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من طرف areeg mahdawi الخميس يوليو 17, 2008 11:06 amScoliosis
When seen from behind, the spine should be straight. Some people have spines that curve to the side. A x-ray will show a "C" or an "S" shaped spine rather than straight. This is known as scoliosis. A normal spine is structured with natural curves when looking at someone from the side. The purpose of these curves serve to round out our shoulders and give our lower back a slight inward shape and also act as a shock absorber for the body.
Scoliosis can occur in diseases such as Spina Bifida and Cerebral Palsy, however the vast majority of scoliosis is seen in otherwise healthy individuals. In these cases where no cause is found, this is known as "idiopathic scoliosis". Scoliosis usually develops in middle or late childhood and before puberty and therefore is called Adolescent idiopathic scoliosis. Scoliosis may also occur in young children and infants and is therefore called juvenile and infantile scoliosis accordingly. Adolescent scoliosis is seen more severely in girls than boys. If there is a previous family history of scoliosis, then the likelihood of its occurrence is greater.
Scoliosis is a problem that usually requires observation with repeated examination in the growing years. Early detection is the single most important factor in ensuring that treatment can be started before a curve becomes too large.
EARLY DETECTION
Although scoliosis is not preventable, detection and treatment early on in childhood is the best way of preventing an existing problem from getting worse.
Idiopathic scoliosis can go unnoticed in children due to the absence of pain in the formative years. It is then important for parents to be aware of certain signs in their child that may indicate the need for scoliosis screening. This may begin when the child is about 8 years of age.
Uneven shoulders or hips
Prominent shoulder or shoulder blades
Leaning to one side
Prominence of one side of the rib cage.
If any one of the above warning signs appear, it is necessary to bring your child to the pediatrician or orthopedic surgeon for proper evaluation.
DOCTOR'S OFFICE VISIT
In planning treatment for your child your orthopedist will examine a variety of important factors such as past medical history of patient and family, the age at which the curve presented, the location and the severity of the curve.
Other important factors are how fast the curve has worsened, and if there is any associated pain. A big concern is whether there may be an underlying spinal cord abnormality. Your doctor will ask questions about headaches, backaches, weakness or numbness of your legs or other neurologic signs.
Skeletal maturity and growth remaining is very important in the treatment and prognosis of scoliosis and therefore your doctor will ask about the onset of menses (the girls first period) as well as the height of both parents.
Next, a complete physical examination is performed. It is advisable that the patient wears a bathing suit, as undressing is required. The exam will focus both on the appearance of the spine, as well as the function of the nerves coming out of the spinal cord.
An x-ray is usually needed to establish the size and shape of the curve, and to make sure there are no other abnormalities of the vertebrae, the bones that make up the spine.
On most follow-up visits, a more streamlined examination is performed, and x-rays are taken if there is a concern of curve progression.
The child with scoliosis has no restrictions to sporting activities. Even a heavy book bag is okay although I am not sure it is advisable.
TREATMENT
Most curves in children will remain small and need only to be followed by your orthopedist every 6 months during growing years. Radiographs (x-rays) should be used sparingly in order to avoid radiation exposure. The child can be followed by simple non-invasive means, such as a scoliometer.
Bracing
If a curve does progress over 25 degrees and your child has at least two years of growth remaining, a custom fitted orthopedic brace may need to be worn to prevent the curve from worsening. Although most braces need to be worn nearly the full day, brace therapy should not interfere with most of your child's physical and social activities. The braces are plastic body jackets and can be well-hidden underneath loose fitting clothes.
You may read of many different types of braces used. Night-time bracing such as the Providence or Charleston brace and straps may have some benefit but are not time tested and lack scientific evidence of their efficacy. I have been asked about the air pouches brace (seen in Jacksonville and advertised on the internet). It is quite bulky and there is no evidence that it has any effect whatsoever. The Boston Brace and Milwaukee brace (rarely used because of cosmesis) have the longest track record. If the child has insufficient growth remaining brace wear will be useless no matter what type of brace is utilized.
How many hours a day does she/he have to wear the brace? There is no simple answer to this question. If the child can tolerate it then 23 hours a day would be ideal. Still the child usually has to wear the brace until skeletal maturity (usually two years after menses) and the psychological effect should be taken into account. The child if need be can remove the brace for all sporting activities and if they can achieve 18 hours a day this is thought to be sufficient. There is no magic number, but the more the better.
Physical therapy, i.e. muscle strengthening, is important if a brace is to be utilized. The brace is removed for these exercises in order to keep the back, abdomen and trunk strong.
