I am sharing a paper which I wrote about Adolescent Idiopathic Scoliosis. I am sharing it because I feel it is important for all parents – or anyone around children- to be aware of and be informed about. I developed Adolescent Idiopathic Scoliosis, which required surgery. Of course, I did not include the entire paper, as most would find the table of contents and abstract not necessary for a blog post. I do hope you learn something new from reading.
Adolescent Idiopathic Scoliosis:
What Every Parent Needs to Know
Scoliosis affects “3 to 5 percent of children with 80 to 85 of those children having adolescent idiopathic scoliosis (Busscher et al., 2010, p.94).” Although this is a low percentage of occurrence, the stakes can be high. Parents need to be aware of the causes and symptoms of scoliosis, as well as the treatments available for adolescent idiopathic scoliosis in order to avoid the problems which can occur if scoliosis is left untreated. If the curve is not treated, it can affect organs in the body, lung function and quality of life.
What is Scoliosis?
According to Asher (2006), scoliosis is a lateral curvature of the spine. According to the definition of Scoliosis Research Society; the degree of the curve has to be greater than 10 degrees (Kotwicki, 2008). Scoliosis has been classified as idiopathic when it is caused by unknown factors. Also, idiopathic scoliosis has a curve in the spine which also rotates. (“When to call a doctor” 2009)
Sign and Symptoms
There are signs and symptoms of scoliosis parents cane be on the outlook for in their children.(“Signs and Symptoms” 2009) These may include:
• observing a curve in their child’s spine
• rib sticks out
• one hip sits higher than the other
• one shoulder higher than the other
• clothes do not sit right on the child
• school screening suspects scoliosis
If and when a parent suspects their child has scoliosis, they should bring their child to a pediatrician in order to be properly diagnosed. Parents should not rely on their child’s school to make a detection of the problem as not all schools conduct the screenings. As of 2003, there were only 21 states which have legislation which requires the schools to conduct the school screenings. There are 12 states which recommend school screen for scoliosis, but it is entirely up to each individual school district if they want to conduct the screenings. Lastly, there are 18 states which have no recommendations or requirements when it comes to scoliosis school screenings. Please refer to Table 1 to see the specific states for each of the three categories.
SCOLIOSIS SCHOOL SCREENINGS
Parents should be aware of the category the state in which they live resides under, so that they may be diligent in keeping an eye on their child’s development.
Three Types of Scoliosis
Idiopathic scoliosis has three categories which is dependent on when it first occurs. Infantile idiopathic scoliosis is when the scoliosis first occurs between birth and three years of age. Infantile idiopathic scoliosis affects boys more often than girls and most of the cases of scoliosis in this age group resolve themselves without intrusive treatment. Juvenile idiopathic scoliosis occurs between three and ten years of age and this type affects girls more often than boys. Lastly, adolescent idiopathic scoliosis happens when it first occurs between the ages of ten and seventeen years of age. Adolescent idiopathic scoliosis is the most common of the three types of idiopathic scoliosis and according to the Scoliosis Center of New York’s website, affects four percent of children between nine and fourteen years of age. Also, according to the same website, which has articles written by several doctors in the pediatric specialty, sixty to eighty percent of all cases affect females.
Adolescent idiopathic scoliosis affects children in a wider age group than the other two groups of idiopathic scoliosis which causes it to be the most common, but there is not a lot of information regarding this disease. This report will shed light on AIS, its treatments and what a parent can expect if their child is diagnosed with this disease.
Adolescent idiopathic scoliosis affects 3 to 5 percent of the population. In a recent online, 24 people said that they were diagnosed with scoliosis between 13 and 15 years old, out of the 42 total that answered. There are different ways to treat adolescent idiopathic scoliosis which are affected by the severity of the curvature. When a curvature measuring less than 20 degrees is diagnosed, most doctors agree the best approach is to simply observe. A doctor will most likely take x-rays of the spine every 3 to 6 months so if the curve progresses, it can be seen earlier rather than later. When the curvature measures between 20 and 40 degrees, the treatment which is most likely to be prescribed is to wear a brace. The type of brace and the amount of time to actually wear the brace depends on the doctor, type of brace as well as the likelihood of compliance by the patient. The goal of wearing a brace is to stop the curvature from progressing, so it is best to wear the brace before the the growth spurts have been completed. A third option for treatment of adolescent idiopathic scoliosis is to have surgery. Surgery is likely to be suggested for patients with curvatures measuring over 40 degrees. Surgery is likely to be suggested for patients whom have completed their growth spurts and the curve continues to progress.
Under 20 Degrees
Doctors will take x-rays or MRIs periodically
20 – 40 degrees
Wearing a brace will only work if the spine is not done growing and the patient wears it for the prescribed time.
Doctors resort to surgery when the curvature is over 40 degrees and the patient is done growing.
Each of these treatments has its own set of guidelines to follow as well as each having its own pros and cons. In the following sections of this report, each treatment is discussed in detail.
