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7 October 2010

Your child and scoliosis

Scoliosis is a fixed lateral curvature of the spine. Frequently noted in adolescents, it is often picked up in "school screening" where a nurse evalautes a childs aligjnment on a forward bend test, and a note is sent home that the child needs evaluation for scoliosis. There are a number of causes of scoliosis and the natural history and treatment differ depending on the cause. Thus, it is important to understand the cause of your child's scoliosis before embarking on a treatment.

Scoliosis may be caused by severe muscle weakness (such as in muscular dystrophy), neurological abnormalities (such as cerebral palsy), spinal cord abnormalities (such as a syrinx which is an abnormal fluid filled cavity within the spinal cord), or congenital abnormalities in the way the bones of the spine are put together (referred to as "congenital scoliosis"). Finally, the most common cause of scoliosis is termed "idiopathic," meaning that the cause is "peculiar to the individual." Approximately 80% of scoliosis that comes into a physician's office is "idiopathic," and only about 30% of these idiopathic curves progress (get worse).

Because there are different types of scoliosis, the behavior and problems that result differ dependent on the cause. For instance, the curvature that occurs in severe cerebral palsy occurs in the lower spine (thoraco-lumbar or lumbar curves) that cause difficulty sitting and may result in pain. However, they do not generally cause problems with the heart or lungs.

While the causes of idiopathic scoliosis remain elusive, there are a number of things that we do know about it. Idiopathic scoliosis can run in families and thus there is some genetic influence. While the gene (or more likely, genes) involved have yet to be defined, we are likely to have a much better understanding of the inheritance of scoliosis soon. There are some patients that have subtle neurological abnormalities, such as abnormal perception of horizontal or abnormal nystagmus (the little flicker that the eyes make when they move side to side). It is unclear if these are a cause of idiopathic scoliosis or a result of the curve. In the future, we may find that "idiopathic" scoliosis is actually a number of different diseases, each of which has its own natural history.

It is also important to recognize that idiopathic curves behave differently depending on their location, the patient's age, and the size of the curve. Curves in the thoracic (chest) region are the most common. They generally result

in a narrowing of the chest wall (a result of rotation of the vertebral body and resulting deformity of the ribs). If the curve is small (less then 40 degrees) by the time the child reaches skeletal maturity, it is not likely to worsen as an adult. Generally, once the thoracic curve gets over 50 degrees, it is like the Leaning Tower of Pisa, and will continue to worsen with time, potentially resulting in problems with the heart and lungs.Thus, if a thoracic curve reaches 50 degrees or more, most surgeons would recommend that the patient undergo surgery to prevent further worsening

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