How do scoliosis start

While every case is different, in many cases, the condition only causes minor changes to the body that are difficult to spot by anyone other than a specialist trained at what to look for.

Pain tells us something wrong is happening in the body and is difficult to live with, prompting patients to seek treatment. While an abnormal spinal curvature sounds like it would be painful, in adolescents who are constantly growing, pain is often a non-issue.

This is understood by the absence of compression on the spine. When it comes to treating adolescents with scoliosis, the main goal is to stay ahead of the curve and its natural tendency to progress. Through X-rays and visual assessment, we can tell how much a person has grown, how much they are going to grow, and how much their curvature has progressed. What we do know is that only in the infantile phase is it possible for a curvature to correct itself.

Growth is the main known cause of progression, so this age group is most likely to experience rapid progression as they go through the puberty stage. Some people ask if compliance is an issue when treating adolescents. While scoliosis definitely carries a psychological effect, most of my patients who fully commit to our customized treatment plans see results quickly, and once those first results are seen, the motivation is there to continue the work.

My first treatment goal is structural; I want to treat the patient and their condition to actually achieve a curvature reduction.

The more a patient is progressing, the more we increase treatment-intensity and monitor them closely. If a patient grows an inch, I want X-rays and measurements done to determine if that growth is speeding up progression; if it is, the treatment plan is adjusted to counteract that tendency.

Once a patient achieves a reduction, the goal is to hold that reduction in a functional way, meaning the spine can maintain a good range of motion and flexibility.

While 80 percent of diagnosed scoliosis cases are idiopathic, the remaining 20 percent have known causes. Known to develop in the first six weeks of gestation, this anomaly is best described as the result of a misformed vertebra.

If you picture a healthy spine as bricks stacked on top of one another separated by discs, in congenital scoliosis, one of those bricks is shaped like a triangle, causing the spine to shift and become misaligned. When it comes to progression with congenital scoliosis, growth is still a big factor. As the most rapid stage of spinal growth is up to age 5 and during the adolescent phase, these are the times that progression is most likely to occur and needs to be monitored closely.

Neuromuscular scoliosis is caused by diseases like muscular dystrophy and cerebral palsy that affect the spine and can lead to an abnormal spinal curvature. This form of scoliosis develops as a secondary complication to larger medical issues caused by disorders of the spinal cord, brain, and muscular system.

Patients with neuromuscular scoliosis are much more likely to experience rapid curvature progression that will continue into adulthood. Progression severity is connected to the level of neuromuscular involvement. In: Nelson Textbook of Pediatrics.

Elsevier; Scherl SA. Adolescent idiopathic scoliosis: Clinical features, evaluation and diagnosis. Ferri FF. In: Ferri's Clinical Advisor Adolescent idiopathic scoliosis: Management and prognosis.

Miller MD, et al. The adolescent: Scoliosis. In: Essential Orthopaedics. Kim W, et al. Clinical evaluation, imaging and management of adolescent idiopathic and adult degenerative scoliosis. In: Current Problems in Diagnostic Radiology. Azar FM, et al. Scoliosis and kyphosis. In: Campbell's Operative Orthopaedics. Surgical treatment for scoliosis. Devlin VJ. Idiopathic scoliosis. In: Spine Secrets. Larson AN expert opinion. Mayo Clinic. The axial plane is parallel to the plane of the ground and at right angles to the coronal and sagittal planes.

Scoliosis affects percent of the population, or an estimated six to nine million people in the United States. Scoliosis can develop in infancy or early childhood. However, the primary age of onset for scoliosis is years old, occurring equally among both genders.

Females are eight times more likely to progress to a curve magnitude that requires treatment. Every year, scoliosis patients make more than , visits to private physician offices, an estimated 30, children are fitted with a brace and 38, patients undergo spinal fusion surgery.

Scoliosis can be classified by etiology: idiopathic , congenital or neuromuscular. Idiopathic scoliosis is the diagnosis when all other causes are excluded and comprises about 80 percent of all cases. Adolescent idiopathic scoliosis is the most common type of scoliosis and is usually diagnosed during puberty. Congenital scoliosis results from embryological malformation of one or more vertebrae and may occur in any location of the spine.

The vertebral abnormalities cause curvature and other deformities of the spine because one area of the spinal column lengthens at a slower rate than the rest. The geometry and location of the abnormalities determine the rate at which the scoliosis progresses in magnitude as the child grows.

Because these abnormalities are present at birth, congenital scoliosis is usually detected at a younger age than idiopathic scoliosis. Neuromuscular scoliosis encompasses scoliosis that is secondary to neurological or muscular diseases. This includes scoliosis associated with cerebral palsy, spinal cord trauma, muscular dystrophy, spinal muscular atrophy and spina bifida. This type of scoliosis generally progresses more rapidly than idiopathic scoliosis and often requires surgical treatment.

There are several signs that may indicate the possibility of scoliosis. If one or more of the following signs is noticed, schedule an appointment with a doctor. In one study, about 23 percent of patients with idiopathic scoliosis presented with back pain at the time of initial diagnosis. Ten percent of these patients were found to have an underlying associated condition such as spondylolisthesis, syringomyelia, tethered cord, herniated disc or spinal tumor.

If a patient with diagnosed idiopathic scoliosis has more than mild back discomfort, a thorough evaluation for another cause of pain is advised. Due to changes in the shape and size of the thorax, idiopathic scoliosis may affect pulmonary function. Recent reports on pulmonary function testing in patients with mild to moderate idiopathic scoliosis showed diminished pulmonary function. Scoliosis is usually confirmed through a physical examination, an x-ray, spinal radiograph, CT scan or MRI.

The curve is measured by the Cobb Method and is diagnosed in terms of severity by the number of degrees. A positive diagnosis of scoliosis is made based on a coronal curvature measured on a posterior-anterior radiograph of greater than 10 degrees. In general, a curve is considered significant if it is greater than 25 to 30 degrees. Curves exceeding 45 to 50 degrees are considered severe and often require more aggressive treatment.

A standard exam that is sometimes used by pediatricians and in grade school screenings is called the Adam's Forward Bend Test. During this test, the patient leans forward with his or her feet together and bends 90 degrees at the waist. From this angle, any asymmetry of the trunk or any abnormal spinal curvatures can easily be detected by the examiner.

This is a simple initial screening test that can detect potential problems, but cannot determine accurately the exact type or severity of the deformity. Radiographic tests are required for an accurate and positive diagnosis. Scoliosis in children is classified by age: 1.

Infantile 0 to 3 years ; 2. Juvenile 3 to 10 years ; and 3. Adolescent age 11 and older, or from onset of puberty until skeletal maturity.