The Curve You Would Never Want To Have

Saturday, August 26, 2006 | 0

Jomar Almeda, M.D.

Viewed from the front or back, the human spine forms one straight line. When viewed from the side, there is the normal characteristic lordotic (forward) curve of the cervical (neck), and lumbar (low back) spine and the kyphotic (backward) curve of the thoracic (upper back) spine. These normal curves are responsible for maintaining one's good posture, and ease of movement.

Unfortunately, some individuals develop curves in the wrong places and direction. Instead of the normal forward and backward curvature of the spine, some develop curves that move laterally (sideways). When this happens, a diagnosis of scoliosis is made. In scoliosis, one may have a curve that moves towards the left or right, in the thoracic region, lumbar region, or both. In some the vertebrae may rotate, making the individual's shoulders or waist even more disproportionate.

What Causes Scoliosis?

In about 85% of cases, scoliosis is idiopathic, or of unknown cause. Scoliosis can also be classified as non-structural or structural. The non-structural type is caused by factors not directly related to the spine. The spine may thus appear curved even if it actually is normal. This occurs with poor posture, when there is discrepancy in leg length and when there is back muscle spasm. This type of scoliosis is treated by correcting these underlying conditions.

Structural scoliosis is caused by conditions arising from the spinal column. These include congenital defects of one or more vertebrae, spinal trauma, tumors, certain connective tissue disorders or neuromuscular disease. Structural scoliosis can sometimes occur as part of a syndrome, as in Marfan's syndrome or neurofibromatosis. In the elderly, it can also be caused by degenerative changes of the spine.

Who Are At Risk?

Scoliosis can affect people of all ages. The idiopathic type which makes up the vast majority of cases usually develops in childhood. It may run in families and is seen more frequently in girls than in boys. Because of increased predisposition when one has a family history of scoliosis, a child who has a parent or sibling with idiopathic scoliosis should be screened and regularly checked by a physician. In adults, some scoliosis may have actually began in childhood even if it was not diagnosed before, or was diagnosed late.

Diagnosis:

Early detection is the key to successful treatment. Idiopathic scoliosis can easily be overlooked in children. Parents should therefore be observant on the presence of any of the following, which raises the suspicion of a child having scoliosis:

1. Disproportionate shoulders.
2. One shoulder blade that appears more prominent than the opposite side.
3. Uneven waist.
4. One hip that appears elevated than the other.

Presence of any of the above signs should warrant evaluation by a physician. Thorough evaluation includes review of the patient's family history and clinical history for congenital and developmental defects, trauma, or other disorders that can be associated with scoliosis. In addition to physical examination, some patients may require x-ray evaluation of the entire spine to enable the physician to accurately measure the spinal curvature.

Treatment:

Treatment of scoliosis is guided by the patient's age at the time of diagnosis, the type of scoliosis, the severity, and location of the curve. Most children with idiopathic scoliosis only need to be observed for any sign of progression. If a curve does progress on subsequent follow-ups, a brace can be used to prevent it from getting worse. Whether bracing will be effective or not will also depend to a great part on patient compliance on the length of time he needs to use the brace.

If scoliosis is severe when first diagnosed, or if treatment with a brace is unsuccessful, surgery may be necessary. Scoliosis caused by other conditions, may require other specialized forms of treatment.

Although exercises have not been shown by studies to prevent the size of the curve from progressing, it remains to be an important aspect of treatment. Patients are advised to exercise for its positive effects on their general health and well-being, and to maintain good physical conditioning.

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The author is with the Workers' Compensation Department of Integrative Industrial and Family Practice Medical Clinics. He can be reached at jomar@lamedcenter.com.

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The views and opinions expressed by the author are not necessarily those of workcompcentral.com, its editors or management.