Surgery
Should the curve be severe when first detected or has progressed to a degree where a brace no longer controls the curve (usually above 50 degrees), surgery may be indicated. This means placing rods next to the vertebrae with a combination of hooks, screws and wires. These then make the spine straighter and allow it to fuse. Fusion is the method of pasting the spine together in order to allow the spinal units to stop curving and rotating on themselves. It is analogous to welding links of a chain together. In severe adolescent idiopathic scoliosis, surgery has been found to be a highly effective and safe treatment.
Children and parents are rightfully concerned about the effects of fusion on mobility. This is true for fusion low into the lumbar spine. With newer techniques this too has become less of a problem.
Newer techniques of anterior spine surgery and thoracoscopic surgery (using a scope and T.V. monitor) have decreased the problems associated with spine surgery as well as made the scars more cosmetic. Monitoring the spinal cord function during the surgery is a pre-requisite in order to decrease the incidence of the rare dreaded complication of paralysis.
While it used to be that patients having scoliosis surgery spent 6 months to a year in bed most children today will be walking in two days and require no brace or cast after surgery.
Scoliosis surgery is not emergent and should be performed electively in optimal conditions. Pre-blood donation is essential. The need for surgery is mainly cosmetic in adolescent scoliosis. There is not going to be heart or lung compression in these children. Heart and lung problems form scoiliosis occur in the congenital and neuromuscular forms. An untreated severe scoliosis patient will most likely get quite deformed and at times painful if untreated, but it is not life threatening.
Alternative treatments
There are many alternative treatments for scoliosis. Although none have been shown to be scientifically reproducible in being effective, there is no harm in trying. Whether it is chiropractic manipulation, electrical stimulation, magnets, acupuncture, cranio-sacral massage, Reikki therapy or holistic remedies, as long as the child is not missing out on standard treatment and follow-up, I see no harm in choosing an alternative treatment as well.
In all, scoliosis is difficult to treat and manage for the patients and families due to the fact that it occurs mainly in adolescent women and has body image issues in its presence and treatment. The overall well being physically and emotionally is much more important than any one modality in treating scoliosis. Scoliosis should not become the focus of the child's life nor the family's. With appropriate treatment from physicians and paraprofessionals, support groups and family and friend encouragement this is quite achievable
When seen from behind, the spine should be straight. Some people have spines that curve to the side. A x-ray will show a "C" or an "S" shaped spine rather than straight. This is known as scoliosis. A normal spine is structured with natural curves when looking at someone from the side. The purpose of these curves serve to round out our shoulders and give our lower back a slight inward shape and also act as a shock absorber for the body.
Scoliosis can occur in diseases such as Spina Bifida and Cerebral Palsy, however the vast majority of scoliosis is seen in otherwise healthy individuals. In these cases where no cause is found, this is known as "idiopathic scoliosis". Scoliosis usually develops in middle or late childhood and before puberty and therefore is called Adolescent idiopathic scoliosis. Scoliosis may also occur in young children and infants and is therefore called juvenile and infantile scoliosis accordingly. Adolescent scoliosis is seen more severely in girls than boys. If there is a previous family history of scoliosis, then the likelihood of its occurrence is greater.
Scoliosis is a problem that usually requires observation with repeated examination in the growing years. Early detection is the single most important factor in ensuring that treatment can be started before a curve becomes too large.
EARLY DETECTION
Although scoliosis is not preventable, detection and treatment early on in childhood is the best way of preventing an existing problem from getting worse.
Idiopathic scoliosis can go unnoticed in children due to the absence of pain in the formative years. It is then important for parents to be aware of certain signs in their child that may indicate the need for scoliosis screening. This may begin when the child is about 8 years of age.
Uneven shoulders or hips
Prominent shoulder or shoulder blades
Leaning to one side
Prominence of one side of the rib cage.
If any one of the above warning signs appear, it is necessary to bring your child to the pediatrician or orthopedic surgeon for proper evaluation.
DOCTOR'S OFFICE VISIT
In planning treatment for your child your orthopedist will examine a variety of important factors such as past medical history of patient and family, the age at which the curve presented, the location and the severity of the curve.
Other important factors are how fast the curve has worsened, and if there is any associated pain. A big concern is whether there may be an underlying spinal cord abnormality. Your doctor will ask questions about headaches, backaches, weakness or numbness of your legs or other neurologic signs.
Skeletal maturity and growth remaining is very important in the treatment and prognosis of scoliosis and therefore your doctor will ask about the onset of menses (the girls first period) as well as the height of both parents.
