The Anatomy of the
The spine is made up of many individual small bones called
vertebrae. These bones are joined together by muscles and
ligaments. Soft, flat "intervertebral discs" separate and cushion
the vertebrae from each other. As the bones are all separate, the
spine is flexible and bends. The vertebrae, discs, muscles and
ligaments together make up the spine.
The normal healthy spine has front to back curves and individual
spines can vary in size and shape. The neck area is called the
"cervical" spine and normally curves slightly inward. The chest
area is called the "thoracic" spine and curves outward. The lower
area of the back is called the lumbar and sacral spine and also
curves slightly inward. When the curve in any of these areas
becomes too big, or curves side-to-side forming a C-shape or
S-shape is when it becomes a problem.
What Causes Abnormal
Curves of the Spine?
There are many causes of abnormal spinal curves:
- "Congenital" causes are defects of the spinal vertebrae from
birth that cause the spine to grow unevenly. These defects may
include absence of one or more vertebrae, partially formed
vertebra, or lack of or abnormal separation of the vertebrae.
- "Neuromuscular" causes come from problems with the nerves and
muscles either present from birth or acquired. These include such
diagnosis as cerebral palsy, spina bifida, muscular dystrophy,
spinal cord tumors, and neurofibromatosis.
- "Syndrome related" spine abnormalities are typically related
to those children with a syndrome such as Down's syndrome,
Klippel-Feil syndrome, or Marfan's syndrome.
- "Idiopathic scoliosis" is the most common type of spine
deformity, which means there is no known cause. There is nothing
that was done to cause it and nothing that could have been done to
prevent it. It often affects adolescents as they go through their
last major growth spurt, which is generally ages 11-13 years for
girls and 13-15 years for boys. It also may affect younger
children. Idiopathic scoliosis frequently, but not always, runs in
families and may be related to genetics or hereditary influences.
There is ongoing scientific research to help scientists and
physicians understand who is affected by scoliosis, why some
scoliosis progresses while some cases do not, and why some
scoliosis responds to bracing and some do not.
When the trunk is viewed from behind, the normal spine appears
straight. Also, the shoulders and hips appear level. The spine
affected by scoliosis demonstrates a lateral or sideways curve. The
spine not only curves sideways but also twists, which may give the
appearance that the person is leaning sideways and/or that they
have a hump on one side of their back. Also, the head may not be
centered over the pelvis (hips). Your clothes may hang unevenly.
Many people with scoliosis also have "hypo-kyphosis". Hypo-kyphosis
is a flattening of the mid part of the back, which is normally
somewhat rounded. These physical signs are more obvious in some
people than others but usually become more obvious as the curve
progresses. Because of all the different and different combination
of spinal curvatures, scoliosis may present very differently in
In early childhood, idiopathic scoliosis occurs in both boys and
girls equally. As children enter adolescence, girls are twice as
likely to develop scoliosis and 8-10 times more likely to have more
severe cases of scoliosis requiring treatment. Scoliosis may be
first noticed in a school screening, a routine physical exam,
sports physical, or by a family member. This is an important
finding and requires follow-up.
There are some neurological symptoms that are NOT associated
with idiopathic scoliosis. These include leg pain, weakness,
numbness and/or tingling, changes in bowel or bladder habits and
severe back pain or back pain at night that awakens the child from
sleep. Also some symptoms of scoliosis may resemble other spinal
conditions such as injury, infection or tumors. Presence of any of
these conditions should be further evaluated by a physician.
What Should Be
In 90% of cases, scoliotic curves are mild and do not require
active treatment. However, it is especially important in the rapid
growth period before and during adolescence to monitor the curve
for progression. This is done by periodic physical exams and
x-rays. Increases in the spinal deformity should be evaluated by an
orthopaedic surgeon. Although scoliosis rarely seems to be a
problem to the child with the curve, the curve can become a problem
in adulthood. These curves are much more successfully treated early
before they become more severe in adulthood.
Brace treatment may be offered versus "watchful waiting". In a
small number of patients surgical correction may be recommended
based on your physical exam and any neurological findings or
physical complaints. Your orthopaedic surgeon may also order an MRI
(magnetic resonance imaging) to evaluate your spinal cord, before
any treatment is initiated.
Brace Treatment for
Brace treatment (orthosis) may be offered or recommended for
increasing scoliosis or kyphosis. Recommendation for bracing is
based on the degree of the curvature, skeletal maturity, and
readiness of the patient and family for the bracing regimen. There
are different types of braces that are all designed to prevent the
spine curve from progressing as the adolescent grows. Your
orthopaedic surgeon will recommend a specific type of brace
depending on your child's age and type of curve. A scoliosis brace
works by pushing on the curve of the spine to hold it in a
straighter position while the child is growing. A scoliosis brace
is made specifically for each individual person. A bracing program
can be very difficult. For example theBoston brace should be worn
approximately 20 hours a day until the end of growth which can be
from one year to several years. It is important to be physically
active and continue with sports, dance, etc during hours out of the
brace. Physical fitness is very important! A brace will not make
the spine straight and cannot always keep a curve from progressing.
Increasing the chances of successful brace treatment requires:
- Early detection of curve, ideally before or early on in the
adolescent growth spurt.
- Mild to moderate scoliosis curves (25-40 degrees).
- Well fitted brace with regular exam and x-rays with
orthopaedic surgeon and orthotist.
- Cooperative patient and supportive family.
- Maintenance of normal activities and sports with
elective time out of the brace for these activities and other
There are specific risks with spine surgery and anesthesia, as
there are with other surgeries. These should be discussed with your
surgeon in a pre-operative conference.
The most important "personal" operative consideration for the
patient and family is readiness for the surgery and a positive
mental attitude. The patient and/or family may not be ready to
commit to surgery the first time the topic of surgical treatment is
presented. Spine surgery for idiopathic scoliosis is not an
emergent procedure and time should be taken to prepare both
mentally and physically for the procedure. A general state of good
health and nutritional status are important to successful surgery
Related to Scoliosis and Treatment
- A lack of calcium will not cause scoliosis but does affect
overall bone health and could potentially have implications in
- Poor posture and carrying heavy book bags or musical
instruments does not cause scoliosis but may contribute to back
- Scoliosis and/or Kyphosis may or may not be associated with
back pain in adolescence.
- Bracing does not make the spine straight.
- SMOKING DOES INTERFERE with bone healing. This includes passive
- Surgery does not interfere with normal child bearing.
- The metal implants may activate the metal detectors at
airports, you are not required to carry any special documentation
however, tell the attendant you have surgical implants. You will be
required to undergo additional examination with "wand" and "pat
down" is you set off the alarm.
- Your diagnosis and any treatment of scoliosis is an important
part of your medial history. Include your diagnosis and treatment
when giving your medical history to any healthcare provider.
- There is currently no known prevention for scoliosis however;
there is ongoing research in this area. At some point during your
diagnosis and treatment of scoliosis, you may be asked to
participate in a scoliosis research study. While participating in a
study may not directly benefit you, it may possibly benefit
children that you may have in the future.
Kitchen Table Wisdom: Stories that Heal - Rachel Naomi
Vertebral Body Stapling to Treat Scoliosis- PREFACE
Vertebral Body Stapling -
Topics for Health
Back Pain in Children & Referral to Orthopaedics or OtherSpecialties
Back in Pediatric Athlete