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Spine Disorders: Idiopathic Scoliosis

Scoliosis is one of three main types of spine curvature disorders. Like a disease on the spinal curvature twisting and resulting in the sideway curves of the spine. It is defined as a lateral, or a side-to-side deviation from the normal frontal axis of the body. Scoliosis is similar to Lordosis, which also been named the swayback, for example when the spine of a person with lordosis curves significantly inward at the lower back.

Kyphosis another characterized by an abnormally rounded upper back (more than 50 degrees of curvature), Everyone’s spine has curves, although scoliosis is a three-dimensional deformity, on an x-ray, scoliosis curves can often have the spine curvature in the form of an S shape. The definition of these conditions is limited and the deformity occurs in varying degrees in all three positions: back-front; side-to-side; top-to-bottom. The rounding of the shoulders and the rhythmical movement of the lower back normally connect all the regions of the spine; from top-to-bottom, cervical, thoracic, lumbar, sacral, and coccyx.

These curves can actually occur at many levels of the spine as the cervical/neck region, thoracic/rib region and lumbar/low back region, as well as occur in multiple regions in the same individual. The spine with scoliosis has abnormal curves with the rotational deformity that turns on its axis like a corkscrew. Some patterns are more common than others, but hardly ever are two spines identical. The spine is made of 33 individual bones stacked one on top of the other. This spinal column provides the main support for your body, allowing you to stand upright, bend, and twist.

Protecting the spinal cord from injury, and also act as shock absorbers along strong muscles and bones, flexible muscles, and ligaments, the sensitive nerves contribute to a healthy spine. Yet, any of these structures affected by strain, injury, or disease can cause pain. Unfortunately, people’s spines naturally curve on their own and occur most often in healthy people. There are more than a couple ways that scoliosis may occur, but the most shocking one is that there is no evident cause for the most common. Idiopathic scoliosis probably results from a combination of genetic and environmental factors.

Studies suggest that the abnormal spinal curvature may be related to hormonal problems, abnormal bone or muscle growth, nervous system abnormalities, or other factors that have not been identified. As a result, Idiopathic Scoliosis is the most common in the history of Scoliosis, Idiopathic meaning that there is no known cause. And even though there are relatively several other types of scoliosis, the cause of the most common form of scoliosis which is Idiopathic remains unknown. Hereditary and genetic factors have been discovered, But Doctors still to this day don’t know what causes the most common type of scoliosis.

Although it appears to involve hereditary factors because the disorder tends to run in families and less common in other different types of scoliosis, Scoliosis does not come from carrying heavy things, athletic involvement, sleeping or standing postures, or minor lower limb length inequality. The two other most common are congenital and neuromuscular. Neuromuscular is where scoliosis is a secondary symptom of another condition such as muscular dystrophy, cerebral palsy and others. Cerebral palsy or muscular dystrophy; anyone of them causing deformities in a shoulder, trunk, and waistline “asymmetry”.

These conditions may be barely noticed at times, but in severe forms, there is significant disfigurement, back pain, and postural fatigue, and it may be associated with heart failure. It also may occur with Cerebral Palsy or may be induced by Spina Bifida. Spina Bifida is a type of birth defect that occurs when the bones of the spine (vertebrae) don’t form properly around part of the baby’s spinal cord. Spina bifida can be mild or severe. The term spina bifida comes from Latin and literally means “split” or “open” spine.

Cerebral palsy refers to a group of disorders that affect muscle movement and coordination of the human body and in many cases, vision, hearing, and sensation are also affected. The word “cerebral” means having to do with the brain. The word “palsy” means weakness or problems with body movement. It is the most common cause of motor disabilities in a kid’s childhood. Congenital scoliosis starts when a baby is born and is different to early onset scoliosis. In very young children, curves caused by early onset scoliosis can sometimes self-correct, without treatment.

This curvature of the spine which may have its onset in a baby’s infancy, but are most frequently discovered in adolescence. Usually, early onset scoliosis is related to idiopathic. Approximately 80-85% of scoliosis cases are classified as Idiopathic scoliosis, which is broken down into more subcategories as infantile, juvenile, adolescent, or adult depending on when onset occurred. Numerous studies have shown the condition is more likely to be adolescent idiopathic scoliosis, positioning the curve more often to the right-side and affecting more girls than boys.

Also, it’s more common in females by 2:1 ratio, however, when curves in excess of 30 degrees are evaluated, females are more frequently affected by a ratio of approximately 10:1. Curves that are larger or continue to grow may need more intensive treatment. However, this is a type of scoliosis that you are born with. The word congenital means that the condition is present at birth. This is what happens because the spine does not develop fully in the womb similar to a type of Spina Bifida. As the spine is meticulously created of these small bones called vertebrae.

