Scoliosis is a rare spinal condition in which the spine abnormally rotates and curves from side to side. Although scoliosis can be present at birth, it usually develops later in childhood or adolescence and is more common in young girls than boys. Many children are screened for scoliosis in school between grades 5 and 9 since the condition typically progresses most rapidly during a child’s growth spurt years.
Scoliosis can range from very mild to extremely severe, depending on the degree of the curvature of the spine. Even though most cases are considered minor and are not painful, the condition may be a source of body image anxiety and low self-esteem for some teens. In more severe cases, the child may suffer potentially serious complications such as respiratory difficulty and physical deformities. Early diagnosis is key to limiting the extent of the curvature.
Curvatures of 10 degrees or less are not considered true scoliosis. Curves less than 30 degrees are usually watched and followed through serial x-rays taken over time as a child grows to catch any significant changes. Curvatures beyond 30 degrees are often treated by an orthopaedic brace to help limit curvature. Physicians will recommend a brace for children still expected to grow. In some cases, a combination of bracing and physical therapy can be effective. ONS physical therapists who are certified in Schroth Best Practice therapy for adolescent idiopathic scoliosis incorporate the technique’s mobilization, breathing and strengthening exercises to stabilize and attempt to reverse thoracic and lumbar scoliotic curves.
The more the spine curves and rotates, the worse the deformity becomes. If a brace and physical therapy fail to control the progression of the curve, surgery is considered. In these instances, the spine has rotated, twisting the chest with it. This pushes the shoulder blade and ribs off the back, creating a hump as well as unevenness in front to the chest. Often the hips follow in a tilted posture.
Scoliosis surgery straightens the curve in the spine and fuses together the individual spinal segments and joints that are involved in the curve. This surgery has been found to be a safe and effective treatment. While severe scoliotic curves cannot be completely straightened, they may often be dramatically improved.
The term kyphosis is used to describe an exaggerated curvature of the spine that gives the back a rounded appearance. Kyphosis can be caused by a number of conditions including poor posture, osteoporosis, long term use of steroids or spine tumors. In the most serious cases, a dramatic curve happens after multiple vertebra fracture and collapse. A physical examination and x-rays of the spine will provide the physician with the information needed to determine the extent of any spinal abnormality. A curve of more than 45 degrees is considered abnormal.
The most common form of kyphosis is attributed to poor posture and is defined as an exaggerated but flexible increase of the natural curve of the spine. This usually becomes noticeable during adolescence and is more common among girls than boys. It is rarely painful and doesn’t it usually lead to a more serious condition. Exercises to strengthen the abdomen and stretch the hamstrings may help take away associated discomfort but usually won’t correct the curve.
Scheuermann’s (shoe-er-mans) kyphosis is most often diagnosed during teen years but is usually a more significant deformity. Although most often a condition of the upper spine, it may also occur in the lower or lumbar region and can be painful with activity as well as long periods of standing or sitting. In an x-ray, the individual vertebrae will appear wedge shaped.
Some infants are born with a spinal column that has not developed properly. Several vertebrae may be misshaped or fused together. As the child grows, these abnormal conditions may progress. Surgical treatment is sometimes recommended at a very young age to limit the extent of the curvature as the spine grows.
Treatment for kyphosis varies depending on the type and severity of the condition. Teens with postural kyphosis will not generally suffer any complications or progression of the condition. Some may even improve with time. An exercise program may help with any back pain.
For patients with Scheuermann’s kyphosis, a conservative treatment program may include exercise and anti-inflammatory medications. If the child is still growing, a brace may be prescribed to help limit the curvature.
If a kyphotic curve is more than 75 degrees, surgery may be an option. The doctor may chose to straighten and fuse the vertebrae of the abnormal segment together. This can stabilize the spine and relieve any pain associated with the instability.