SCOLIOSIS: Early Detection in Adolescents

BY DR. CHAN YIN KEEN, DC | B.HSci (Chiro), M.Clin.Chiro | ONE SPINE CHIROPRACTIC

 

Scoliosis (pronounced SkoleeOHsis), is a condition where in the spine curves side to side. On an xray radiograph the spine may look like it’s shaped like the letter S or C, rather than in a straight line. We will find there are several causes for scoliosis such as congenital spine deformities (where it is present at birth), neuromuscular conditions or even genetic conditions which could cause it. By far the most common form to walk through a doctor’s office though is Adolescent Idiopathic Scoliosis (AIS).

AIS is a form of scoliosis that tends to start in and around the ages of 10 to 18 years of age. The word idiopathic, aside from being quite a mouthful, means that the cause is unknown. The literature out there will tell you that anywhere from 65% to 80% of scoliosis cases are idiopathic in nature and that AIS affects anywhere from 0.475.2% of all adolescents. The curves themselves are measured using a method called the Cobb angle, and any curves to the left or right that are over 10° would be classified as scoliosis.

That is all fine and well, but what does it all mean practically for us parents and what are we supposed to look for in our kids? Generally speaking, you’re looking for things like a shoulder sitting higher than the other, or an arm hanging a little lower than the other, the hips not sitting evenly, a bit more muscle bulk on one side of the spine, or even ribs being more prominent on one side. There’s also the more general signs and symptoms like back and shoulder pain and/or decreased amount of mobility like difficulty flexing or bending their bodies. A more serious case would be say if the child has breathing difficulties due to the rib cage impeding normal lung function.

There are several questions that will likely go through your mind when your primary care practitioner tells you your son or daughter has scoliosis. Questions like; Will it get better? Will it get worse? Can we do something about it? What happens if we do nothing?

To better answer these questions, one needs to understand that progression of a curve is dictated by several factors, such as bone maturity (age), how big the curve is, gender and even familial history. The ratio for girls and boys needing treatment for AIS is skewed to girls 10:1, thus you will almost always see it in girls rather than boys. The size of the curve and age of the child are inversely related when it comes to progression of the condition. That is to say, the older the child, the less likely for the curve to increase in size, while the smaller the curve the less likely of it progressing too.

So for instance if a girl in the age range of 13 to 15 years old were to have a curve of less than 20° when first diagnosed, there’s a 10% chance of progression of the scoliotic curve. If we have another girl in the same 13 to 15 age range but her curve is sitting at around 50° then the chance of progression jumps from 10% to 70%. Whereas a girl in the age range of 10 to 12 with a Cobb angle of under 20° would have a risk of progression at around 25%. If another girl of the same age had a curve of over 40° she would have a 90% risk of progression.

In short, if a child has a scoliotic curve early on they do have a risk of it worsening over time, and if the curve is greater the poorer the prognosis. Thus early detection is key to ensuring a favourable prognosis as you are in a better position to apply early intervention before the scoliosis curve has progressed.

Pertinently, early detection allows us more options in terms of what kind of intervention can be done compared to a later discovery with a more serious curve where surgery to install steel rods and perform spinal fusion might be the only option left.

Which brings us to what kinds of interventions are out there. As mentioned briefly, if the scoliotic curve is progressing rapidly and other factors such as degenerative instability are present, surgery may be the recommended procedure of correction. Preference should always be to less invasive methods of correction if possible. The traditional approach to a scoliosis curve when it’s under 20° is observation, or to “wait and see”. Your doctor will periodically monitor the progression and make a decision as to whether intervention is required or not.

Should they recommend that intervention is required but not to the point of surgery, you will find that noninvasive methods available include bracing, physical therapy or even chiropractic care. These methods of intervention are easy to incorporate into a child’s lifestyle, allowing a measure of care that can help stem the progression of their curve without resorting to surgery.

In conclusion, treating scoliosis, in particular Adolescent Idiopathic Scoliosis, is a matter of detecting it early to be able to make an informed decision as as to how to proceed. That way the child has the best chance of maintaining a low level of curvature without resorting to surgery. If you notice any changes about your child’s back, or something does not seem quite right about it, consider having your child assessed by your doctor or chiropractor.

 

One Spine Chiropractic offers chiropractic solutions for people with musculoskeletal problems. For more information about Scoliosis: Early Detection in Adolescents, please contact One Spine Chiropractic at 088-210 373. Visit them at Centre Point Sabah on the 3rd Floor.

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