Scoliosis or Kyphoscoliosis is an abnormal position of the spine which can be seen in many age groups. The incidence of idiopathic scoliosis of more than 10 degrees are usually estimated to occure in 2-3% of children younger than 16 years old, and fewer than 10% of children along with curves greater than 10 degree will need treatment. For scoliosis in adolescents, it is more common in girls, plus tends to progress during the child’s growth spurts. Once growth stops, one can expect a curve less than 40% to also stop advancing.
An example of kyphoscoliosis which is an abnormal ahead (kyphosis) alignment of the spine might be a teenagers with Scheuermann Kyphosis (round back deformity of the upper back), or the elderly with progressive degenerative changes of the lumbar spine that has resulted in a loss of normal stability and posture.
This abnormal musculoskeletal alignment of the spine has an evasive cause in teenagers thus title Idiopathic scoliosis.
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In our elderly human population, it is typically related to the naturally progressive degenerative (arthritic) process, while those of us who are middle age may have a blend of both processes observed above consistent with a pre-existing idiopathic scoliosis which has now started to display signs of aging.
Scoliosis will be classified into a number of different groups which helps to predict patient diagnosis, and treatment. These categories are based in part on the underlying disease process which may have influenced the main cause, presents, or progression of the irregular spinal curvature. The most common types of scoliosis include:
· Idiopathic Scoliosis
· Degenerative Scoliosis
· Neuromuscular Scoliosis
· Congenital Scoliosis
· Post-Traumatic Scoliosis
Treatment for Scoliosis
The treatment options available to patients with scoliosis depends on a number of factors which include but is not limited to scoliosis magnitude, the provides of active scoliosis progression, age of the patient, other symptoms such as back again pain or leg pain, spine specific diagnosis such as stenosis, tumor, infections, herniated discs, degenerative joint disease, and finally the presents of various other non-spine related conditions which may effect the patient’s ability to undergo surgical procedure such as cardiac, renal, or pulmonary disease. The treatment options for scoliosis are extremely simple and can be summarized into three basic options.
Most individuals with scoliosis can be observed and will not require surgery. Bracing is only indicated for the young skeletally premature patient who is actively growing having a high risk curve for progression. Choices on bracing are made by your orthopedic surgeon based on your child’s skeletal maturity, scoliosis magnitude, and location from the curves. The length of time in the brace will be different based on a number of parameters noted over. Bracing is not indicated in adults for your treatment of their curve but may be used for pain control for their degenerative arthropathy.
Not all surgeons who perform spine work are trained to deal with scoliosis and the vast majority of Scoliosis Surgeons are Orthopedic Surgeons that obtained additional training during their residency and completed a separate Orthopedic backbone fellowship with particular attention in the diagnosis and treatment of patients with any of the above noted types of scoliosis.
Previous scientific studies upon idiopathic scoliosis painted a harsh picture for those with scoliosis, usually perpetuating the misconception that idiopathic scoliosis in children lead to disability as an adult from back discomfort and cardiopulmonary problems. The weak points of these original studies have been exposed as they often included more severe forms of scoliosis (neuromuscular, congenital, etc) which carry an often more spectacular natural history and prognosis. The truth is that scoliosis in general does not forecast future problems and only those rare scoliosis curves that progress in case left untreated will lead to upcoming issues. It is therefore very important that anyone that is suspected of having scoliosis be evaluated carefully by an Memory foam Spine Surgeon. Prompt diagnosis, serial observation over a period of years, and timely treatment may prevent any future scoliosis related problems.
The main issue with degenerative scoliosis is the prospect of progressive loss of normal posture. This is often a very disabling problem leaving the person unable to stand up straight and maintain ahead gaze (Normal horizontal line of sight), as well as a dramatic increase in oxygen and energy requirements. This increase in energy requirements by the patient increases almost on a linear basis with the bigger the kyphosis magnitude. Stephen Ondra published in the Spine Journal in 2007 that patients with a twenty five degree forward posture should expect a 25% increase in energy requirements and those patients with a 50 diploma forward posture would see a 60 per cent increase in energy demands just to stroll and maintain normal activities of daily living. Having a forward posture like the female demonstrated here is very disabling. Surgery for these patients will often reduce suffering and improve life style by permitting the individual to return to many activities of daily living that the rest of us take for granted. The vast majority of patients undergoing this intensive surgery to treat their degenerative kyphoscoliosis are very happy with their results.