic Resonance Imaging. Magnetic resonance imaging (MRI) is an advanced imaging procedure that does not use radiation, as x-rays do. It is expensive, however, and not generally used for an initial diagnosis. MRI can, nevertheless, identify spinal cord and brain stem abnormalities, which some studies indicate may be more prevalent than

previously believed in children with idiopathic scoliosis. It also may be particularly useful before surgery for detecting defects that could lead to potential complications. Determining the Extent of the Curve There are various methods for determining and classifying the extent of the curve. Cobb Method. The technique known as the Cobb method nearly always calculates the degree of the curve.
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On an x-ray of the spine, the examiner draws two lines: One line extends out and up from the edge of the top vertebrae of the curve. The second line extends out and down from the bottom vertebrae. The technician then draws a perpendicular line between the two lines. Measuring the intersecting angle determines the degree of curvature. Treatment of Scoliosis

The majority of cases of scoliosis do not require treatment.

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If the curve is less than 25, no treatment is required, and the child can be reexamined every four to six months. If the curve is more then 25 but less than 30, a back brace may be used for treatment. Curves more than 45 will need to be evaluated for the possibility of surgical correction. Surgical correction involves fusing vertebrae together to correct the curvature and may require inserting rods next to the spine to reinforce the surgery. Treatment options depend more on how likely it is that the curve will worsen than on the angle of the curve itself. A child with a 20 curve and four more years of growth may require treatment while a child with 29 of curvature who has stopped growing may not require treatment. Brace y y Milwaukee Brace - (C shaped) full torso brace has a neck ring with rests for the child and for the back of the head Yamamoto Brace (S-shaped) gives more emphasis on posture, strengthening of muscles and correction of muscles imbalance.

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Surgery Spinal fusion joining of two pieces together. It involves connecting of two or more vertebra with pieces of bone taken from the pelvis.

Scoliosis: Ahead of the curve

A spinal defect caused Newsnight's Madeleine Holt years of pain she even wore a back brace on TV. Then she found a radical new treatment. By Esther Walker 'I have been on a seven-year back odyssey,' says Madeleine Holt, as she hangs from a set of wall bars to demonstrate her daily back exercises. "When I was 14 and diagnosed with scoliosis, I felt quite excited I was special. But then later on, I realised what it really meant." What it would mean for her was years of chronic neck pain, thousands of pounds spent searching for a cure and a whole year of wearing a brace round the clock even on television for her job as Newsnight's culture correspondent. Scoliosis an abnormal curvature of the spine affects three or four children in every 1,000. It gets worse with age and can be identified by the Adam's Forward Bend Test, which used to be common in school medical exams; the patient bends at the hips, with the feet together and the arms hanging down. The tell-tale sign of scoliosis is when one side of the back is higher than the other. Scoliosis is more common in girls, who account for eight out of 10 cases; there is also a genetic link, with 25 per cent of sufferers having a relative with spinal curvature. The measurement of the curvature is called a Cobb angle, an angle of 10 per cent being mild and 90 per cent severe. The traditional treatment for scoliosis is a back brace, which limits the angle of curvature, or, in more extreme cases, surgery to insert metal rods in the spine. The latter became more commonplace after the invention of the Harrington Rod, which was inserted into the back and fused to the spine, holding it straight. Although modern implants are more flexible and are extendable, surgery for scoliosis carries the same risks as any other. "I was fine until I was 27," says Holt, now 42. "I was working as a reporter for the BBC, and there was a lot of standing around and then sitting at a computer. Considering my condition, it was probably the worst job I could have had. I started to get chronic pain in my neck and upper back, which would start after I had been sitting or standing for 20 minutes. The only thing that helped was either a hot bath or a stiff drink." By the time she was 34, the pain was unbearable and, worried that it would be difficult to have children and continue working with the condition, she embarked on a mission to find an effective treatment. "I found a clinic in Louisiana, which promised to eliminate pain and straighten your spine. I went to the States four times and spent thousands of pounds having a fibreglass brace fitted from my hips to my shoulders, which I wore for 18 hours a day. I would wear it while I was interviewing people on television." After a year, this had little effect, so Holt went back to the NHS. "The consultant laughed when he saw the brace, and said that scoliosis doesn't cause pain; he said that any pain I was feeling was psychosomatic. Then he asked me if I was single or depressed. I was certainly depressed after seeing him."