Sometimes these vertebrae do not form fully as the child grows in the womb. Sometimes one or more do not form at all, which causes the spine to grow unevenly once a child is born. The cause of vertebral anomalies that occur during embryological development and may be accompanied by other organ anomalies or may be caused by an abnormal formation of the vertebrate, vertebral absence, partial formation, or lack of separation can cause asymmetrical growth and can result in a deformity. Detection is essential if you can identify it early enough, you may be able to alter the curve and make small adjustments to keep the spine in line.

Unfortunately, scoliosis is not preventable, diagnosis and treatment early on in childhood are the best way of preventing an existing problem from getting worse. However, it is very hard to detect scoliosis. Parents should be aware of some signs to help indicate the need for a screening. Such are: Uneven shoulders or hips prominent shoulder or shoulder blades leaning to one side prominence of one side of the rib cage. If any of these signs become evident, the child should immediately be taken to the doctor for further evaluation, which will be helpful with early detection.

The focus is always on the appearance of the spine, as well as the function of the nerves coming out of the spinal cord. Depending on the severity of the curvature, treatments for scoliosis may vary. The non-operative treatment of scoliosis involves observing the deformity with examinations and repeated x-rays. Under certain circumstances, when spinal growth remains, a brace may be used in combination with follow-up x-rays. Physical therapy exercises have not been shown to be an effective treatment for scoliosis. Bracing is one type of treatment that has been successful.

It has been documented that the application of a Milwaukee brace can improve the juvenile curves and reduce the surgical indication for surgery to 20 percent. Most back braces need to be worn as much as possible The brace must be removed for muscle strengthening exercises in order to keep the spine, abdomen, and trunk strong to prevent further injury. Brace treatments vary and are used to prevent scoliosis from getting worse when you have: A curve that is moderate in size from 20 to 30 degrees, with the definite possibility of becoming progressive and showing an increase by more than 5 degrees since when first diagnosed.

Scoliosis has a significant risk of progression: up to 22%, once scoliosis passes 20°, the risk of progression more than triples to 68% and the worst results are seen in children whose curves are greater than 20 degrees at the time of the first indication. Scoliscore is test used to determine the propensity of progression of scoliosis without the need for diagnostic X-Rays. This is a DNA test that can indicate the likelihood of progression into a severe curve for children diagnosed with idiopathic scoliosis.

This test is appropriate for children nine to thirteen years of age with a mild to a severe curve. The test is performed easy and pain-free by analyzing the patient’s saliva which is collected in the doctor’s office. The Test analyzes 53 genetic markers correlated with curve progression and has a 99% negative predictive value in determining the risk of progression. The test was developed in collaboration with over 110 clinicians worldwide, was designed through the analysis of over 10,000 patient samples and was validated in three multi-center independent clinical trials.

Scoliscore assigns a number from 1-200 to indicate a low, medium or high-risk likelihood for curve progression. The assigned number is based on the child’s DNA and their current Cobb angle (angle of the curve on scoliosis x-rays). This test is revolutionary as it allows the child and parents to have a more reliable indicator of their child’s future spinal health. Risk stratification combined with family history, current status and remaining growth left allows for a customized treatment discussion which may allow for reduced x-ray exposure and frequent follow-ups.

The majority of these cases are closely followed-up and monitored for the worsening of the curve. The serious condition of the spinal curves that progress beyond 30 degrees is often recommended for an aggressive treatment of multiple level spinal fusion surgeries. Scoliosis surgery throughout its history has improved over the past several decades, choosing surgery is never easy, and many patients find that the risks and poor treatment outcomes make this the last resort. ‘’The last resort’’ is this procedure that can be very dangerous considering you’re dealing with the spine and its entirety.

Doctors use the Harrington rod instrumentation that was invented to treat instability and the deformity of the spine. By using special rods and placing them next to the vertebrate of the spine along with a combination of hooks, screws, and wires, to carefully attempt the straightening of the curved part of the spine. Finally adding a small amount of bone graft that is placed over the spine to fuse it in a straight position. The bone graft heals over the next several months, the spine becomes solid and will not curve again.

But the part of the spine that has not been fused will still be flexible, and allow nearly normal overall movement. By far, without this particular spinal fusion surgery, the instability and disorder may result in severe spinal deformities, disabling pain and impairing the bodies neurological, hormonal, and nutritional systems. Scoliosis being a similar disease among others that attacks the muscles and ligaments of the spinal column, causing C-shaped or S-shaped curvatures on the spine.

An S-shaped curve is created when a secondary curve counterbalances primary abnormal curve. One of the many problems that are associated with spinal fusion surgery for scoliosis is that it is extremely expensive and most people cannot afford to have it done. There are many alternative treatments for scoliosis. Even though none of them have been scientifically proven to help in reducing the curvature, there is no real harm in experimenting with them.

Whether it is electrical stimulation, magnets, acupuncture, craniosacral massages, Reiki therapy or holistic remedies, as long as the person involved is still receiving the necessary standard treatments and follow-up, there is nothing wrong with it. All in all, scoliosis is difficult to treat and manage for the patients. It occurs mainly in adolescents and has devastating body image issues in its presence leaving patients to struggle with poor body image, social anxiety, and depression.

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