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| Volume 1, Issue 8 | AUGUST 2002 |
| Inside This Issue | |||||
| 1 | Scoliosis | ||||
| 2 | Updates and Announcements | ||||
Medical Information Fact Sheet
In scoliosis, the spine curves to one side. A spine affected by scoliosis may have an S shape or a C shape. Usually, a curve to one side develops followed by a compensating bend in the opposite direction.
Scoliosis is usually painless and mild in form and may only require follow-up and observation. In more extreme cases the spine can rotate as well, resulting in ribs becoming more prominent to one side. Severe scoliosis can cause ongoing back pain and even difficulty breathing.
Very young children can get scoliosis but adolescent idiopathic scoliosis (onset at 10 years or older) is more common. Scoliosis affects an estimated 2 percent of Americans, most often children.
Scoliosis rarely occurs in adults. Sometimes it is a worsening of a condition that began but was misdiagnosed or mistreated. In other cases, adult scoliosis may be the result of degenerative joint condition in the spine.
Signs & Symptoms:
Signs of scoliosis, that a parent may begin to notice when the child is about 8, may include:
- Uneven shoulders
- Prominent shoulder blade or shoulder blades
- Uneven waist
- Elevated hips
- Leaning to one side
Doctors define scoliosis in a particular person based on the number of factors related to the curve, including:
- Shape. Aside from appearing like the letter C or S, a curve may occur in two or three dimensions. A nonstructural curve is a side to side curve. A structural curve involves twisting of the spine and occurs in three dimensions.
- Location. The curve may occur in the upper area (thoracic), the lower back area (lumbar) or between those two areas (thoracolumbar).
- Direction. The curve can bend to the left or right.
- Angle. Doctors figure out the angle of the curve using the vertebra at the apex of the curve as the starting point.
- Cause. Many theories have been proposed regarding the causes of scoliosis. They include connective tissue disorders, hormonal imbalance and abnormality in the nervous system. For 80% of the cases the cause is unknown.
Most scoliosis is of unknown cause, but there does appear to be a developmental connection in many cases. Most cases occur just before and during adolescence, when children are going through a growth spurt.
Risk factors for curve progression may include:
- Gender. Girls are 10 times more likely to experience curve progression.
- Age. The younger the child is when scoliosis appears the greater the chance of curve progression.
- Angle of the curve. The greater the curve angle, the higher the likelihood that it will get worse.
- Location. In girls having lower back scoliosis, it is less likely the curve will progress.
- Height. Taller girls have greater chance of curve progression.
- Spinal problems at birth. Children who have scoliosis at birth (congenital scoliosis) may experience rapid advancement of the curve.
The onset of scoliosis is gradual and almost always painless, and a significant curvature can develop without a parent or child knowing it. Early detection is important to prevent the curve from progressing.
Unfortunately the condition usually progresses during the same time that children become more self conscious (ages 10-16) and avoid exposure, so parents and others are not likely to see the problem. Have the child examined if anyone notices the signs of scoliosis.
Scoliosis has the potential to lead to serious health problems such as severe back pain, difficulty breathing, physical deformity, and injury to the lungs and heart. Be sure to have the child see the doctor if there is a family history of scoliosis.
School Screening is controversial. It is supported by the American Academy of Orthopedic Surgeons and the Scoliosis Research Society even though it has been abandoned in other countries.
Screening can identify children with scoliosis who are candidates for treatment, and treatment is better and more effective if started early. The disadvantages include the possibility of identifying and labeling some children who don't have scoliosis. Incorrect labeling can be emotionally difficult for children and may lead to unnecessary expense and the inconvenience of doctor appointments. But better definition of criteria for referral to a doctor has reduced inappropriate doctor's visits and referrals.
The doctor will want to ask about the child's personal and family medical history and may take these diagnosis steps.
- Physical examination. Your doctor observes the spine. Scoliosis is defined as a spinal curvature greater than 10 degrees. A normal spine would be at 0 degrees. A curve that was horizontal or parallel to the floor would be 90 degrees. Most doctors can detect a 10-degree curve during a physical exam. Some curve patterns are easier to see than others. In almost all cases, larger curves, which are uncommon, are easier to recognize than smaller curves. As the spine bends to the side, it rotates as well.
- X-rays. The doctor may use x-rays to confirm the diagnosis. The x-ray allows the doctor to determine the curve size, which is necessary to make treatment decisions.
In some cases, scoliosis may result in complications:
- Lung and Heart Damage. Depending on the degree of the curvature, the rib cage may cause injury to heart and lungs. Lung infections and pneumonia can occur.
- Bone Loss. With scoliosis, one is at a higher risk for developing loss of bone density (osteopenia). Especially for women who had scoliosis in their youth, the risk of osteoporosis increases with age.
- Back problems. Adults who had scoliosis as a child are more likely to have chronic back pain than the general population. Also, people with untreated scoliosis may develop inflammation and arthritis of the spine (spondylosis). People who had early surgical treatment for scoliosis as children are at a higher risk for low back pain.
Most children who have an abnormal spine curve have it to a relatively small degree, and only observation is needed to make sure the curve does not progress. Doctors usually recommend observation for people with curve less than 20 degrees. People whose skeletons are still growing need checkups at 3-to-6 month intervals to see if there have been changes in the curvature.
If the curve progresses to a more serious degree, treatment may involve using orthopedic braces and in some cases surgery.
Doctors recommend the use of braces for growing children with adolescent idiopathic scoliosis who have curves of 25 to 40 degrees. Bracing does not cure the scoliosis or even improve the curve. But studies show that bracing can successfully prevent curve progression in more than 90 percent of people who wear braces and who wear them for 23 hours a day.
Doctors typically recommend surgical treatment for people whose curves are greater than 40 to 50 degrees. Scoliosis surgery is generally successful in improving posture and the function of the back.
Mayo Clinic. (2002, April 02). Scoliosis: What is Scoliosis? Mayo Clinic. Retrieved on July 31, 2002 from the World Wide Web: http://www.mayoclinic.com/findinformation/diseasesandconditions/invoke.cfm?id=DS00194
HCPCFC PROGRAM UPDATES and ANNOUNCEMENTS!!!
August has been a busy month for training of the new employees. We appreciate their hard work and effort in excelling in their new positions. Thank you to the staff that has taken the time to help the newest assets to the Health Program for Children in Foster Care (HCPCFC).
We would like to welcome:
Karen MacLeod - covers Indio court/DPSS
Susan Cho - covers Banning/Hemet
Ruth Harden - covers Temecula/Lake Elsinore/Corona
WELCOME!!!!!!
Editor: Kristen Thompson, PHN; and Karen MacLeod, PHN
Contributors: Kim Robitaille, PHN, MSN, Supervising PHN; and Judy Earp, MHA, Director of Public Health Nursing.
