A boy with a hemi-vertebrae

This is a 6 year old boy with a hemivertebrae at L4 treated by excision. The associated curvature corrected from 37° to 0. The boy had no restrictions after 6 months.

 

Congenital scoliosis

Congenital scoliosis is a curvature of the spine that results from anomalies or abnormally developed vertebrae, the building blocks of the spinal column. These anomalies occur in utero at 4-6 weeks of gestation. Specific abnormalities include hemivertebra, which is a wedge-shaped or half vertebra, unsegmented bar, which is a failure of the normal separation of the individual building blocks of the spine, and mixed abnormalities. The number of abnormal vertebra, their location, and the growth potential around these abnormal vertebrae, is what determines how severe congenital curvature will become. For very mild single vertebra anomalies, a deformity may not be readily apparent and may be picked up incidentally on a chest x-ray or other study done for another purpose. In patients in whom multiple anomalies are noted, the trunk may be severely shortened and severe spinal deformity may be noted. In these cases, the curvature will often progress, resulting in severe lung disease and/or neurological deficits if left untreated.

Patients with congenital scoliosis also have a high incidence of abnormalities in other organ systems. For example, there is a 10% incidence of cardiac abnormalities, a 25% incidence of genito-urinary abnormalities, and up to a 40% incidence of intraspinal anomalies. Therefore, the patients are carefully worked up and even patients, who are seemingly otherwise normal, are sent for testing prior to surgery. Tests performed include an echocardiogram, renal (kidney) ultrasound, and screening MRI of the entire spine. Intraspinal anomalies that can occur include lipomas or fatty benign tumors of the spinal canal, scar tissue within the spinal canal, bony or cartilaginous spicules within the spinal canal, (diastematomyelia) and various other problems. These may require separate treatment from the spinal curvature itself.

The treatment for congenital scoliosis is aggressive in that if progression is noted, even for relatively small curves, surgery is indicated. This turns out to be the most conservative approach in that early surgery often allows the patient to avoid much more extensive surgery later. It is not uncommon for patients of one to one and a half years of age to undergo surgery that is relatively limited in nature. Nonoperative treatment consists of observation at 4 to 6-month intervals and if progression is noted, surgery is indicated. Bracing may be used in only a small percentage of patients in whom compensatory curvatures adjacent to congenital anomalies may be treated to prevent them from worsening.

Thoracolumbosacral orthosis (TLSO) & Milwaukee brace

In children their bones are still growing and they might have moderate scoliosis, the doctor may recommend a brace. Wearing a brace won’t cure scoliosis, or reverse the curve, but it usually prevents further progression of the curve. Most braces are worn day and night. A brace’s effectiveness increases with the number of hours a day it’s worn. Children who wear braces can usually participate in most activities and have few restrictions. If necessary, kids can take off the brace to participate in sports or other physical activities.

Braces are discontinued after the bones stop growing. This typically occurs:

1. About two years after girls begin to menstruate
2. When boys need to shave daily
Braces are of two main types:
1. Underarm or low-profile brace. This type of brace is made of modern plastic materials and is contoured to conform to the body. Also called a thoracolumbosacral orthosis (TLSO), this close-fitting brace is almost invisible under the clothes, as it fits under the arms and around the rib cage, lower back and hips. Underarm braces are not helpful for curves in the upper spine.

2. Milwaukee brace. This full-torso brace has a neck ring with rests for the chin and for the back of the head. The brace has a flat bar in the front and two flat bars in the back. Because they are more cumbersome, Milwaukee braces usually are used only in situations where an underarm brace won’t help.

Wish they had the spinecor brace back in 2000

The complications of scoliosis

While most people with scoliosis have a mild form of the disorder, scoliosis may sometimes cause complications, including:

Lung and heart damage
In severe scoliosis, the rib cage may press against the lungs and heart, making it more difficult to breathe and harder for the heart to pump. In very severe scoliosis, damage to the lungs and the heart can occur. Anytime breathing is compromised, the risk of lung infections and pneumonia increases.

Back problems
Adults who had scoliosis as children are more likely to have chronic back pain than are people in the general population. Also, people with untreated scoliosis may develop arthritis of the spine.

Scoliosis

Different types of curves

Doctors group curves of the spine by their location, shape, pattern, and cause. They use this information to decide how best to treat the scoliosis.

