Scoliosis: Diagnosis and Treatment

By John J. Vaughan, MD

Scoliosis is a deformity of the spine that affects 2-3 percent of the population.  It is an abnormal sideways or lateral curvture of the spine.

There are many types of scoliosis. About 90 percent of patients with scoliosis have a type known as idiopathic scoliosis. We do not know what causes this type of scoliosis, but the "trait" for it tends to run in families. Other types of scoliosis are associated with neurologic, muscular, and bone diseases.

When scoliosis first develops it is usually not painful. One of the first signs of scoliosis  is a change in physical appearance. Common physical findings are one shoulder or one hip may be higher than the other side, an abnormal "crease" at the waist, or dresses and skirts may appear to have a crooked hemline. When a patient with scoliosis is viewed from behind while bending forward at the waist, a "rib hump" is frequently visible next to the spine.

Many cases of scoliosis are first discovered by the patient or a family member. In the state of Kentucky, all school children in the sixth and eighth grade school children are screened for scoliosis and spinal deformities if parental permission is given. Several cases of scoliosis are discovered this way. Also, family physicians and pediatricians can diagnosis scoliosis on physical exam.

Once the presence of scoliosis is suspected, a physician can order a spinal x-ray to confirm the diagnosis. The degree and the type of the curvature can be determined from the X-ray.

Treatment of idiopathic scoliosis is largely dictated by the degree of the curvature and by the age and skeletal maturity of the patient. In growing children and teenagers, small curves (10º to 25º) can be treated with observation. Moderate curvatures (25º to 40º) are frequently treated with a spinal brace to prevent progression of the curvature. When curvatures are greater than 45º, a spinal fusion procedure is sometimes necessary to prevent further curve progression and to correct the deformity.

 

 

 

 

The drawing on the left illustrates a scoliotic spine before surgical treatment. The drawing on the right shows the same spine after surgical treatment, which consisted of inserting Cotrel-Dubousset rods to correct the spinal deformity.

 

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Last Updated: 10/4/03