What is scoliosis?
Scoliosis is a side to side or lateral curvature of the spine that may progressively worsen. A lateral curve of the spine of 100 or more is usually accompanied by a rotation to the left or right, producing the prominence or hump. (should have picture of patient’s back) The greater the curve, the worse the prominence.
What is Adolescent Idiopathic Scoliosis (AIS)?
AIS usually appears in late childhood or early adolescence. AIS is the most common form of idiopathic scoliosis accounting for 80-85% of cases, affecting about 3% of children ages 10-16, or 4 out of 100 adolescents. The risk of progression depends the child’s age and maturity curve size at diagnosis. Curves of less than 300 generally don’t progress after maturity, while curves of more than 400 usually do continue to progress significantly into adulthood.
What causes AIS?
The cause of AIS is not known (idiopathic) but is believed to be a genetically determined condition. We do know that AIS is not caused by carrying a heavy backpack, playing sports or any other activity. The incidence of small curves, less than 200, is equal in girls and boys. However, girls have a much higher incidence of progressive curves than boys.
What are the symptoms?
Generally, the only symptom is the appearance of the spine, usually discovered by a school screening or routine physical examination. Shoulder and/or waist asymmetry is usually present. Pain is uncommon in the adolescent with scoliosis of any degree. However, as the child ages scoliosis may become painful.
No one wants to be different, particularly the teen aged girl. On occasion, the change in body shape produced by scoliosis can have a negative psychological effect. Dr. Shufflebarger is sensitive to these concerns and particularly how the impact of diagnosis and treatment can affect an adolescent’s privacy and need for support during this vulnerable time.
How is AIS Diagnosed?
Dr. Shufflebarger will discuss your child’s health history and family history and conduct a physical examination including range of motion testing, and observe the child’s gait, posture and body symmetry. He will conduct a neurological examination. Standing X-rays will be ordered to view the entire spine. Other x-rays may be performed to test flexibility. MRI studies may be ordered.
How is AIS treated?
AIS treatment often involves regular monitoring with x-rays to check for progression of the curve. Many times, no treatment is needed. However, scoliosis can get worse during growth. Bracing may be recommended to stop or slow progression during growth.
Conservative treatment will include observation and bracing. Studies report that bracing is efficient, safe and successful in about 75% of compliant AIS patients.
The treatment choice depends on the degree of curvature and the potential for progression, very much related to the patient’s age. Surgery is reserved for patients with curves that progress past the point where bracing is expected to be effective in preventing progression. Usually at 500 surgery is indicated. Between 400 and 500, surgery may be considered.
Dr. Harry L. Shufflebarger is a board-certified orthopedic surgeon and a nationally and internationally recognized expert in the care of all pediatric spine disorders, including scoliosis. In addition to his many accomplishments in research and innovation in pediatric spine conditions, he is a kind and compassionate doctor who is sought out by parents the world over.