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Adolescent idiopathic scoliosis

Adolescent idiopathic scoliosis



Overview             

Adolescent idiopathic scoliosis (AIS) is a structural, side-to-side curvature of the spine exceeding 10 degrees, developing in children aged 10 to 18 without a known cause. It primarily affects adolescents during their rapid growth spurts and is more common and severe in females.

Symptoms

Uneven Shoulders: One shoulder is higher than the other or appears to droop.

Scapular (Shoulder Blade) Prominence: One shoulder blade may stick out more or appear tilted compared to the other.

Rib Hump: A visible prominence on the back or an arch in the rib cage, usually most noticeable when the child bends forward.

Hip and Waist Asymmetry: One hip appears higher than the other, or the waistline looks uneven, causing a torso "lean".

Uneven Arm Gap: The space between the arms and the torso may differ from side to side.

Crooked Head Position: The head may not be perfectly centered with the rest of the body.

Fatigue: Mild muscle aches in the back or general fatigue in the lower back after standing or sitting for long periods.

Clothing Fit: Clothes may begin to hang unevenly or fit poorly.

Causes

The term points to several leading medical theories regarding its origins:

Genetic Predisposition: Nearly 30% of patients with AIS have a family history of the condition. While no single gene has been definitively identified, inherited genetic traits influence both the onset and the severity of the spinal curvature.

Hormonal Imbalances: Hormonal fluctuations during puberty—especially those involving growth hormones and melatonin—are heavily researched factors. Some studies suggest hormonal changes contribute to unequal bone and muscle development.

Asymmetric Bone and Muscle Growth: During rapid pubertal growth spurts, uneven growth rates between the left and right sides of the vertebrae or surrounding muscles may cause the spine to curve.

Nervous System Abnormalities: Subtle disruptions in the central nervous system or issues with proprioception (how the brain senses body position) may affect how muscles support the spine symmetrically.

Diagnosis

1. Physical Examination

A pediatrician or orthopedic specialist typically begins with a physical evaluation to look for postural asymmetry.

Adam’s Forward Bend Test: The patient bends forward at the waist while the doctor checks for rib humps, asymmetrical shoulder heights, or an uneven waistline.

Scoliometer Measurement: If a curve is spotted, a Scoliometer measures the angle of trunk rotation. A measurement of 5° to 7° or more is usually considered abnormal and requires follow-up imaging.

2. Diagnostic Imaging

Standing Spinal X-Rays: Full-length, standing posteroanterior (PA) and lateral X-rays are the gold standard for confirmation.

Cobb Angle Calculation: The radiologist measures the Cobb angle on the X-ray, which quantifies the severity of the curve in degrees.

3. Neurological and Secondary Cause Checks

Because "idiopathic" means there is no known medical or congenital cause, doctors perform an extensive neurological exam. If the patient experiences severe pain, a left-facing curve (which is rare), or abnormal neurological symptoms, a Magnetic Resonance Imaging (MRI) is often ordered to rule out spinal cord or nerve abnormalities.

Treatment

1. Observation and Physical Therapy

Observation: For curves less than 25°, patients are monitored with serial standing X-rays (typically every 4 to 6 months) to track the curvature as they grow.

Physical Therapy: Physiotherapeutic Scoliosis-Specific Exercises (PSSE), such as the Schroth method, are utilized to strengthen core muscles, improve posture, and enhance neuromuscular control to complement bracing.

2. Bracing Indications: Recommended for patients with a Cobb angle of 25° to 45° who are still growing.

Goal: Bracing does not correct existing curves; rather, it aims to halt progression during peak growth spurts.

Compliance: The brace must typically be worn 13 to 20+ hours a day until skeletal maturity is reached.

3. Surgical Options

Spinal Fusion: The gold standard for curves exceeding 45° - 50°. It involves using metal rods and screws to straighten the spine and permanently fuse the vertebrae together.

Vertebral Body Tethering (VBT): An FDA-approved, motion-preserving alternative to fusion for select candidates. It utilizes a flexible cord screwed to the vertebrae to guide the spine's growth into a straighter position.

Type of Doctor Department : A Pediatric Orthopedic Surgeon or an Orthopedic Spine Surgeon

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