Scoliosis Not Just a Problem for the Elderly

The condition often surfaces in boys and girls just before adolescence

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By Amanda Gardner
HealthDay Reporter

SUNDAY, Aug. 6, 2006 (HealthDay News) -- Its common name is curvature of the spine, and you most often see it in its most dramatic, debilitating form -- the elderly, hunched over, grasping walkers or canes as they struggle to walk just a few yards.

But scoliosis -- its scientific name -- more often strikes young girls and boys just as they hit adolescence.

Late-onset idiopathic scoliosis -- or LIS -- is the most common form of the disease and is generally diagnosed after the age of 10. The condition, which has no known cause other than genetics, affects 3 percent of children between the ages of 8 and 16, and about 60,000 teens in the United States.

It's more common in girls than boys, can appear in children as young as 5, but usually strikes during the adolescent growth spurt.

Scoliosis manifests itself as a side-to-side curvature of the spine. On an X-ray, the spine appears more as an "S" or "C" than a straight line. In some cases, the bones in the spine may also rotate so the person's waist or shoulders appear uneven.

"Before we had school screening, we used to see girls come in with their mothers complaining that they had to hem their skirts differently because of the asymmetry it causes, although there was no actual difference in leg lengths," said Dr. Stuart L. Weinstein, professor of orthopaedic surgery at the University of Iowa.

The trick is to catch the disease when it first appears.

"It's important that primary-care physicians check for this and look for it on each annual exam," said Weinstein. "School check-ups, particularly when one gets to the adolescent growth spurt at 10 to 16 years of age, are also important. Doctors need to look for it, as do families."

The severity of the condition varies widely; some cases merit treatment, such as surgery or bracing, and others do not.

For children and teens with mild scoliosis, doctors frequently recommend a strategy of "watchful waiting" -- regular monitoring to make sure the curve doesn't worsen.

If a severe curve is left untreated, however, it can result in not only cosmetic deformities such as asymmetrical shoulders, hips and ribs, it can also push against body organs and lead to heart and breathing problems.

Fortunately, diagnosing LIS is simple.

"The most common way of diagnosing teenage idiopathic scoliosis is with a forward bending exam, in which the school nurse or nurse or pediatrician bends the patient forward and looks for asymmetries in the posterior lumbar spine or posterior chest," said Dr. Keith Bridwell, past president of the Scoliosis Research Society.

"If there's any asymmetry of 5 degrees or more, then the patient is referred to an orthopedic surgeon, who orders a set of X-rays to see if it is or is not scoliosis," said Bridwell, who is chief of spine surgery and a professor in the department of orthopaedic surgery at Washington University School of Medicine in St. Louis.

Scoliosis is usually diagnosed when the curvature is 10 degrees or more. Still, the curve needs to reach 25 or 30 degrees for physicians to start worrying. "If it's under about 20 degrees, the probability of it getting worse or causing any health problems is very small," Weinstein said.

There are three basic categories of treatment, depending on the severity of the condition.

If the curve is mild -- say under about 25 degrees -- most doctors recommend "watchful waiting."

"If the child has growth left, it's observation and seeing the child back once in a while," Bridwell said. This category represents the majority of cases. Scoliosis in this mild category may or may not be visible and will not affect activities, including sports.

A smaller number of children have curves in the 25- to 40-degree range, which often require some kind of back brace to stop the curve from getting worse, but not reverse it. There is some controversy over whether bracing is really effective and which children really need it.

"You don't know if you have two equal children what the prognosis is going to be," Weinstein said. "Some feel very sure that bracing prevents progression, and others are not so sure."

For severe curves (45 or 50 degrees or more), surgery is generally recommended. Traditionally, surgery has involved fusing the vertebrae of the spine. Today, there are new options, including one procedure that offers an alternative to bracing.

Stapling is a new procedure that seems to be particularly suited to children who are athletes, dancers, gymnasts, cheerleaders or are active in some other way and want to remain flexible, said Susan Porth, a spinal cord injury/scoliosis nurse practitioner at Shriners Hospital for Children in Philadelphia.

"Basically, it involves using surgical staples along the convex or the outer side of the spine that's curving," Porth explained. "The stapling is designed to hold in check the progression of the scoliosis. It's not meant to correct it."

And stapling does not preclude vertebrae fusion in the future, if the person needs it. "We haven't done anything that can't be undone," Porth said.

Still, experts say more research and advances are needed to make significant strides against advanced cases of scoliosis.

More information

To learn more, visit the Scoliosis Research Society.

SOURCES: Stuart L. Weinstein, M.D., Ignacio V. Ponseti Chair and professor, orthopaedic surgery, University of Iowa, Iowa City; Keith Bridwell, M.D., past president, Scoliosis Research Society, and Chief of Spine Surgery and professor, department of orthopaedic surgery, Washington University School of Medicine, St. Louis; Susan Porth, M.S.N., C.R.N.P., spinal cord injury/scoliosis nurse practitioner, Shriners Hospital for Children, Philadelphia

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