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Scoliosis

Scoliosis is when a person’s spine curves from side to side.
About

When this curve occurs, the spine looks more like an S or a C rather than a straight line. This curve can lead to changes in one’s shoulders, ribcage, pelvis, waist, and the overall shape of one’s back.

Scoliosis affects many individuals in Canada. It is more common in girls than boys.

Common types

Idiopathic Scoliosis

“Idiopathic” means of unknown cause. Idiopathic scoliosis is when the spine is curved sideways but there is no known cause of this curvature. It is believed that genetics may play a role in the development of idiopathic scoliosis. This is the most common type of scoliosis and can develop at any age.

Congenital Scoliosis

“Congenital” means present at birth. Congenital scoliosis occurs when the bones in the spine (vertebrae) are not shaped properly (abnormality) from birth. This is the 2nd most common type of scoliosis.

Neuromuscular Scoliosis

Neuromuscular scoliosis is caused by a neuromuscular disease or condition (e.g. cerebral palsy, spinal muscular atrophy, and spina bifida). Neuromuscular scoliosis is also known as secondary scoliosis. This is the 3rd most common type of scoliosis.

Diagnosis 

Scoliosis is diagnosed by a physical exam followed by an X-ray. The X-ray views the vertebrae to see if they are in a straight line or curve to form the shape of an “S” or a “C”. The X-ray may also tell the size of the curve. The size of the curve is measured in degrees:

  • Small curve: less than 20 degrees
  • Moderate curve: between 20 and 50 degrees
  • Large curve: greater than 50 degrees

 

Treatment

There are several different ways to treat scoliosis. The type of treatment selected depends on the type and size of the curve.

Your orthopedic surgeon (bone and joint doctor) will discuss with you the possible treatment options for your scoliosis. 

Observation

If you have a small curve in your spine, you will be observed over time to see if there are any changes in the curvature.

Bracing

For a medium-sized curve, you may be observed over time or treated with a brace. The brace will not cure or reverse the scoliosis, but may prevent the scoliosis from getting worse. Once the brace is removed, you will be observed for a period of time.

Surgery

If your curve is larger, you may require surgery. Surgery is done to improve or correct the curvature in the spine and prevent it from getting bigger.

 

Healthy lifestyle

Regardless of the treatment that you and your doctor decide, it is important to maintain a healthy lifestyle!

  • Be physically active: yoga, pilates, and swimming are good activities to help develop core muscle strength.
  • Eat healthy: a good diet will help your overall body health.
  • Avoid unhealthy lifestyle behaviours (e.g. smoking)
  • Attend regular follow-up visits with your doctor and follow their recommendations regarding activity and lifestyle modifications



Early Onset Scoliosis

Scoliosis can develop very early on in childhood. 

Types 

There are several different types of Early Onset Scoliosis

Infantile Idiopathic Scoliosis

“Idiopathic” means of unknown cause. Idiopathic scoliosis is when the spine is curved sideways but there is no known cause of this curvature. Infantile idiopathic scoliosis occurs in children between birth and up to 3 years of age.

Juvenile Idiopathic Scoliosis

JIS occurs in children between the ages of 4-10 years old. Similar to Infantile Idiopathic Scoliosis, there is no known cause.

Congenital Scoliosis

Congenital Scoliosis is a spine deformity caused by vertebrae that are not properly formed in utero. There can be medical conditions associated with congenital scoliosis. It can present in infancy, childhood or adolescence. Your orthopedic surgeon will be able to tell you if a hemivertebra (partial vertebra) is present or if the vertebrae are joined together abnormally.

Treatment

As children grow, they will have many follow up visits with the orthopedic doctor to monitor the progress of the spine curve. The doctor will make recommendations at each visit. These individualized recommendations can include ongoing observation with a) either an xray and/or physical exam b) a course of bracing or c) discussion about the need for surgery. 

At some point of time, the doctor may feel it is necessary to perform other tests which will give them more information about the structure and development of the spine. These include: 

  • CT scan (a form of x-ray using computerized tomography) which shows three-dimensional reconstruction of the spine. This gives the surgeon more accurate information if surgery is required.
  • An MRI of the spinal cord (a non-invasive medical imaging procedure which uses a powerful magnet that provides detailed three dimensional images of soft tissues) which would show the spinal canal and rule out any abnormalities.  

Growth-friendly surgery

If the doctor determines that surgery is the best treatment course for a child with scoliosis, they may discuss several options in order to help guide the growth of the spine as a child continues to grow. 

This will require multiple surgeries over time: 

  • the initial placement of the guided growth device
  • subsequent lengthenings to continually assist the spine to grow straight as the child grows. 

There are two different types of guided growth devices. 

Growing rods

Growing rods use implanted hooks, screws and expandable rods attached to the spine which control the spinal curve and allow for the spine to grow. Growing rods need to be lengthened approximately every 6 months. Eventually a more permanent spinal fusion will become necessary which halts growth in the area of instrumentation. 

A follow-up appointment will be required to remove the stitches after each lengthening.



VEPTR (Vertical Expandable Prosthetic Titanium Rib)

A VEPTR is a type of device used for the treatment of thoracic insufficiency syndrome involving rib and spine deformities. These devices can be attached to the ribs, pelvis, or spine. A limited number of patients are appropriate for this type of lengthening option. As with the growing rods, small incisions are required to do the lengthening approximately every 6 months. A follow up appointment will be required to remove the stitches after each lengthening. 



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