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Thoracic Scoliosis

What does “Scoliosis” mean?

The word “scoliosis” comes from the Greek word “scolios” which means “crooked”. A scoliosis of the spine is a “crooked” spine.

What is a Scoliosis?

A Scoliosis is a deformity of the spine where the spine looks “s-shaped” when looking at it from behind. Looking at it from the side it is normal to have an S-shaped curvature.

A scoliosis is defined by a curvature and rotation of vertebrae of the spine of more than 10 degrees on an X-Ray.

What are the different types of Thoracic Scoliosis?

Scoliosis curvatures can be mainly divided into 3 groups:

  1. Congenital: those which are present at birth (25%)
  2. Idopathic: those which for reasons unknown (65%)
  3. Neuromuscular: those which are due to diseases of the nerves or muscles (10%)

What is an Idiopathic Scoliosis?

Even though idiopathic scoliosis does not have a known reason, it is suspected that it is genetic in nature. However, the exact gene is not known. Adolescent (middle, late childhood) idiopathic scoliosis is the most common form of scoliosis overall. This disease is self-limiting, meaning it comes to an end when we stop growing. It is more common in girls than boys.

What is a Pseudoscoliosis?

In adults, an idiopathic scoliosis is often seen as a form of degenerative disease of the spine. When spinal discs and joints degenerate more on one side of the spine than the other, a “pseudoscoliosis” develops. Pseudoscoliosis means that it looks like a scoliosis from childhood, but it actually is not.

How common is a Scoliosis?

Scoliosis is present in 2-4% of children between the ages of 10 – 16 years of age. Overall Scoliosis affects approximately 2% of the population. There is a strong genetic component. If there is a family history of scoliosis, there is a 20% chance of passing it on.

What are the symptoms from a Thoracic Scoliosis?

In children, the beginning of a scoliosis is usually at ages 6-8. Scoliosis is typically a “silent disease”, meaning it is typically not painful and the parents may not be aware.

Here are some possible observations parents can make to be suspicious of a scoliosis:

1. The child is leaning to one side when standing or walking

2. The waist seems higher on one side

3. The shoulders seem uneven when standing or walking

4. One shoulder blade seems to stick out more than the other, especially when bending forward

Do adolescent scoliosis just continue to get worse?

Adolescent scoliosis do not necessarily worsen over time. Some remain quite stable even while the child is growing. When children stop growing, so does the scoliosis. Only 10% of children with scoliosis require some type of medical intervention.

What are risk factors for a Scoliosis to require worsen over time?

Here are some risk factors:

  1. Female gender
  2. Large Curvature
  3. Immature skeleton (still growing)
  4. How long a child is still expected to grow

How do you know when a child stops growing?

Spine specialists use something called a “Risser Grade”. This is done by taking an X-Ray of the pelvis. A growth plate of the pelvis (iliac apophysis) is used to measure how close a child is to stop growing or if growth has already stopped. The Grading system goes from 1 to 5, 5 meaning that growth has stopped.

How is a Thoracic Scoliosis diagnosed?

Spine specialists use the information from the patient history, physical examination and special tests to make the diagnosis of a Thoracic Scoliosis:

  1. History

Usually the patient is brought to the spine specialist because either a parent or the school has noticed some of the changes listed just above.

Sometimes there is a family history and the parents are concerned about the possibility of a scoliosis.

At times, children will complain about pain or tightness in the spine.

      2. Physical Examination

Here are some physical examination techniques spine specialists may use to confirm the presence of a scoliosis:

a. Visual inspection of the spine with the patient undressed. Touching or pushing on the spine (palpation) to feel a deformity    

b. Gait testing                     

c. Forward bending at the waist, looking for a “hump” on one side of the spine (Adam’s Forward Bend Test)

 d. Touching or pushing on the spine (palpation) to feel a deformity                                                       

e. Sensation (sensory) testing in the legs

f. Strength testing (motor) in the legs

g. Reflex testing

 

      3. Imaging

a. X-Rays

The best way to confirm a scoliosis is through X-Rays. There are special “scoliosis films” which show the entire spine from head to tailbone. This allows the doctor to evaluate the whole spine. The degree of the scoliosis is usually measured (Cobb angle) and used as a means to follow the progression of the curvature as well as to make a decision for surgery.

When a scoliosis is known to exist, X-Rays are often repeated every 3-12 months to look for any changes.

b. CT-Scan

Even though CT scans can show the bone anatomy of the spine in great detail, they are usually not used due to the high dose of radiation.

c. MRI Scan

MRI scans are usually not needed to establish the diagnosis of a scoliosis. An exception is a scenario where a neuromuscular scoliosis is suspected. In this situation, the spinal cord and spinal nerves as well as the spinal muscles can be evaluated.

How is a Thoracic Scoliosis treated?

The majority of idiopathic adolescent scoliosis do not require any type of treatment, but rather observation and periodic X-Rays. For patients with a severe scoliosis, rapidly progressing scoliosis or who have symptoms the following are some treatments available:

 

  1. Non-Surgical

a. Physical Therapy

There is a “Schroth Method” of specific physiotherapy and targeted exercises which has been shown to be helpful. This method has actually been shown to significantly reduce a scoliosis.

b. Bracing

Bracing is sometimes recommended in moderate-severe or worsening cases of scoliosis. It can be useful when the bones are still growing. The hope is often to avoid a surgery.

     2. Surgical

Surgery is considered after the bones have stopped growing and the curvature is severe. Generally a scoliosis in the range of 45 to 50 degrees is considered a surgical condition.

The surgery can be accomplished as an anterior (front) or posterior (back) surgery. The anterior approach is actually done from the side of the spine but targets the vertebrae and discs on the front of the spine. The posterior approach is done from the back with screws and rods inserted into the vertebrae.

Here are some surgical options:

  1. Thoracic Fusion with Instrumentation
  2. Thoracic Osteotomy and Fusion