The spine is made up of bones, known as vertebrae, and gelatinlike discs. The vertebrae encircle and protect the spinal cord, and the discs act as shock absorbers between the vertebrae. Scoliosis is a sideways curve in the spine. When the condition occurs in children 10 years of age or older, it is known as adolescent idiopathic scoliosis. The condition may start during puberty, during a growth spurt in the teens or in early adulthood.

Symptoms

Scoliosis symptoms often appear during adolescence, and most often are discovered during a routine physical exam. Pain is not typical in patients with scoliosis, but if it occurs, more investigation should be done. Typical symptoms include:
One shoulder appears higher than the other
Clothes do not hang straight
Lower-back fatigue develops after sitting or standing a long time
Back muscles ache


Causes and Risk Factors

Females have a higher risk of scoliosis than males. Six to eight of every 10 cases involve girls. About 2 to 3 percent of children between the ages of 10 and 16 have detectable scoliosis.


Diagnosis

For a patient with a spinal curvature, a physician may take a medical history and conduct a physical exam to determine whether the symptoms are due to scoliosis. A physical examination can determine whether the curve of the spine is more obvious when the patient bends forward. Most often the spine curves to the right in the upper back and to the left in the lower back, causing the right shoulder to be higher than the left. One hip may be more prominent than the other.

X-rays are generally the best diagnostic imaging tool for patients with scoliosis, because the images allow the physician better views of the curvature in the spine. The X-rays are taken at various angles while the patient is standing in order to reveal the curvature. An MRI may also be used to diagnose scoliosis. Additional procedures, such as blood tests, may be done to rule out other conditions.

Treatments

After the condition has been diagnosed, the scoliosis patient should be seen by a spine specialist as soon as possible. Treatment is directed at preventing further deformity by using a cast, a brace or surgical correction. Nonoperative care, such as back braces, may be helpful in the early stages for a curvature less than 45 degrees. A curvature greater than 45 to 50 degrees must be treated with surgery to keep the patients heart and lungs working properly over time.

Surgical techniques include:
Minimally invasive correction of scoliosis
Endoscopic thoracic release
Spinal fusion with instrumentation

Outcomes will depend on where and how much the spine curves and how old the individual was when the symptoms appeared. The greater the curve, the greater the chance that the curvature will worsen as the patients bones mature.

In children and adolescents, scoliosis and its treatment may have a negative effect on self-esteem. Wearing a brace may cause self-consciousness. The patient’s primary doctor should work with the spine specialist on diagnosis, counseling about treatment options and dealing with adjustment issues. The knowledgeable and highly trained staffs at the Cedars-Sinai Department of Neurosurgery Spine Program and Spine Center are able to work with the patient to determine the best treatment option available.