Clinical Negligence Australia

Scoliosis

Scoliosis is a sideways curvature of the spine. It is most common in the thoracic spine but can occur in the cervical or lumbar spine as well. There are three main causes of scoliosis. It can be a condition you were born with, called congenital scoliosis. It is caused by the spine bones, vertebrae or ribs become fused during intrauterine development resulting in scoliosis you see at birth. Neuromuscular scoliosis happens when problems such as poor muscle tone or weakness of the muscles causing the spine to curve. Idiopathic scoliosis has no known cause and is most common in adolescents, especially girls.

Some people may be likely to have curvature of the spine, especially girls. It happens during spurts of growth, especially in the early teen years. It is less common in infants and in young children, when it occurs equally in boys and girls.

The symptoms of scoliosis can be minimal or even absent. When present, the major symptoms are back pain in the lower back or mid back. You can have tiredness, uneven shoulders in height and an obvious lateral curvature of the spine, seen best when the individual is bending forward. If you have kyphoscoliosis, the spine is twisted forward and to the side, leading to forward and lateral displacement of the spine. There can be symptoms of fatigue when you are sitting or standing for long periods of time and wear and tear of the vertebrae.

The major way to determine scoliosis is to do a complete history and physical examination. The child or adult is asked to bend forward and the doctor looks for lateral displacement of the spine and uneven shoulder blades. The degree of curvature is confirmed with a spinal x-ray, which will tell the degrees of curvature of the spinal components. The healthcare provider does a neurological examination to look for changes in strength, reflexes or sensation. There is a scoliometer that measures the degree of curvature of the spine and an MRI of the spine that detects the location of any neurological deficits that might have happened.

The treatment depends on the causes of the disease and where the curvature is located. How much more growth a patient has left will alter the type of treatment given to the patient. If the patient has idiopathic scoliosis and a less than 20 degree lateral alignment, there is no treatment given. The patient is watched using x-rays every six months until they stop growing.

As curvature gets worse (above around 30 degrees) and if the child is still growing, the doctor will recommend a spinal brace which cannot reverse the curvature but will prevent further curvature of the spine. There are several types of braces, including the Milwaukee brace, the Boston brace, the Wilmington brace and the Charleston brace. The braces differ in the types of ways that they act against the spine. They type of brace used depends on the characteristics of the curvature and the age of the individual. The brace can be changed as the individual grows and the curvature changes. It doesn't work in congenital neuromuscular scoliosis and doesn't work well in infantile or juvenile scoliosis.

Surgery can be done in severe cases of scoliosis or in scoliosis in which there is much pain and debility. It is usually done when the bones have stopped growing but can be done earlier in degrees of curvature greater than 40 percent. The surgery corrects the curve to some extent and fuses the bones of the curve so they don't go on to a greater degree of curvature. Surgery can't always straighten the spine completely but can come close. Metal rods are put down the sides of the spine with hooks and screws used to knit the bone together. An incision is made through the back in order to have access to the spine and nearby areas. After the spinal fusion, a brace is used to keep the spine stable after the surgery is done.

The disease itself and the treatment of the disease can do a great deal of emotional damage to the affected person. It can be threatening to the self image of the individual, especially if they are teenagers. This means that a great deal of emotional support is necessary for the individual.

The prognosis of scoliosis depends on the cause, severity and location of the curvature. The greater the curvature, the greater is the chance that the curve will get worse, even when the growth has stopped happening. The greater the initial curvature at diagnosis, the greater are the chances of further lateral curvature. Curves greater than 100 degrees are possible and often affect breathing. Mild cases treated with braces tend to do extremely well without further complications. If surgery is done, the prognosis is also good. Babies with scoliosis often suffer from other congenital defects and management is quite complicated at times.


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