1. Location – To identify a curve’s location, doctors find the apex of the curve (the vertebra within the curve that is the most off-center); the location of the apex is the “location” of the curve. A thoracic curve has its apex in the thoracic area (the part of the spine to which the ribs attach). A lumbar curve has its apex in the lower back. A thoracolumbar curve has its apex where the thoracic and lumbar vertebrae join (see “Normal Spine” diagram).

2. Shape – The curve usually is S- or C-shaped.

3. Pattern – Curves frequently follow patterns that have been studied in previous patients (see “Curve Patterns” diagram). The larger the curve is, the more likely it will progress (depending on the amount of growth remaining).

Different types of curves

A giraffe with scoliosis

Hate to see kids with scoliosis

i hate to see little kids suffer with scoliosis

What happens if the curve requires surgery?

When a young person exhibits a worsening spinal deformity, surgical treatment may be indicated to improve the deformity and to prevent increasing deformity in the future. The most common surgical procedure is a posterior spinal fusion with instrumentation and bone graft. The term “instrumentation” refers to a variety of devices such as rods, hooks, wires, and screws, which are used to hold the correction of the spine in as normal an alignment as possible while the bone fusion heals. The instrumentation is rarely removed.

A number of factors influence the recommendation for surgery:
1. The area of the spine involved;
2. Severity of the scoliosis;
3. Presence of increased or decreased kyphosis;
4. Pain (rare in adolescents, more common in adults);
5. Growth remaining; and
6. Personal factors.

Operative Considerations
The goal of surgery is to fuse the spine at the optimum degree of safe correction of the deformity. There are always risks that accompany any surgical procedure. These should be discussed with your orthopaedic surgeon. Some important points in planning your surgery are:
1. A comprehensive preoperative conference
2. Donating your own blood (if possible)
3. Good nutritional status before and after surgery
4. Exercise program before and after surgery
5. Positive mental attitude

What are the different types of treatment.

Observation- This is for curves that have a small degree measurement when you are growing (adolescent scoliosis), or for moderate size curves (< 40-45 degrees) when you are done growing. For adults, observation and physical therapy are for those patients who have mild symptoms and have curves which are not large.

Bracing- This is for curves between 25 and 45 degrees in growing children to prevent further progression of the curve while growth of the spine remains. The goal of bracing is to prevent further progression since the brace cannot correct curves.

Surgical Treatment- This reserved for curves which are generally greater than 50 degrees for adolescent patients and adults. Surgery can be performed for smaller curves if the appearance of the curvature is bothersome to the patient or if symptoms are associated with the scoliosis in the adult patient. The goals of surgical treatment are to obtain curve correction and to prevent curve progression. This is generally achieved by placing metal implants onto the spine which are then attached to rods which correct the spine curvature and hold it in the corrected position until fusion, or knitting of the spine elements together.

What causes scoliosis?

Eighty-five percent of people with scoliosis have the “idiopathic” type. “Idiopathic” means “no known cause.” However, the term is not quite accurate, as we actually know quite a bit about the cause and natural history of idiopathic scoliosis. Idiopathic scoliosis frequently runs in families and there is a growing body of evidence that genetics plays a major role. Idiopathic scoliosis may appear at any age but most often appears in early adolescence. At this age, young people are reluctant to allow their bodies to be seen by parents and other adults, and the problem may not be detected until it is quite severe. As a result, the Scoliosis Research Society and the American Academy of Orthopaedic Surgeons have endorsed school screening programs to detect scoliosis curves before they may become advanced and more difficult to treat.

Several less common types of scoliosis have a different cause. These curves may be due to abnormally formed vertebrae already present at birth (“congenital scoliosis”), disorders of the central nervous system such as cerebral palsy, muscle diseases such as muscular dystrophy, or genetic diseases such as Marfan’s syndrome or Down syndrome. Scoliosis may also be seen following infections of the spine or fractures involving the spine.

This is how i feel

This is exactly how i feel sometimes

Hey my scoliosis people

The sole purpose of me creating this blog is to bring awareness to those who have scoliosis and are learning to live with it. It’s also to make people more knowledgeable about scoliosis, whether they have it, know someone who does, or have kids with it. Its also a place where people can talk about their journey with scoliosis, whether it be mental, emotional, and the obvious physical effects.

I know first hand how it feels to have scoliosis. I’ve dealt with the pain and the insecurities, the hatred of having a curved spine and seeing people with a straight spine. So if anyone have any question please ask and i will be more than happy to respond to the best of my knowledge. We can also, exchange advice on how to handle the pain, or any other non-surgical treatment that has worked.