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Scoliosis - Highlights

Description

An in-depth report on the causes, diagnosis, treatment, and prevention of scoliosis.

Highlights:

Overview:

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 support the neck.
Thoracic (T) vertebrae connect to the rib cage.
Lumbar (L) vertebrae are the largest bones of the spinal column.

Scoliosis is the abnormal curving of the spine. While the normal spine has gentle natural curves, scoliosis typically causes deformities of the spinal column and rib cage. In scoliosis, the spine curves from side-to-side to varying degrees, and some of the spinal bones may rotate slightly, making the hips or shoulders appear uneven.

Treatment Approaches:

Braces tend to be used in children with curvatures between 25 - 40 degrees who still will be growing significantly.
Surgery is suggested for patients with curvatures over 50 degrees in untreated patients, or when braces have failed. In adults, scoliosis rarely progresses beyond 40 degrees, but surgery may be required if the patient is in a great deal of pain or if the scoliosis causes neurological problems.
Most scoliosis operations involve fusing the vertebrae. The instruments and devices used to support the fusion vary, however.
A new device, the vertical expandable prosthetic titanium rib (VEPTR), is showing promise in the treatment of severe congenital scoliosis with chest deformities. The device, which is implanted through surgery, can be adjusted as the child grows.
Vertebral body stapling is an experimental technique that may prevent curve progression in some young patients with curves less than 50 degrees. It involves stapling the outer curve of the side of the spine facing the chest, which helps stabilize and reduce progression of the inner curve.

Resources

www.scoliosis.org -- National Scoliosis Foundation
www.srs.org -- Scoliosis Research Society
www.scoliosis-assoc.org - - Scoliosis Association
www.aaos.org -- American Academy of Orthopaedic Surgeons
www.niams.nih.gov -- National Institute of Arthritis and Musculoskeletal and Skin Diseases
www.ispine.com -- Information on the spine

References

Aebi M. The adult scoliosis. Eur Spine J. 2005;14(10):925-948.

Akbarnia BA, Marks DS, Boachie-Adjei O, Thompson AG, Asher MA. Dual growing rod technique for the treatment of progressive early-onset scoliosis: a multicenter study. Spine. 2005;30(17 Suppl):S46-S57.

Budweiser S, Moertl M, JÃrres RA, et al. Respiratory muscle training in restrictive thoracic disease: a randomized controlled trial. Arch Phys Med Rehabil. 2006;87(12):1559-65.

D'Astous JL, Sanders JO. Casting and traction treatment methods for scoliosis. Orthop Clin North Am. 2007;38(4):477-484.

Everett CR, Patel RK. A systematic literature review of nonsurgical treatment in adult scoliosis. Spine. 2007;32(19 Suppl):S130-134.

Freeman III, BL. Scoliosis and Kyphosis. In: Canale ST, Beatty JH. (eds.) Campbell's Operative Orthopaedics. 11th ed. Philadelphia, Pa: Mosby Elsevier; 2007.

Gao X, Gordon D, Zhang D, et al. CHD7 gene polymorphisms are associated with susceptibility to idiopathic scoliosis. Am J Hum Genet. 2007;80(5):957-965.

Guille JT. Fusionless treatment of scoliosis. Orthop Clin North Am. 2007;38(4:541-545.

Hedequist DJ. Surgical treatment of congenital scoliosis. Orthop Clin North Am. 2007;38(4):497-509.

Hell AK, Campbell RM, Hefti F. The vertical expandable prosthetic titanium rib implant for the treatment of thoracic insufficiency syndrome associated with congenital and neuromuscular scoliosis in young children. J Pediatr Orthop B. 2005;14:287-293.

Ilharreborde B, Morel E, Fitoussi F, et al. Bioactive glass as a bone substitute for spinal fusion in adolescent idiopathic scoliosis: a comparative study with iliac crest autograft. J Pediatr Orthop. 2008;28(3):347-351.

Latalski M, Fatyga M, Gregosiewicz A. The vertical expandable prosthetic titanium rib (VEPTR) in the treatment of scoliosis and thoracic deformities. Preliminary report. Ortop Traumatol Rehabil. 2007;9(5):459-466.

Lenssinck ML, Frijlink AC, Berger MY, et al. Effect of bracing and other conservative interventions in the treatment of idiopathic scoliosis in adolescents: a systematic review of clinical trials. Phys Ther. 2005;85(12):1329-1339.

Lonner, B. S. Emerging minimally invasive technologies for the management of scoliosis. Orthop Clin North Am. 2007;38(3): 431-440.

Luhmann SJ, Bridwell KH, Cheng I, Imamura T, Lenke LG, Schootman M. Use of bone morphogenetic protein-2 for adult spinal deformity. Spine. 2005;30(17 Suppl):S110-S117.

Motoyama EK, Deeney VF, Fine GF, et al. Effects on lung function of multiple expansion thoracoplasty in children with thoracic insufficiency syndrome: a longitudinal study. Spine. 200631(3):284-290.

Patil CG, Santarelli J, Lad SP, et al. Inpatient complications, mortality, and discharge disposition after surgical correction of idiopathic scoliosis: a national perspective. Spine J. 2008 Mar 19 [Epub ahead of print]

Richards BS, Vitale M. Screening for Idiopathic Scoliosis in Adolescents: Information Statement. AAOS-SRS-POSNA-AAP. Available online.

Rose PS, Lenke LG. Classification of Operative Adolescent Idiopathic Scoliosis: Treatment Guidelines. Orthop Clin N Am. 2007;38:521-529.

Sarwark J, Sarwahi V. New strategies and decision making in the management of neuromuscular scoliosis. Orthop Clin North Am. 2007;38(4): 485-496.

Shaughnessy WJ. Advances in scoliosis brace treatment for adolescent idiopathic scoliosis. Orthop Clin North Am. 2007;38(4):469-475.

Thompson GH, Akbarnia BA, Kostial P, Poe-Kochert C, Armstrong DG, Roh J, et al. Comparison of single and dual growing rod techniques followed through definitive surgery: a preliminary study. Spine. 2005;30(18):2039-2044.

U.S. Preventive Services Task Force. Screening for Idiopathic Scoliosis in Adolescents: A Brief Evidence Update for the U.S. Preventive Services Task Force. June 2004. Agency for Healthcare Research and Quality, Rockville, MD.

Waldhausen JH, Redding GJ, Song KM. Vertical expandable prosthetic titanium rib for thoracic insufficiency syndrome: a new method to treat an old problem. J Pediatr Surg. 2007;42(1):76-80.

Yuan N, Fraire JA, Margetis MM, Skaggs DL, Tolo VT, Keens TG. The effect of scoliosis surgery on lung function in the immediate postoperative period. Spine. 2005;30(19):2182-2185.

Reviewed last on: 5/24/2009
Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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