This is the most common type of scoliosis and although
the cause is unknown we do know that it tends to run in families, and that
girls are more likely to be affected than boys.
Minor deformity, that may not even be recognised when
someone looks at your back, is quite common and affects approximately 4%
of the population. The male and female incidence is fairly equal for
this type of curve.
More severe deformity, where medical review and regular
checks are indicated is more common in girls. The male : female
incidence of individuals requiring treatment being 1:8.
In
most cases it is the presence of a deformity that leads to presentation.
It is important that your local doctor or specialist
look for associated disorders or conditions (eg neurofibromatosis) that may be
responsible for the deformity, and which may require treatment in its own
right.
The presence of a "rib hump" is
characteristic. This is best seen in the forward bend test. There may
also be asymmetry of loin skin creases, breast and shoulder height and pelvic
obliquity.
Back pain is no more frequent in patients with
idiopathic scoliosis than in the general population.
Treatment:
The aim of treatment is to
prevent severe deformity.
In most cases, all that is
required in the first instance is observation over a period of time to
assess if the deformity is progressive (i.e. increasing in
magnitude).
Curves that are severe at the
time of presentation may, however, require treatment without a period of
observation.
The need to treat curves that
are greater than 30o depends on several
factors. The age of the patient, the extent or stage of skeletal
maturation, the location of the curve and the clinical appearance of the
patient.
In some cases brace treatment
is considered appropriate, particularly in young children to delay surgical
intervention until such time as the spine is large enough to use standard
operative techniques.
In general terms brace
treatment will not result in significant correction of the deformity evident
at the time of presentation. Brace treatment will however often hold a
deformity and prevent further progression. The brace does however,
need to be worn for around 23 hours per day to be effective, and is usually
required for a period of eighteen months to three years or until growth has
almost finished. From this point the brace is then worn only at night
for another 6 months.
As a result of the physical
and social effect of confining a young girl in a brace for this period of
time, the use of this type of orthosis has decreased significantly in the
last ten years.
Treatment options should
however be discussed with your specialist.
Surgical intervention and
correction is indicated in the treatment of progressive curves greater than
40o,
and for large curves (90 - 100o)
without evidence of progression. Surgery is also indicated where the
clinical appearance of the spine, the deformity, is already significant or
unacceptable, as this situation is not likely to alter significantly after
the completion of brace treatment.
Prognosis:
The probability of curve
progression is related to the pattern of the curve, the magnitude of the
curve, skeletal maturity and the age at presentation. No correlation
has been found between progression and the sex of the patient, the extent of
deformity, the presence of a family history of deformity or radiographic
measurements.
Once established, the curve is
likely to increase during the growing period.
The chance of undergoing
further deterioration after reaching skeletal maturity is slight, but curves
> 50o may increase at a rate of about 1o per year. Deterioration in this
circumstance is however usually delayed for some years, with the deformity
increasing as degenerative changes progress.
Larger curves in a younger
child, and higher curves (upper thoracic curves) have a worse prognosis.
The images below are of the
same 15 year old girl taken immediately before undergoing corrective
surgery, and prior to discharge from hospital.
This girl gained 6.5 cm
height, and was very pleased with the improvement in her overall appearance.
Scoliosis
refers to lateral curvature of the spine. Deformity of this type may be
"structural" and fixed, or postural and mobile. 
