Scoliosis is a complex deformity or curvature of the spine and entire torso and has been recognized clinically for centuries (Asher, Marc A. ). “For a few of the patients an underlying cause can be determined, including congenital changes, secondary changes related to neuropathic or myopathic conditions, or later in life from degenerative spondylosis. However, the cause of most scoliosis is not known and since about 1922 such patients have been diagnosed as having idiopathic scoliosis (Asher, Marc A. ).”
Based on the observation of three distinct periods of climax, scoliosis has been sub-divided into three groups; infantile, before the age of 3; juvenile, age 5 to 8; and adolescent, age 10 until the end of growth. This categorization is now extensively used. “Eighty percent or more of idiopathic scoliosis is of the adolescent variety. As it is often not possible to determine the age of onset, age at presentation/detection is more accurate (Canavese, Federico). ” “The prevalence is very dependent on curve size cut-off point, decreasing from 4. 5% for curves of 6 degrees or more to only 0.29% for curves of 21° or more.
It is also very dependent on sex, being equal for curves of 6–10° but 5. 4 girls to 1 boy for curves of 21° or more (Asher, Marc A. ). ” Adolescent idiopathic scoliosis can probably best be considered as a complex genetic trait disorder. There is often a positive family history but the pattern of inherited susceptibility is not clear. Current information suggests that there is genetic heterogeneity. This indicates that multiple potential factors are acting either dependently or independently in its pathogenesis (Asher, Marc A. ).
Up to moderate deformities, recognized at a 40 degree curvature, bracing is the most common treatment. Brace treatment has been mainly simulated by directly applying external forces on the rib cage and on the lumbar spine. However, its ef? ciency in preventing the progression of scoliotic deformities is still controversial and the biomechanics of brace treatment is still poorly understood. For instance, there is still no concurrence about the favorable design of a brace. The shape of the brace, the location of pads attached to the brace, and openings vary amongst orthotists (Clin, Julien).
Nevertheless, brace treatment is favorable in comparison to no treatment at all. For example, the Scoliosis Research Society conducted a study in 1985 to scrutinize the correctness of the bracing treatment. “Patients of the same age, same curve pattern and severity were divided into two groups: one treated with bracing; and the other, untreated. Results published in 1993 demonstrated that brace treatment is effective compared to natural history (Canavese, Federico). ” Studies conducted on the number of hours per day of brace-wearing show that the more hours per day the brace is worn, the better the result.
The brace is usually prescribed for fulltime wear with some time set aside for bathing, swimming, physical education and sport. The patient should be encouraged to be pursue sporting activities while continuing to wear the brace if possible. Contact sports are not allowed with the brace to protect other participants, as the brace can significantly injure another if contacted the right way. These activities generally represent an average of two to four hours a day to ensure that the brace is worn 21 to 23 hours daily (“Minimally Invasive”).
Other treatments of scoliosis include surgical treatment to straighten the curve of the spine (Asher, Marc A. ). “Surgical treatment was initiated in 1914. When the results were evaluated in 1941 they were found to be poor. As a result of the untiring work of John Moe, Paul Harrington, and many others these results had considerably improved by 1962. Due to advances in surgery the number of scoliosis curves greater than 100° had dropped considerably by 1973.
The indications for surgery as an adult are pain, appearance, and pulmonary problems, i.e. shortness of breath. However, it is unusual for these symptoms to be severe enough to warrant surgery. In addition only those with surgery had pain management problems (Asher, Marc A. ). ” Although there are some risks associated with surgery they have decreased substantially. Death is very unlikely but can occur, especially in patients operated as adults (Horn, Pamela). “Knowledge of the natural history of adolescent idiopathic scoliosis has expanded greatly in the last two decades.
It has become clear that only about one in ten curves progresses to the point that treatment with bracing is warranted, and only one in 25, or 0. 1%, to the point that surgery is warranted. Bracing appears to prevent about 20% to 40% of appropriately braced curves from progressing 6° or more. Surgery, consisting of instrumentation and arthrodesis has virtually eliminated large thoracic curves. Although most patients are satisfied with their results, follow-up at 20+ years shows significant, clinically relevant decrease in function and increase in pain compared to controls. Re-operation is required in 6 to 29%. And, a very few have pain management problems (Asher, Marc A. ). ”
Works Cited
- Asher, Marc A. , and Douglas C. Burton. “Scoliosis. ” Adolescent Idiopathic Scoliosis: Natural History and Long Term Treatment Effects 1 (2006): 1-10. Web. 23 Sept. 2012.
- Clin, Julien, Carl-Eric Aubin, Stefan Parent, and Hubert Labelle. “Biomechanical Modeling of Brace Treatment of Scoliosis. ” Effects of Gravitational Loads (2011): 743-53.
- International Federation for Medical and Biological Engineering 2011, 02 Feb. 2011. Web. 23 Sept. 2012.
- Canavese, Federico, and Andre Kaelin. “Adolescent Idiopathic Scoliosis: Indications and Efficacy of Nonoperative Treatment. ” Indian Journal of Orthopaedics 45. 1 (2011): Academic Search Complete. Web. 23 Sept. 2012.
- “Minimally Invasive Scoliosis Surgery: An Innovative Technique In Patients With Adolescent Idiopathic Scoliosis. ” Scoliosis (17487161) 6. 1 (2011): 16-25.
- Academic Search Complete. Web. 23 Sept. 2012. Horn, Pamela. “Scoliosis. ” Clinician Reviews 22. 8 (2012): 16-22. Academic Search Complete. Web. 23 Sept. 2012.