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We’ve seen the thin, prepubescent children wearing back braces from chin to thigh. Whatever it is, it looks tortuous. The condition is called idiopathic adolescent scoliosis—a mouthful to say. Fortunately, pain usually does not accompany this physical condition. And two treatments can make dramatic changes in the course of this deformity.
For reasons yet to be discovered, scoliosis—curvature of the spine—affects children. (If adults develop scoliosis, it usually is a complication associated with arthritis.)
While up to three children per 100 might have a spinal curve of 10 degrees or more, many are small children who will outgrow the problem. Boys and girls seem to be equally affected in the early years. With a curvature of 30 degrees or more, only 1.5 to 3 per 1000 are affected.
In adolescent scoliosis patients, only one in nine will be males. “But, in those who have the condition, it is generally more aggressive,” says Rex Marco, M.D., assistant professor in the Department of Orthopaedic Surgery and chief of Spine Surgery and Musculoskeletal Oncology at The University of Texas Medical School at Houston.
Early detection is the most important element in treatment and likely to be first diagnosed by the school nurse or a pediatrician. “In a very young child, it’s usually seen on an X-ray ordered for something else, such as a chest X-ray,” Marco says. “There’s a simple standard test for scoliosis that school nurses or pediatricians use. It requires only that the patient bend from the waist. With the child in this position, most curves can be seen.”
He adds that newer braces are much less visible, a psychological advantage over older models--the awkward devices made memorable by a half dozen teen movies. Scoliosis may develop during a time of social development, striking just before a growth period such as the start of adolescence. “Newer braces are not as big and bulky, and they pull and retrain muscles to support the back,” says Marco.
One of the newest additions in this field is the Spine Cor brace that was recently introduced with great success in England and Montreal and premiers in the U.S. at the UT Spine & Scoliosis Center. It promises more freedom of movement for sports such as gymnastics and recreational activities like dancing.
“With early detection, we can stop the advancement of the curvature. While the brace will not repair the damage, it halts the progression of the deformity,” Marco says.
Thoracoscopic procedures have allowed less invasive surgical treatment. While surgeons still sometimes use the older “Harrington Rod” method, with hooks at each end that stretch and straighten the spine, newer procedures employ screws or hooks at each vertebra in the area of the deformity to better control correction. With thoracoscopic surgery, small incisions are made through the side of the rib cage and from the back. With older methods, the incision and resulting scars were much larger. Compared to earlier methods, thoracoscopic surgery patients generally spend less time in the hospital, are home within five to seven days and are soon walking.
Yet, one form of scoliosis in which the space between the vertebrae collapses and puts pressure on the nerves may be caused by osteoarthritis and generally strikes adults over 50.
As with children, this form of scoliosis manifests as asymmetry at the waistline. While in children the condition is not generally accompanied by pain, adults experience pain in the legs and back from nerve compression in the spine.
When the space between the vertebrae collapses, the discs bulge, the ligament in the spinal canal thickens and the nerves in the spinal column are compressed or “pinched.”
Marco says that the first form of treatment in both children and adults is observation. The next stage might be bracing, followed by surgery. “Newer braces may, in theory, help the body adapt, help the patient move, and potentially correct the size of the curve,” he says. Marco adds that surgery is restricted to young people who have curves of more than 40 to 50 degrees and mature patients whose curvatures exceed 50 degrees. “Surgery usually halts the progress of the deformity, and we can usually correct the curve by 40 to 50 percent.”
With early detection followed by appropriate evaluation and treatments, the damage of scoliosis can be halted and in many cases diminished.
To maintain a healthy back, Dr. Marco suggests that you follow some simple health advice:
Send us your questions for the experts, comments or suggestions.
Last Updated: 7-30-2006
The University of Texas Health Science Center at Houston (UTHealth), the most comprehensive academic health center in The UT System and the U.S. Gulf Coast region, is home to schools of biomedical informatics, biomedical sciences, dentistry, medicine, nursing and public health. UTHealth educates more healthcare professionals than any health-related institution in the State of Texas and features the nation’s seventh-largest medical school. It also includes a psychiatric hospital and a growing network of clinics throughout the region. The university’s primary teaching hospitals include Memorial Hermann-Texas Medical Center, Children’s Memorial Hermann Hospital and Lyndon B. Johnson General Hospital. Founded in 1972, UTHealth’s 10,000-plus faculty, staff, students and residents are committed to delivering innovative solutions that create the best hope for a healthier future.
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Dr. Rex Marco is an assistant professor in the Department of Orthopaedic Surgery at the UTHealth Medical School.
Simple Ways to Help
Young and Old Eyes
May is Healthy Vision Month and it is imperative to take care of eyes whether they’re young or old.
Children should have their vision checked by age 6, even if there aren’t any signs of eye problems. Healthy eyes and vision are very important to a child’s development. Finding and treating eye problems early on can save a child’s sight. Two common eye problems in children are:
Both of these eye problems can be treated if they are found early.
Here are ways to help your child develop vision skills:
Don’t let poor vision put elders at risk. Leave a three-foot, clear path through each room of their house. Outline edges of steps, coffee tables, doorways and bathtubs with colored tape to contrast with surrounding areas. Install lights along outdoor pathways and keep foyers well lit to avoid having to enter dark areas. Replace switch plates with colors that contrast with walls, or outline them with tape of contrasting colors. It is also always smart to use nightlights during the night.
