The vertebral column, also known as the spinal column or simply spine, is a column of 26 bones in an adult body (24 vertebrae interspaced with cartilage in addition to the sacrum and coccyx). In adolescents, the column consists of 33 bones as the sacrum's five bones and the coccyx's four do not fuse together until after adolescence. The spine is further divided into regions: cervical (the neck), thoracic (upper back), lumbar (lower back), sacral, and coccygeal. In between the vertebrae are thin regions of cartilage known as intervertebral discs, which are made of a fibrous outer shell (annulus fibrosus) and a pulpy center (nucleus pulposus).These cartilaginous intervertebral discs, which act as "shock-absorbers," help distribute weight, and keep vertebrae oriented in the correct spacing.
Scoliosis is a condition that can occur in toddlers and young children, but primarily affects children from the age of 10 till they are fully grown as well as older adults. Scoliosis is a sideways curvature of the spine that most often occurs during a growth spurt, but the cause for most scoliosis is unknown. Most cases of scoliosis are mild, but it is possible for children to develop spine deformities that progressively get worse as they grow. There are several different types of scoliosis that may affect children with the most common being the following:
Idiopathic Scoliosis - Idiopathic scoliosis means that the exact cause of scoliosis is unknown, however, it is typically hereditary. Idiopathic scoliosis is the most common type as upwards of 80% of scoliosis cases are idiopathic.
Congenital Scoliosis - Congenial scoliosis is a birth defect, meaning that the child is born with scoliosis. This occurs when one or more parts of the vertebrae either does not form completely or does not separate accurately.
Neuromuscular Scoliosis - Neuromuscular scoliosis is caused by medical conditions that affect the nerves and muscles in the form of weakness or imbalance. Common neuromuscular conditions that have been linked to scoliosis are cerebral palsy, spinal cord injury, or muscular dystrophy.
Common signs and symptoms of scoliosis are:
- Uneven shoulders where one shoulder blade appears more prominently than the other
- Uneven waist where one hip is higher than the other
- Severe cases of scoliosis are linked with back pain and difficulty breathing
If a curve caused by scoliosis gets worse, it can cause the spine to twist or rotate. If signs and symptoms of scoliosis are present in children, it’s advised to visit a physician to avoid further curving as well as other spine-related problems. If the back pain is associated with weakness, a visit to the physician is a must.
Scoliosis is diagnosed with a combination of patient history, physical examination, and imaging studies. After discussing the individual's symptoms, the physician will examine the individual by checking for posture, gait, and the placement of the bones within the spine. Additionally, the physician will test for sensation, muscle strength and stability. The physician will then order an X-ray, which will confirm the diagnosis of the scoliosis and reveal the severity of the curvature of the spine. If the physician suspects another condition, he or she may order additional imaging tests such as an MRI, CT, or bone scan to rule out other possibilities for the symptoms.
Most children who are diagnosed with mild scoliosis, which means that there is a slight curve in the spine, typically don’t require treatment, but will need to visit the physician for routine checkups to track any further changes to the curvature of the spine. The decision to begin treatment is always made on a case-by-case basis where a number of factors such as the severity, pattern, and location of the curve, as well as the sex and the maturity of bone growth of the affected individual are taken into consideration.
Bracing - In cases where the child has moderate scoliosis and the bones are still growing, the physician may recommend wearing a brace throughout the day and night. Wearing a brace might prevent further progression of the curve, but it is by no means, a method to cure scoliosis or reverse the existing curve. Braces are discontinued once the bones stop growing.
Surgery - In cases where the child has severe scoliosis, the physician my recommend an operative treatment. Severe cases of scoliosis progressively worsen with time. Options must be discussed extensively with the physician to determine the appropriate plan of treatment.
Since scoliosis typically does not cause any pain, individuals who have curves that do not require surgery are able to participate in the same activities and sports as people without scoliosis with little to no restrictions on any activities. Similarly, individuals who undergo an operative treatment are able to do most all activities; however, it's important that they contact their physician prior to starting a new activity to ensure there are no specific restrictions.
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