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Scoliosis

About: Scoliosis is an abnormal curvature of the spine. Signs and symptoms of scoliosis may include:
• Uneven shoulders; One shoulder blade that appears more prominent than the other
• Uneven waist; One hip higher than the other; Leaning to one side
• Fatigue
If a scoliosis curve gets worse, the spine will also rotate or twist, in addition to curving side to side. This
causes the ribs on one side of the body to stick out farther than on the other side. Severe scoliosis can cause
back pain and difficulty breathing.
There are three other main types of scoliosis:
+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. This type of scoliosis
develops in people with other disorders including birth defects, muscular dystrophy, cerebral palsy, or
Marfan's disease. 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 and teens, degenerative
scoliosis occurs in older adults. It is caused by changes in the spine due to arthritis. 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.
+Others: There are other potential causes of scoliosis, including spine tumors such as osteoid osteoma. This
is a benign tumor that can occur in the spine and cause pain. The pain causes people to lean to the opposite
side to reduce he amount of pressure applied to the tumor. This can lead to a spinal deformity.

Causes: Doctors don't know what causes the most common type of scoliosis. When a cause can't be
identified, scoliosis is called idiopathic.
Sometimes, an underlying disease that affects the neuromuscular system, a leg-length discrepancy or a birth
defect may cause scoliosis. Scoliosis can also begin during fetal development. Congenital scoliosis is a type
of birth defect that affects the development of the vertebrae and may occur with other congenital problems,
such as heart or kidney abnormalities.
Scoliosis runs in families and may involve genetic (hereditary) factors that haven't yet been identified.
Doctors also recognize that spinal cord and brainstem abnormalities play a role in some cases of scoliosis.
Scoliosis isn't caused by poor posture, diet, exercise, or the use of backpacks.

Pathophysiology:
Idiopathic: Much has been written regarding the potential influence of melatonin on the
development of idiopathic scoliosis. This has largely originated from studies in which the pineal gland was
removed in chickens and scoliosis developed. These same studies suggested that the melatonin deficiency
following pinealectomy might be the underlying reason for the development of scoliosis. Bagnall and his
coauthors studied pinealectomized chickens to which they administered therapeutic doses of melatonin. They
were unable to demonstrate any ability of the melatonin to prevent the development of scoliosis. It is fair to
say that no final answer is yet available.
Some authors have suggested that a posterior column lesion within the central nervous system might be
present in patients who have idiopathic scoliosis. Such central nervous system dysfunction was hypothesized
to be manifested as decreased vibratory sensation. McInnes and her fellow researchers later pointed out that
the vibration device used in earlier studies (a Bio-Thesiometer) did not demonstrate sufficient reliability
characteristics to allow valid conclusions. This line of research might be attractive to those who feel that a
postural disturbance is the root cause of scoliosis.
Neuromuscular: The pathophysiology is not well understood. It seems logical to assume that
scoliosis in these conditions is caused by muscle weakness, but this conclusion is difficult to support because
some conditions are accompanied by spasticity and others by flaccidity. Furthermore, no consistent pattern of
scoliosis is associated with a particular pattern of weakness.

Treatment: Most children with scoliosis have mild curves — less than 20 degrees — and probably won't
need treatment with a brace or surgery. Periodic checkups and X-rays are needed to be sure the curve doesn't
worsen (progress). Children who are still growing need checkups about every four to six months to see if
there have been changes in the curvature of their spines.
The decision to treat scoliosis is based on many factors. While there are guidelines for mild, moderate and
severe curves, the decision to begin treatment is always made on an individual basis. Treatment decisions
depend on your child's age, maturity, sex, family history, curve size on X-rays and how much he or she is
likely to grow.

Braces
If a child has a curve of 25 to 40 degrees and is still growing, the doctor may recommend using a brace.
Wearing a brace won't cure or reverse scoliosis but it usually prevents further progression of the curve. Most
braces are worn all the time, during the day and night. Scoliosis braces can prevent progression and the need
for surgical treatment up to 90 percent of the time. Like many treatments, scoliosis braces are only effective
if they are worn as directed. Both the child and the child's family need to understand the importance of
wearing the brace.
Once the skeleton is mature — about 15 to 16 years old for girls and 17 to 18 years old for boys — or if the
curve is too large — more than 40 to 45 degrees — a brace won't help.
Braces aren't useful for the treatment of congenital scoliosis because the curve is caused by abnormally
shaped bones in the spine.
Braces are of two main types:
• Underarm or low-profile brace. This type of brace is made of modern plastic materials and is contoured
to conform to the body. Also called a thoracolumbosacral orthosis (TLSO), this close-fitting brace is
almost invisible under the clothes, as it fits under the arms and around the rib cage, lower back and hips.
A custom brace is molded to place corrective forces on the curve. Other types of braces place pads in
areas to stabilize the curve.
• Milwaukee brace. This full-torso brace has a neck ring with rests for the chin and for the back of the
head. The brace has a flat bar in the front and two flat bars in the back. A Milwaukee brace may be used
for curves in the upper spine. However, this brace is not commonly used today.

Surgery
If a child's curve is greater than 40 to 50 degrees, the doctor will likely recommend surgery because scoliosis
of this size tends to get worse throughout a child's lifetime. Scoliosis surgery involves techniques to fuse or
join the vertebrae along the curve. Surgery is most commonly done through an incision in the middle of the
back. For very rigid or severe curves, additional surgery may be needed through the side of the body.
"Fusion" means joining two pieces together. In the treatment of scoliosis, fusion involves connecting two or
more of the bones in your spine (vertebrae) with new bone. The process is similar to what occurs when a
broken bone heals. Eventually, the vertebrae fuse together preventing further progression of the curve.
Doctors attach metal rods, hooks, screws or wires (implants) to the spine to hold the vertebrae together
during the months after surgery while the bones fuse or heal together. The implants are left in the body, even
after the bones have fused, to avoid another surgery. These implants can't be seen or felt. In addition to
supporting the fused area, implants also apply force to the spine to help correct the deformity and help
straighten the curve.
Scoliosis surgery is a complicated orthopedic surgical procedure. The operation takes several hours.
Hospitalization can last five to seven days, and activities are restricted for several months. The results of
surgery are usually very good, with dramatic improvement in the scoliosis curve size.
Complications may include bleeding, infection, pain, nerve damage or failure of the bone to heal. Rarely,
another surgery is needed if the first one fails to correct the problem.

Other therapies
Other treatments that have been studied for treatment of scoliosis include:
• Electrical stimulation of muscles
• Chiropractic manipulation
• Exercise
There's no evidence that any of these methods prevent spinal curvature from progressing. Although exercise
alone can't stop scoliosis, exercise may have the benefit of improving overall health and well-being.