When the curvature is less than twenty degrees, most doctors will recommend a treatment plan of observation. This is typically done through x-rays or MRIs every 4 to 6 months, or as needed. The main goal with observation is to simply keep an eye on any curvatures detected, so that if they do progress then the child’s doctor will be able to diagnose it earlier rather than later. (“Scoliosis Treatment Overview” 2009) Observation is most appropriate for curvatures less than twenty degrees as well as curves which have a low risk of progression. The child’s doctor can determine if the curvature is likely to progress by determining the maturity of the skeleton. If the skeleton has reached maturity, meaning that it has finished its’ growth spurts, there is an unlikely chance it will progress. If the curvature does progress then the doctor will likely discuss other treatment options. (“Treatment: Non-Surgical Observation” 2008, “Treatment and Care: Idiopathic Scoliosis, 2011)
When a curvature of the is measured to be between twenty and forty degrees, most likely a brace will be suggested as a form of treatment. It is important to point out that the purpose of wearing a brace is not to correct the curvature of the spine, but to prevent it from getting worse. (“Scoliosis: Other Treatment” 2009) There may be misconceptions about what a brace looks like as well as what a child is allowed to do while wearing the brace. There are many different types of braces which a doctor may prescribe a child to wear, but the two main types are called a Milwaukee brace and a thoracolumbosacral, or TLSO. (“How Scoliosis is Treated” 2012)
Misconceptions. There are known instances where a child develops eating disorders, which many claim are a result of having adolescent idiopathic scoliosis and more specifically from wearing a brace. There have been several studies which have suggested otherwise. In one such study, Alborghetti et al.(1998), showed female scoliosis patients has a lower rate of eating disorders than the general population. Also, parents should make sure the child participates in activities which the child enjoys. Wearing a brace does not mean they cannot swim, go horse-back riding, or even take up running.
Milwaukee brace. The Milwaukee Brace has two purposes in treating adolescent idiopathic scoliosis. First, it is worn to stabilize the spine and second, to prevent the curvatures from progressing. (“Milwaukee Brace” 2010) As illustrated in Picture 1, the Milwaukee Brace is constructed of metal and hard plastic in order to prevent the curvatures from growing as well as to keep the child’s posture in a relatively straight line.
Most doctors will prescribe the brace to worn in short intervals until the child works its way up to wearing it for 23 hours a day. The reason why a doctor will have the child wear it in increasing intervals is so that the child can get used to wearing it. The brace will be uncomfortable and confining, but it is very important that the child follows the protocol set by their doctor.(“Milwaukee Brace” 2010)
Although a child may feel awkward wearing the brace, it is important that they remain as active as possible. The reason for this is to keep the muscles strong. Most doctors will prescribe a series of exercises for this purpose.(“Exercises and Activities” 2010) It is also important that the child has a strong support system both at home and at school as studies have shown patients conform to the protocols for wearing the brace if there is a good support system in place.
Thoracolumbosacral. A Thoracolumbosacral Brace, or TLSO, is typically worn when the curvature is in thoracic part of the spine, otherwise known as the lower back. This particular brace is close fitting and depending on the clothes the child wears, observers may not know the child is wearing a brace. (“Scoliosis: Treatment and Drugs” 2010) Picture 3, below, shows what a typical TLSO brace looks like. Parents should take into account that their child’s specific TLSO brace may look slightly different as each brace is fitted to the patient. Again, it must be stressed that the function of the brace is to prevent the curvature from getting worse and not to reverse the curvature.
Effectiveness. The purpose of wearing a brace is to prevent the curvature or curvatures from progressing while lending support to the growing spine. There have been many studies conducted to find out out effective wearing a brace is and if it really worth the time, effort and stress. As with any theory, it is an on-going investigation. Some patients find success with wearing a brace, while others find that the curvature progresses.
Doctors will continue to monitor the child while wearing a brace so they can see immediately if the brace is working for the child or not. Many things can affect how well the brace works in treating the curvatures. The most important step in ensuring success is proper wear and maintenance of the brace. Secondly, a good support system is beneficial because if the child does not have a good support system, they are less likely to comply with wearing the brace.
Unfortunately, there may be times when the curvatures progress even when the child wears the brace as directed. In these cases, the doctor will re-evaluate and in some instances surgery may be suggested.
In the majority of the cases where a brace has been worn, surgery ends up being performed. This is largely because “only about fifty percent of young scoliosis patients wear their braces” (“Health Issues: Scoliosis” 2012).
When is it required. A doctor will recommend surgery when the curvature has reached fifty degrees or more. (“Health Issues: Scoliosis” 2012, “Scoliosis Surgery:Things to Consider” 2011) Typically, when the curvature reaches this point, it is a likely sign it will continue to progress. As the size of the curvature continues to progress, the child’s lung function can be impaired along with other impairments to the body.
Pros. One important aspect of having surgery done to repair the curvatures is that, in most cases, Dr. Ulrich, Jr(2012) stated the surgery can correct the curvature by up to fifty percent. For parents whose children have curvatures in the 50 degree range or higher, this is great news. Also, the surgery prevents the curvatures from getting worse.
