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Scoliosis is a defined as a side to side deviation or curvature of the spine when viewing the body from the front or back. Generally the cause in most cases is unknown. Severe curve progression has an increased incidence in the female population. Some known causes include congenital malformation of the spinal column, neuromuscular scoliosis caused by cerebral palsy or spina bifida, genetic anomalies and other conditions.
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Congenital scoliosis,
note triangular hemivertebra |
Correction of congenital scoliosis
with posterior instrumentation |
Typically, other than the above mentioned congenital scoliosis and neuromuscular scoliosis, most scoliosis is called idiopathic scoliosis. This is further divided into infantile, ages birth to 3 years, juvenile, ages 3 to 9 years, and adolescent, ages 10 to 18 years. Curves appearing earlier in life may be more likely to progress as there is more time and growth potential prior to skeletal maturity, which may slow curve progression. Later in life degeneration may occur in the spine due to age or unusual stresses on the spine and previously mild and undiagnosed scoliosis may progress and become symptomatic. This is referred to as degenerative scoliosis.
Curvature may be mild to severe and treatment is varied depending on severity and response to conservative means. Generally a mild curve of less than 10 degrees is considered spinal asymmetry not scoliosis. Curves larger than 10 degrees are often watched for progression by X-ray measurement over time. If the patient is skeletally immature as determined by the pelvic growth plate on X-ray, bracing may be helpful in controlling progression. Not all cases are candidates for bracing as this depends on the type and severity of curve. Bracing is not always considered until curves reach 20-25 degrees or show rapid progression in skeletally immature individuals.
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