An in-depth report on the causes, diagnosis, treatment, and prevention of scoliosis.
- The spine is a column of small bones, or vertebrae, that supports the entire upper body. Scoliosis is an abnormal curving of the spine.
- About 10% of adolescents have some degree of scoliosis, but fewer than 1% of them develop scoliosis that requires treatment.
- Among persons with relatives who have scoliosis, about 20% develop the condition.
- In 80% of patients, the cause of scoliosis is unknown. Such cases are called idiopathic scoliosis.
- Screening programs for scoliosis, which began in the 1940s, are now required in middle or high schools in many states, but there is considerable debate over whether screening programs are effective.
- A recent review of previous studies found that using the forward bend test alone in school screenings is not sufficient, but not enough data exists on the usefulness of other tests in screening programs.
- Braces tend to be used in children with curvatures between 25 - 40 degrees who still will be growing significantly.
- Most scoliosis operations involve fusing the vertebrae. The instruments and devices used to support the fusion vary, however.
- Increasingly, surgeons are using the anterior approach, in which the surgeon performs the operation through the chest wall to correct the spinal curve. Because the frontal approach allows the procedure to be performed higher up in the spine than standard procedures, the patient may have a lower risk for lower-back injury later on. In addition, transfusion rates are much lower with the anterior approach.
Scoliosis affects about 2 - 3% of the United States population (about 6 million people). It can occur in adults, but it is more commonly diagnosed for the first time in children aged 10 - 15 years. About 10% of adolescents have some degree of scoliosis, but fewer than 1% of them develop scoliosis that requires treatment. The condition also tends to run in families. Among people with relatives who have scoliosis, about 20% develop the condition.
Scoliosis that is not linked to any physical impairment, as well as scoliosis linked to a number of spine problems, may be seen in the adult population as well.
Vertebrae. The spine is a column of small bones,
or vertebrae, that support the entire upper body. The column is grouped into three sections of vertebrae:
- Cervical (C) vertebrae are the 7 spinal bones that support the neck.
- Thoracic (T) vertebrae are the 12 spinal bones that connect to the rib cage.
- Lumbar (L) vertebrae are the 5 lowest and largest bones of the spinal column. Most of the body's weight and stress falls on the lumbar vertebrae.
Each vertebra can be designated by using a letter and number; the letter reflects the region (C=cervical, T=thoracic, and L=lumbar), and the number signifies its location within that region. For example, C4 is the fourth vertebra down in the cervical region, and T8 is the eighth thoracic vertebra.
Below the lumbar region is the sacrum. a shield-shaped bony structure that connects with the pelvis at the sacroiliac joints. At the end of the sacrum are 2 - 4 tiny, partially fused vertebrae known as the coccyx or "tail bone."
The Spinal Column and its Curves. Altogether, the vertebrae form the spinal column. In the upper trunk, the column normally has a gentle outward curve (kyphosis ) while the lower back has a reverse inward curve (lordosis ).
The Disks. Vertebrae in the spinal column are separated from each other by small cushions of cartilage known as intervertebral disks. Inside each disk is a jelly-like substance called the nucleus pulposus. which is surrounded by a tough, fibrous ring called the annulus fibrosis. The disk is 80% water. This structure makes the disk both elastic and strong. The disks have no blood supply of their own, relying instead on nearby blood vessels to keep them nourished.
Processes. Each vertebra in the spine has a number of bony projections, known as processes. The spinous and transverse processes attach to the muscles in the back and act like little levers, allowing the spine to twist or bend. The particular processes form the joints between the vertebrae themselves, meeting together and interlocking at the zygapophysial joints (more commonly known as facet or z joints ).
Spinal Canal. Each vertebra and its processes surround and protect an arch-shaped central opening. These arches, aligned to run down the spine, form the spinal canal, which encloses the spinal cord. the central trunk of nerves that connects the brain with the rest of the body.