Cons. As with any surgery there are things that may go wrong during and after the surgery. Ulrich(2012) pointed out that “it is extensive surgery” and it should only be done if “deformity is likely.” It is important to discuss all risks associated with scoliosis surgery. Following is a list of some of the risks parents should be aware of if their child needs to have surgery.(“Scoliosis Surgery” 2012)
as with any back surgery paralysis of any kind is a risk. It happens between 1:1,000 and 1:100,000 times. During surgery the spine and nerves will monitored to prevent this from happening.
• Excessive blood loss:
scoliosis surgery entail lots of muscles and skin being moved around, so there is a chance of excessive blood loss. Many surgeons will have the patient donate their own blood to the surgery as a precaution.
• Other risks and complications:
◦ rods breaking or the screws coming loose – modern medicine has decreased this possibility
◦ infection – less than 1 %
◦ spinal fluid leak – rare
Aftercare. The success of any surgery rests on how well the aftercare instructions are followed and this is even more true for back surgery. The spine, nerves and muscles have been moved, cut and re-arranged so making sure the child follows all of the aftercare instructions precisely is key to a successful outcome. Dr. Ulrich, Jr’s (2012) paper also gave typical aftercare instructions.
• May move around 2 – 3 days after surgery
• May stay in the hospital 4 – 7 days
• Return to school 2 – 4 weeks after surgery.
• Limited activities until fusion is complete which includes
◦ No twisting, bending or lifting for the first 3 months
◦ No jarring or physical contact activities for 6 – 12 months after surgery
Over the next 1 – 2 years after surgery the child will be seen regularly until the bone has been solidly fused together, after that no further follow up is needed.
One more side note that parents, especially mothers, may be interested to know is that “females who have undergone scoliosis surgery can get pregnant and have vaginal births”. The hardware is titanium and is made to give a bit, but not move significantly.(“Scoliosis Surgery” 2012)
The idea of anything wrong happening to their child understandable upsets parents. Many times parents will seek out alternative treatments as a way around any invasive treatments. It is important for parents to know there are no exercises, stretches or physical therapy which can correct the curvatures happening in the child’s spine. (“Scoliosis Treatment” 2012) According to the American Chiropractic Association, “spinal manipulation, therapeutic exercise, and muscle stimulation have been advocated” for the treatment of scoliosis, but “none of these therapies have been shown to consistently reduce scoliosis.”
Conducting my research on adolescent idiopathic scoliosis has shed light on the fact that it is not a well researched area in the medical field. There is a lot of information on what scoliosis is and how to treat it, but information regarding what causes scoliosis is severely lacking. It is clear that in order to make headway in treating the disease there needs to be more research done in the area of what causes scoliosis to happen.
Parents need to be aware of the signs and symptoms of the disease so they may be able to see scoliosis happening in their child sooner rather than later. As with any disease, early detection is key to preventing the curvature from reaching critical degrees. Although there is no way to stop the curvatures from progressing totally, it is important for parents to take all possible steps before to surgery. Surgery is a massive venture, so using it as a last resource is what should happen. Lastly, there should be more research conducted with DNA in order to discover why some people develop scoliosis and others do not. It would also be beneficial to understand what makes some curves progress while others do not.
Adolescent idiopathic scoliosis. (n.d.). Scoliosis Center of New York. Retrieved March 19, 2012, from http://www.childrensorthopaedics.com/Scoliosis.htm
Bracing. (2001, December 11). iscoliosis. Retrieved March 19, 2012, from http://www.iscoliosis.com/treatment-nonsurgical-bracing.html
Grivas, Theodoros B., Marian H. Wade, Stefano Negrini, and Joseph P. O’Brien. “Full Text | SOSORT Consensus Paper: School Screening for Scoliosis: Where Are We Today?” Scoliosis. 26 Nov. 2007. Web. 20 Feb. 2012. http://www.scoliosisjournal.com/content/2/1/17.
“Idiopathic Scoliosis in Children and Adolescents – Your Orthopaedic Connection – AAOS.” AAOS – OrthoInfo. Web. 20 Feb. 2012. <http://orthoinfo.aaos.org/topic.cfm?topic=A00353>.
Kotwicki, Tomasz. “Evaluation of Scoliosis Today: Examination, X-rays and beyond.” Disability & Rehabilitation 30.10 (2008): 742-51. Print.
Milwaukee Brace. (2010, March). Cincinnati Children’s. Retrieved March 19, 2012, from http://www.cincinnatichildrens.org/health/m/milwaukee/
Scoliosis: What Happens. (2009, August 27). WebMd. Retrieved March 19, 2012, from http://www.webmd.com/back-pain/tc/scoliosis-what-happens
Treatment and Care. (n.d.). Idiopathic Scoliosis. Retrieved March 19, 2012, from http://www.childrenshospital.org/az/Site2028/mainpageS2028P4.html
Ullrich, Jr. M.D., P. F. (2012, January 1). Scoliosis surgery: Potential risks and post-operative care. Spine Health. Retrieved March 19, 2012, from http://www.spine-health.com/conditions/scoliosis/scoliosis-surgery-potential-risks-and-postoperative-care