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Idiopathic scoliosis 
What is idiopathic scoliosis?
What is idiopathic scoliosis? Idiopathic scoliosis is a spinal deformity of unknown cause in a healthy child. This deformity can easily be seen in a posterior X-ray, but, in fact, scoliosis is a three-dimensional deformity with important vertebral rotation. Idiopathic scoliosis is classified according to the age at onset in: infantile (ages 0 to 3 years), juvenile (ages 4 to 10 years), adolescent (11 to 17 years) and adult (>17 years).
Infantile scoliosis appear in children younger than 3 years, and specially before 6 months of life. The vast majority has a good evolution, but a small group develops a progressive deformity and needs treatment. An adolescent girl with a thoracic deformity represents the typical presentation.
What is its cause? The term idiopathic means unknown cause to explain the deformity. Most scoliosis (80%) is idiopathic; the remaining cases (20%) are associated with a wide variety of disorders. The diagnosis of idiopathic scoliosis requires the exclusion of these disorders. Children of parents with scoliosis have high probability to develop the deformity. However, it has be impossible to establish the genetic mechanism. There are two periods of fast growing in the childhood: between born and two years and the adolescence. The curve can grow rapidly in both periods. In fact, if there is growth, the deformity can progress. When the patient finalizes bone maturation, deformity cannot progress.
What zone of the back can be affected? Deformity can affect any part of the back. The thoracic deviation is the most frequent pattern. Cervical spine or pelvis rarely are affected.
Occasionally we can see a double curve, that is, a curve towards one side and another curve towards the other side.
What is a compensatory deviation? All scoliotic curves have accompanying compensatory curves above and below. Their function is to maintain the balance between head and pelvis.
Is there any relationship between scoliosis and leg length discrepancy? Scoliosis means a three-dimensional deformity and it does not have any relationship with leg length discrepancy. However, when a patient has leg length discrepancy, the spine produces a curve to maintain the balance of the body. In this situation, a real deformity does not exists. If we put a sight below the foot of the shorter leg, the curve disappear.
What is a scoliotic posture? We use the term scoliotic posture when the spine shows a curve that seems a scoliosis but it is not a true deformity. A patient can show a scoliotic posture when he has a leg length discrepancy or when he has back pain and secondary muscle contracture.
Should the patient go to the doctor? A patient affected by scoliosis should have a assessment by a orthopedist. The doctor can recommend the best treatment for a particular case.
Which is the treatment? The main goal of the treatment is to finish bone maturation (14-16 years) with a deformity below 45-50 degrees, because this deviation do not produce restrictions in daily activities and it is not progressive. The treatment depends on the degree of the deformity, the age of the patient and de degree of the bone maturation. Deformities below 20 degrees in a immature child only need medical control every 3-6 months to assess evolution. Deformities around 25 degrees in a immature child need a closed control because it has a high probability of progression. So, if it progress, the child should wear a orthose to brake the worsening. Deformities below 45-50 degrees in a mature child (girls with 13-14 years and boys with 15-16 years) usually do not progress and they do not need treatment. Deformities above 45-50 degrees should be considered for surgical correction.
How long orthoses have to be worn? If the patient has a low bone maturation, the orthose should be worn 22-23 hours/day. If the patient is advanced in bone maturation, the orthose can be worn 16 hours/day. That is, the child put it on when he leaves the school and he removes it the following day.
Are there different kind of orthoses? There are basically two different types of orthoses: contact corsets and functional corsets. The first type contact closely the skin, they are more comfortable and they are not visible below clothes. They work modeling directly the spine. We restrict its use in children below 10 years because it can influence in the correct development of the thoracic cage.
Functional corsets, such as the Milwaukee one, have external metallic bars which finish in pads below the chin an below the nape. They work because children do extension of the neck to avoid contacting the anterior pad, and this action stretchs the spine. We use this kind of corsets in children below 10 years and in children with deformities in the upper thoracic spine.
What does a surgical approach means? A surgical procedure in a scoliosis means to reduce at the maximum the deformity and to fix the spine by means of a metallic devices.
The spine achieves a more normal position but it becomes more rigid.
WARNING: Contents of this page are only for general information. We recommend going to the pediatric orthopedist. We don't take charge of wrong interpretations of these contents. If you have any doubt,
please, contact with us. BIBLIOGRAPHY: |
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