﻿The spine has a natural curvature shaped like an “S” when viewed from the side. The neck and
lower back regions are “C” shaped while the middle chest region has a “reverse-C” shape. When viewed
from the back the spine appears straight. An abnormal curvature in this plane, with rotation
of the vertebrae, is called scoliosis. When comparing a normal spine and scoliosis in
this view, you’ll immediately notice the abnormal sideways curve compared to the normal straight
spine. Although a small degree of curvature is common, anything exceeding 10 degrees in children
younger than 10 or 20 degrees for patients older than 10 years is considered
scoliosis. The severity of the deviation varies depending on the individual and,
in mild cases, individuals often don’t experience any symptoms beyond the cosmetic deformity.
The most common form of scoliosis, accounts for 80% of all childhood scoliosis cases.
It's called idiopathic, which means, there is no specific cause. Abnormal curves found in infants
usually resolve spontaneously (90%), but juvenile scoliosis is often progressive
and has the potential for severe deformity with heart or lung issues. Studies show that skeletally
mature patients with idiopathic scoliosis do not progress when the curves are less than 30 degrees,
whereas those greater than 50 degrees do continue to progress. Between 30 and 50 degrees, the potential
for progression is unknown, and individual. Degenerative scoliosis, on the other hand,
results from asymmetric disc degeneration -- that is the natural wear and tear of the spine over
time -- it affects roughly 40% of the population and is most prevalent in the elderly. This
type of scoliosis usually occurs in the lower back with an average curvature of 30 to 40 degrees.
Some of the associated symptoms include difficulty standing upright,
back pain, and sciatica, which is radiating pain from your lower back down to your legs.
Children are usually screened for scoliosis during their annual check-up. Doctors will check for any
asymmetry between shoulder blades as well as shoulder and hip height. You should be able
to draw a horizontal line between the tops of the patient’s shoulders and across the waist.
Those with scoliosis will not have these straight horizontal lines,
instead, the lines will be diagonal. The measurement of interest for scoliosis
is the Cobb angle. To measure it, one must first identify which vertebrae are at the end of the
curve deformity; their endplates will then be the most tilted towards each other. Lines are then drawn
along the endplates and the angle created from the intersection of these two lines are measured.
This measurement is what’s being referred to when discussing the degree of spine curvature.
The earlier you treat scoliosis, the better the outcome will be. That being said, mild curves
of 20 degrees or less may not experience symptoms beyond some back strain or fatigue in
prolonged positions. Those with more pronounced curves are at risk for more severe complications,
particularly patients with curves that are 50 degrees or more in the thoracic region and 40
degrees in the lumbar region. Left untreated, individuals are at greater risk for spinal
instability, disc herniations, spondylolisthesis, sciatica, uneven gait, and even nerve damage.
Bracing has been used to prevent progression of scoliosis. It’s typically recommended for
patients with a moderate curve between 20 and 40 degrees that is also progressive.
Braces are designed to be worn for 16 to 23 hours until the patient is fully grown.
While the research behind the efficacy of bracing is variable, it’s still considered the best
nonsurgical option for a growing child and current developments look to improve
the efficacy and overall usability. In cases where a patient’s quality of life
can be affected, surgical intervention might be necessary to correct the patient’s scoliosis.
The most common surgery is spinal fusion to stabilize the abnormal curvature of the
spine. Modern pedicle screw systems are also used to reduce and correct the rotation of the spine.
However, the average rate of complication remains quite high standing at around 22% in
patients with adolescent idiopathic scoliosis. The development of new innovative strategies
including GPS-guided robotics surgery and close monitoring of the spinal cord and nerve root have
resulted in improved outcomes. I hope this video helped you understand
the current research on scoliosis. Until next time, this is Dr. John Shim.