Next, a complete physical examination is performed. It is advisable that the patient wears a bathing suit, as undressing is required. The exam will focus both on the appearance of the spine, as well as the function of the nerves coming out of the spinal cord.
An x-ray is usually needed to establish the size and shape of the curve, and to make sure there are no other abnormalities of the vertebrae, the bones that make up the spine.
On most follow-up visits, a more streamlined examination is performed, and x-rays are taken if there is a concern of curve progression.
The child with scoliosis has no restrictions to sporting activities. Even a heavy book bag is okay although I am not sure it is advisable.
TREATMENT
Most curves in children will remain small and need only to be followed by your orthopedist every 6 months during growing years. Radiographs (x-rays) should be used sparingly in order to avoid radiation exposure. The child can be followed by simple non-invasive means, such as a scoliometer.
Bracing
If a curve does progress over 25 degrees and your child has at least two years of growth remaining, a custom fitted orthopedic brace may need to be worn to prevent the curve from worsening. Although most braces need to be worn nearly the full day, brace therapy should not interfere with most of your child's physical and social activities. The braces are plastic body jackets and can be well-hidden underneath loose fitting clothes.
You may read of many different types of braces used. Night-time bracing such as the Providence or Charleston brace and straps may have some benefit but are not time tested and lack scientific evidence of their efficacy. I have been asked about the air pouches brace (seen in Jacksonville and advertised on the internet). It is quite bulky and there is no evidence that it has any effect whatsoever. The Boston Brace and Milwaukee brace (rarely used because of cosmesis) have the longest track record. If the child has insufficient growth remaining brace wear will be useless no matter what type of brace is utilized.
How many hours a day does she/he have to wear the brace? There is no simple answer to this question. If the child can tolerate it then 23 hours a day would be ideal. Still the child usually has to wear the brace until skeletal maturity (usually two years after menses) and the psychological effect should be taken into account. The child if need be can remove the brace for all sporting activities and if they can achieve 18 hours a day this is thought to be sufficient. There is no magic number, but the more the better.
Physical therapy, i.e. muscle strengthening, is important if a brace is to be utilized. The brace is removed for these exercises in order to keep the back, abdomen and trunk strong.
Surgery
Should the curve be severe when first detected or has progressed to a degree where a brace no longer controls the curve (usually above 50 degrees), surgery may be indicated. This means placing rods next to the vertebrae with a combination of hooks, screws and wires. These then make the spine straighter and allow it to fuse. Fusion is the method of pasting the spine together in order to allow the spinal units to stop curving and rotating on themselves. It is analogous to welding links of a chain together. In severe adolescent idiopathic scoliosis, surgery has been found to be a highly effective and safe treatment.
Children and parents are rightfully concerned about the effects of fusion on mobility. This is true for fusion low into the lumbar spine. With newer techniques this too has become less of a problem.
Newer techniques of anterior spine surgery and thoracoscopic surgery (using a scope and T.V. monitor) have decreased the problems associated with spine surgery as well as made the scars more cosmetic. Monitoring the spinal cord function during the surgery is a pre-requisite in order to decrease the incidence of the rare dreaded complication of paralysis.
While it used to be that patients having scoliosis surgery spent 6 months to a year in bed most children today will be walking in two days and require no brace or cast after surgery.
Scoliosis surgery is not emergent and should be performed electively in optimal conditions. Pre-blood donation is essential. The need for surgery is mainly cosmetic in adolescent scoliosis. There is not going to be heart or lung compression in these children. Heart and lung problems form scoiliosis occur in the congenital and neuromuscular forms. An untreated severe scoliosis patient will most likely get quite deformed and at times painful if untreated, but it is not life threatening.
Alternative treatments
There are many alternative treatments for scoliosis. Although none have been shown to be scientifically reproducible in being effective, there is no harm in trying. Whether it is chiropractic manipulation, electrical stimulation, magnets, acupuncture, cranio-sacral massage, Reikki therapy or holistic remedies, as long as the child is not missing out on standard treatment and follow-up, I see no harm in choosing an alternative treatment as well.
In all, scoliosis is difficult to treat and manage for the patients and families due to the fact that it occurs mainly in adolescent women and has body image issues in its presence and treatment. The overall well being physically and emotionally is much more important than any one modality in treating scoliosis. Scoliosis should not become the focus of the child's life nor the family's. With appropriate treatment from physicians and paraprofessionals, support groups and family and friend encouragement this is quite achievable
