Identifying Scoliosis

Congenital Scoliosis refers to bony abnormalities of the spine present at birth. These anomalies are due to either the abnormal formation or improper separation of the vertebrae. There is no known cause.

In the first six to eight weeks of embryonic life, a developmental change occurs that results in the failure of formation of one or more vertebral bodies, most often in the thoracolumbar spine which results in a scoliosis and/or kyphosis that usually very slowly worsens with much later childhood growth.

The second type of Congenital Scoliosis is the failure of segmentation where the vertebral bodies do not separate to form normal discs and bones. This type of scoliosis causes a tethering of one side of the bony spinal column causing a scoliosis. Both types of congenital scoliosis types can sometimes be seen on neo-natal ultrasound scans, though not always.

Imaging Evaluation:

• MRI
• Ultrasound
• CT Scan

 
Treatment Options:

• Observation and monitoring by a spine specialist
• Bracing – generally not typically effective
• Surgery

Infantile Scoliosis is a curvature of the spine that develops before three years of age. There is no known cause for the development of this form of scoliosis and both boys and girls are equally affected. Careful observation is required over the child’s growth and sometimes bracing is needed earlier than other types of scoliosis.

Treatment Options:

• Observation and monitoring by a spine specialist
• Bracing
• Surgery – rarely

Juvenile Scoliosis develops between the ages of three and ten years. Approximately 15% of all idiopathic scoliosis diagnosis will be that of juvenile scoliosis.

Juvenile curvatures that reach 30° tend to worsen without treatment, so it is imperative that a treatment plan is in place to monitor the curve.

Treatment Options:

• Observation and monitoring by a spine specialist
• Bracing – mainly used to manage the curve – usually between 20-25 degrees
• Surgery – vertebral body stapling and tethering are newer surgical treatments for only some curvatures. “Posterior Growing Rods” are also a surgical option for some if bracing has not been successful

Adolescent Scoliosis develops between the ages of ten and eighteen. This form of scoliosis is a lateral spinal curvature, with rotation, that appears before the onset of puberty and before skeletal maturity. It progresses with skeletal growth and usually ceases at the end of skeletal growth.

There are many theories about the cause of Adolescent Idiopathic Scoliosis (AIS). With approximately 30% of patients having a family history of scoliosis, research continues to look for a genetic connection.

Treatment Options:

• Observation and monitoring by a spine specialist
• Bracing – usually if curve is 20-25 degrees of Cobb Angle measurement
• Surgery – depending of size of curve, amount of rotation and position in the spinal column. Options – posterior rods, side of chest approach thoracoscopic rod, open side of chest and abdomen rod. All options partially fuse the spinal column in that segment where the scoliosis is found.

Idiopathic Scoliosis is the term used for any structural spinal curvature for which the cause has not been established. This is the most commonly diagnosed type of scoliosis where there is no evidence of underlying physical or radiographic occult pathology.

Neuromuscular Scoliosis is an irregular curvature of the spine caused by disorders of the spinal cord, brain, muscular and nervous systems. The muscular system and nerves are unable to maintain alignment of the spine resulting in a curvature.

Neuromuscular Scoliosis is associated with diseases like:

• Cerebral Palsy (CP),
• Spinal Muscle Atrophy (SMA),
• Myopathic/Neuropathic (muscular/nervous system-related) disorders like muscular dystrophy, poliomyelitis or spinabifida;
• Arnold-Chiari Malformation/syrinx or
• Trauma to the spinal cord – paraplegic/quadriplegic

Curve progressions are far more likely to progress into adulthood.

Treatment Options:

• Observation and monitoring by a spine specialist
• Physical therapy
• Bracing
• Wheelchair and seating modifications
• Surgery – usually posterior fusion rods

• Syndromic Scoliosis
• For example – Angelman Syndrome, Prader Willi Syndrome, Rett’s Syndrome, Down Syndrome (Trisomy 21)
• Connective tissue diseases (Marfan’s Syndrome and Ehlers-Danlos Syndrome)
• Generalised Ligamentous Laxity – causes a “lazy postural scoliosis”
• Genetic conditions (osteochondrodystrophy [dwarfism], Achondroplastic dwarfism, Noonan Syndrome, Neurofibromatosis), and certain syndromes related to multiple developmental defects like VATER syndrome (often part of congenital hemivertabra as a cause for scoliosis)

 
Treatment Options:

• Observation and monitoring by a spine specialist
• Physical therapy
• Bracing
• Wheelchair modifications
• Surgery