“She’s a little crooked,” the doctor said after he examined my niece. She was bending forward and the doctor nodded repeatedly. “Let’s correct that now before it gets worse.”
As it turns out, my niece’s spine didn’t look right. She was showing early symptoms of scoliosis, a condition that occurs when the spine curves towards the side, and is shaped like a “C” or “S.”
When someone’s spine is not normal, one of three conditions can occur:
- Kyphosis – when the spine’s deviation points outward
- Lordosis – when the spine’s deviation points inward
- Scoliosis – when the spine’s deviation points sideways
Scoliosis: the basics
So what exactly did my beautiful but crooked niece have?
A slightly out of shape spine obviously. A normal spine shows a curve from above the shoulder blades, and another curve in the lower back. So what causes this abnormality? Doctors can’t agree…not yet anyway. All they can tell us for now is that in 80% of the cases, there is no cause. When no cause or causes are identified, we have what the medical profession calls idiopathic scoliosis.
I was relieved that my niece was diagnosed at her age – six. Doctors say that the condition is diagnosed in the first seven years of a child’s life. And girls are more likely to exhibit symptoms than boys.
We did say that in 80% of the cases, the cause is unknown. The remaining 20% can either be a birth defect or a neurological abnormality. Scoliosis does not just involve the spine’s abnormal shape, but also twisted bones in the spinal column.
The doctor who examined my niece said that a minor curve shouldn’t be too worrisome. When the curves are larger, however, it can lead to imbalance, fatigue, and back pain. In more serious cases, it can disrupt one’s breathing. Or worse, bring about spondylosis (arthritis of the spine).
When it’s possible to identify the cause, there are three types:
- Congenital scoliosis – defects at birth affect the spine and possibly other organs,
- Neuromuscular scoliosis – points to nerve and muscle problems preventing efficient support to the spine, common in patients being treated for cerebral palsy and muscular dystrophy,
- Degenerative scoliosis – a condition whereby discs in the vertebrae begin to deteriorate.
The doctor explained that scoliosis is usually diagnosed by using one of two major methods: detailed physical observation or imaging. He didn’t have to use imaging in my niece’s case because he had already noticed the apparent lack of symmetry in her shoulders and waist. Whether this “easy” diagnosis was a result of her young age, we don’t know.
Diagnosing scoliosis through imaging methods includes MRI (for getting information about the bones and tissues), CT scan (for taking various angles to create a 3D image of the skeleton), and Xrays (for showing how the spine looks).
Treatment is determined, in large part, by the degree of spine curvature. Other factors such as age, the type of curvature, and the type of scoliosis are also taken into account before a specific treatment approach is recommended.
Bracing and surgery appear to be the more common options.
Bracing is recommended when the (a) child is still growing and his spine curves more than 25-30 degrees, or (b) when the child is still growing but the curvature is getting worse. Bracing will not treat scoliosis, but can stop the curvature from getting worse.
For more serious cases, surgery is the recommended approach. When we say “more serious”, we mean that the spine curves more than 45 degrees. When two or more vertebrae need to be joined, spinal fusion surgery is suggested.
Doctors will usually blurt out esoteric terms when discussing the diagnosis and treatment for scoliosis. You may have heard of the Cobb angle (measures the spine’s curvature with the use of Xrays); scoliometer (also measures the degree of spinal curvature) and foraminotomy (this procedure is to alleviate pressure on spinal nerves by enlarging the opening in the back at the point where nerve roots leave the spinal cord).
Note that adults experience two main types of spinal curvature: identical to diagnosing diabetes, spinal abnormalities can be described as type I adult scoliosis or type II adult scoliosis. The first is when adults had idiopathic scoliosis (cause unknown) as adolescents, and experienced little or no symptoms. It happends when the symptoms become more pronounced because the spine has progressively degenerated.
Type II occurs in adults when a degenerative disease is affecting the spinal column, or when diseases like osteoporosis develop later in life.