Youngsters in the preteen and teen years are concerned about being "normal" and fitting in with the group. But unfortunately, that's when a few of them have to deal with an abnormal condition called scoliosis. In this disorder, the spine curves sideways, usually in the shape of an "S" or a "C."
Those with severe cases often need to have a procedure or spend long periods of time wearing a back brace. And while neither is a kid's idea of fun, these treatments can help prevent problems with heart and lung function in the long run.
Any child can develop scoliosis, but it's most commonly seen in girls during the "tween" years of about ages 8 to 12. There are three main types of scoliosis:
Congenital: Present at birth, this kind is caused by failure of the vertebrae to form normally during fetal development.
Neuromuscular: This genetically influenced variety is associated with neurological conditions, including cerebral palsy, spina bifida, muscular dystrophy, spinal cord tumors and neurofibromatosis, a genetic condition affecting the peripheral nerves that is also characterized by light-brown spots on the skin.
Idiopathic: This term, which describes 80 to 85 percent of cases, means the cause is unknown.
"New data now suggest that many cases of scoliosis are genetic," says Lawrence Stankovits, M.D., a pediatric orthopedic surgeon at Monmouth Medical Center. Because the condition can run in families, he recommends that any child who has a relative with the condition should be checked at annual physical exams.
Scoliosis is common enough that pediatricians routinely screen for it. "The telltale signs of scoliosis are uneven shoulders, lack of waist-crease symmetry and, most important, the appearance of an uneven ribcage when the child bends forward in a 'diving' position," says Dr. Stankovits. Such abnormal findings should trigger a referral to a scoliosis specialist, he says.
The specialist will conduct a physical exam and possibly order imaging tests to make a diagnosis. An X-ray of the spine lets the doctor measure the curve in degrees and see its location, shape and pattern. An MRI (magnetic resonance imaging) test or CT (computed tomography) scan may also be used. The goal in treating scoliosis, Dr. Stankovits explains, is to stop the progression of the spinal curvature.
The treatment chosen is based on the patient's age, the type and degree of the curvature and how much more he or she is likely to grow. "Not all curves progress, so most children need simple observation at four- to six month intervals until growth is complete," he says. This is recommended if the curve is less than 25 degrees.
Growing youngsters with spinal curves of 25 to 45 degrees in many cases need to wear a back brace. Most braces are made of firm plastic that is pulled tight with Velcro straps and worn over an undershirt. A brace won't straighten the spine; its job is to prevent curvature from increasing more than 5 or 10 degrees, eliminating the need for an operation. Braces may be worn overnight or for as many as 18 hours a day, depending on the curvature's location and severity. They can be taken off when the child participates in sports.
Surgery may be required if a youngster's spinal curve is more than 45 percent, or if a brace does not slow its progression. The procedure involves fusing together two or more bones in the spine. The surgeon may put in a metal rod or other device to hold the spine in a corrected position until the bones fuse, which usually takes six to nine months. After the operation, the implants remain in the spine to maintain its corrected position.
At Monmouth, scoliosis specialist Dr. Stankovits works with spine specialists Marc Menkowitz, M.D., and Steven Paragioudakis, M.D., to perform procedures. "Detailed surgical planning is vital to minimize the long-term side effects of spinal fusion," Dr. Stankovits explains. "We use state-of-the-art instrumentation techniques and real-time spinal cord monitoring to ensure optimal outcomes."
After surgery, patients are usually walking without a brace by the second or third day and are discharged from the hospital within a week. A return to some sports is possible in six to nine months.
Though the cause of most cases of scoliosis remains elusive, Dr. Stankovits reports that research has revealed a family of genes that shows which curvatures are more likely to progress. "This information," he says, "will someday be used to make earlier decisions about which patients can benefit from wearing a brace."
To find out more about the treatment of scoliosis at Monmouth Medical Center, please call 1-888-724-7123.
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