Holt also went to Australia to try foot orthotics, and even bought a hydraulically powered handset, which had some effect, but didn't eliminate the chronic pain in her neck. Then last December, Holt found out about a new clinic, called Scoliosis SOS in Suffolk, which offered the Katharina Schroth method, a physiotherapy-based set of exercises to "re-educate" the back muscles. Once they are taught the techniques, the patient must do half an hour a day of maintenance exercises. The clinic was set up last year by 19-year-old Erika Maude (see box, below). Maude was diagnosed with scoliosis when she was 11 and found the Schroth method so effective that she established a clinic in Surrey. It treats up to 35 patients, of all ages and with varying degrees of scoliosis. Dr Olga Gronowska-Szczecina has been working at the clinic since it opened. Originally from Poland, she practised general medicine there. "In Europe and America, it is more common to treat scoliosis with exercises rather than surgery," she says. "Perhaps surgeons here are told that this is what scoliosis is and you treat it with surgery. We have dealt with some really severe cases of scoliosis here an 80 or 90 degree Cobb angle, and where there have been problems with the heart and the lungs. Some patients have had difficulty breathing, but with this method there has been great improvement. "There has also been improvement with pain management. It is not true to say that scoliosis doesn't cause pain. Those that come to the clinic with pain usually leave without any. There is really not enough attention paid to this condition in this country. A comprehensive screening programme using the Adam's Forward Bend Test would be the best way to improve early diagnosis." The Katharina Schroth treatment works with both the muscles and the skeleton. The programme consists of exercises, using props such as small beanbags, pipes, poles and wall bars to correct the typically asymmetrical scoliotic posture. Because scoliosis affects each individual differently, patients have a tailor-made exercise programme. "It was a revelation," says Holt. "After going to the clinic for a month, my neck had de-rotated by two-thirds and all the pain had gone. I was two centimetres taller and I looked straighter, partly because my posture was so much better, but also because my muscles were pulling my body into a more aligned position. My spine is still curved, but is shows much less. I have to do the exercises every day, which is not easy with two small children. But it is worth it. "One of the best things about Erika's clinic was that I met so many people who had such similar stories to mine," adds Holt. "For me, it blew the theory that scoliosis doesn't cause pain out of the water. Some of us had tried all sorts of weird things before we found the clinic; others had had surgery that had been ineffective. It was poignant at times; scoliosis often affects people who are hyper-mobile, which is another way of saying that you're bendy, so there were young girls there who wanted to be ballerinas but now couldn't because of the condition. There were people there who could barely walk. It's not cheap it cost me 2,400 but the results of the Schroth method are extraordinary as long as I do my exercises, I have no pain."

The dangers of any surgery are well-documented and, even with scoliosis surgery, only 50 per cent of a spinal curvature can be corrected. In 2001, a 15-year-old boy from East Anglia was left paralysed from the chest down after an operation to correct the curvature of his spine went wrong. Another problem with surgery for scoliosis is that the waiting lists are so long that a patient's curvature can increase significantly during that time; scoliosis usually starts to become noticeable during the emotionally awkward time of adolescence. At the moment, there is no national recommendation for schools to test for scoliosis using the Adam's Forward Bend Test. Clinical studies in the US and Germany have revealed that the Adam's test returns too many false-negative results to be considered reliable. Whether you are tested for scoliosis in school or by your GP, currently depends on local authority policy. "What makes me happy," says Holt, "is that I've found out that they are planning to re-introduce school nurses by 2010. The Adam's Forward Bend Test might not be absolutely definitive, but it's a good way of catching most cases early, which is vital." The road to realignment The Schroth method has been used with some success in Europe since 1921. The only other dedicated clinics offering the Schroth method in Europe are in Germany and Spain. It was brought to England by 19-year-old scoliosis sufferer , who was first diagnosed around her 11th birthday, when her mother noticed a slight hump on her right shoulder when she bent forwards. It was initially dismissed by the GP, but Erika was eventually referred to a consultant who diagnosed scoliosis, and advised her that the condition should be carefully monitored. By the time that Erika finally saw an orthopaedic surgeon at the age of 13, her Cobb angle was measured at 34deg and she was immediately fitted with a Boston Brace, which she wore for two years. A year later, however, Erika's hump had grown worse. After researching her options, in 2002 Erika took up a place at the Quera Salva clinic in Barcelona. Using the Katharina Schroth method, Erika soon halved the curvature of her spine. Erika won a scholarship from PricewaterhouseCoopers to study Business Economics and Finance at Loughborough University. In May last year, however, she turned this down to start Scoliosis SOS.

Written Report (Scoliosis)

Submitted to: Mrs. Alfie Robles Submitted by: Diane Joyce V. Gonzales