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:
UPDATED: 7-30-2006
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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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Tetanus booster for adults
Tetanus does not result from the rusty nail or whatever created the wound. The danger lies in the bacteria Clostridium tetani that lives in the soil or manure on that nail or gardening tool. When these spores get into a wound—deep or shallow—they can produce a potent toxin. Also called lockjaw, tetanus seriously affects the central nervous system and can be fatal.
Onset of symptoms can occur anytime from three days to three weeks. Call your health care provider if you have an open wound, particularly if:
Adults should have a tetanus booster shot every 10 years, known as the Td vaccine. It is a "2-in-1" vaccine that protects against tetanus and diphtheria. It contains a slightly different dose of diphtheria vaccine than what you received as a child. It can be given to anyone older than 7 years and is injected, usually into the arm.
Instead of the standard Td booster every 10 years, adults between the ages of 19 and 65 should receive Tdap one time in their adulthood to boost the immune system for pertussis, as well as tetanus and diphtheria.
Diphtheria, a contagious bacterial infection created that causes severe inflammation of the throat and larynx and can also affect the whole body. Pertussis or “whooping cough” is a serious bacterial infection that afflicted children and infants before vaccines were available. Adults may be infected later in life as their immunities wane. Neither of these infections are related to tetanus, but both vaccines are compatible and convenient to use with the tetanus booster.
