STORY BYWe’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:
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Dr. Rex Marco is an assistant professor in the Department of Orthopaedic Surgery at the UT Medical School.
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Packing Bag Lunches Safely
If you pack lunches for your child to take to school, be careful that you do not accidentally expose them to foodborne illness.
Bagged lunches, especially those containing perishable foods, need to be packed and handled properly in order to keep the food safe. In general, perishable foods should not be left at room temperature for more than two hours. If left out too long, the temperature of the food can enter the danger zone where bacteria grow most rapidly, which is between 40 and 140 degrees Fahrenheit.
Below are some tips to help families pack bagged lunches safely:
Before eating lunch or snacks at school, make sure your child washes his or her hands with soap and warm water for at least 20 seconds. If your child's school does not have a handwashing program in place, encourage them to adopt a such a program, as handwashing is one of the best ways kids and parents can protect health and stop the spread of germs.
