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Scoliosis

Scoliosis

Scoliosis

Scoliosis is a musculoskeletal disorder that causes an abnormal curve of the spine or backbone. From the Greek word skolios, meaning crooked, scoliosis is a medical condition where the spine is curved from side to side sometimes resembling an “S” or a “C” rather than a straight line. There are certain conditions that can cause scoliosis, but the most common scoliosis is called idiopathic, which means we don’t know what the cause is. Often the curve becomes more obvious during a growth spurt in early adolescence. Scoliosis can be mild to severe, and small curves do not always progress enough to need treatment. The size of the curvature determines the treatment options. We monitor the progression of the curvature through X-rays over time. The more growth the individual has remaining, the greater the risk of progression over time.

Scoliosis is not contagious and does not usually cause pain. One out of every ten young people in the United States develops scoliosis, but only some of them will require treatment. Some factors contributing to scoliosis are muscle diseases, such as cerebral palsy or muscular dystrophy, birth defects in the development of the spine, or injuries. However, in about 80 percent of cases, the cause is not known.

Types of scoliosis:

  • Infantile idiopathic scoliosis – occurs in children under age 3
  • Juvenile idiopathic scoliosis – affects children between the ages of 3 and 10
  • Idiopathic scoliosis – generally occurs in children after the age of 10; girls have a greater likelihood to develop idiopathic scoliosis

Shriners Hospitals for Children — Greenville has a dedicated team of orthopaedic surgeons who specialize in caring for all types of pediatric spinal deformities. The senior surgeons at the hospital have decades of experience and are internationally known for their clinical research on the treatment of scoliosis.

Signs of scoliosis

Scoliosis can be hereditary and it is recommended that a child who has a parent or sibling diagnosed with idiopathic scoliosis receive regular check-ups for early detection.

Children and teens with scoliosis rarely exhibit symptoms and sometimes the condition is not obvious until the curvature of the spine becomes severe. Sometimes you may notice that your child’s clothes are not fitting correctly or that hems are not hanging evenly. In some cases, your child’s spine may appear crooked or their ribs may protrude. Some markers to watch for in a child who has scoliosis are:

  • One shoulder may appear higher than the other
  • One shoulder blade may stick out farther than the other
  • One hip may appear higher than the other
  • Head is not properly centered over their body
  • When bending from the waist, the ribs on one side are higher
  • Waistline may appear flat on one side

Diagnosing scoliosis

Medical history – When confirming a diagnosis of scoliosis, a doctor will confer with you and your child while also reviewing your child’s medical records to determine any current medical conditions contributing to the curved spine, such as birth defects, syndromes or additional disorders associated with scoliosis. Questions regarding muscle weakness, numbness, tingling, pain or any problems controlling the child’s bowel or bladder, will be asked and reviewed to determine a diagnosis.

Physical examination – A full examination of your child’s back, chest, feet, legs, pelvis and skin will be performed. The doctor will also check to determine if your child’s shoulders are level, whether their head is centered and if the opposite sides of the body appear even. Your child’s back muscles will be checked while they are bending forward to determine if one side of the rib cage is higher than the other. If there is any significant asymmetry between opposite sides of the body, the doctor may order an X-ray evaluation.

X-ray evaluation – Should the patient’s medical history or physical examination suggest possible scoliosis, a series of two X-rays will be taken – one X-ray from the back and the other from the side. Each X-ray captures the entire spine and occasionally the doctor will need additional tests if there are other issues.

Curve measurement – If your child requires an X-ray evaluation, the doctor will measure the curve on the X-ray. For curves greater than 20 degrees, treatment is required. Doctors classify curves of the spine by location, shape, pattern and cause.

Location – To accurately identify the curve’s location, the doctor locates the apex of the curve, or the vertebra within the curve that is the most off-center.

  • Thoracic curve has its apex in the thoracic area, the area of the spine where the ribs attach.
  • Lumbar curve has its apex in the lower back.
  • Thoracolumbar curve has its apex where the thoracic and lumbar vertebrae join.

Curve – The types of idiopathic curves in scoliosis are usually C-shaped, one curve; or S-shaped, two or more curves.

Pattern – Studies in scoliosis patients show that curves frequently follow specific patterns. The larger the curve, the more it will progress depending on how much the patient is likely to grow. Curves in the thoracic area often make the shoulders and wing bones of the upper back, also known as the scapula, appear uneven. Curves in the lumbar area may cause one hip to stick out more than the other and even make pants or a skirt hem seem crooked.

Evaluation and treatment of scoliosis

Observation

If the child’s idiopathic curve measures less than 25 degrees, doctors follow patients through observation and examine them every four to six months while the patient is growing. X-rays are typically used to assess whether or not the curve is getting bigger. If the curve is not getting bigger, usually there is no further treatment recommended.

Mehta casting

Mehta casting is for children with infantile idiopathic scoliosis. A Mehta cast is a plaster cast that is applied in the operating room from the patient’s collarbone to the bottom of the spine. When the cast is applied, pressure is placed on the cast causing the spine to straighten. When the cast hardens, it holds the spine in this position. Subsequent casts each progressively straighten the patient’s spine. Each cast is worn for two to three months, and then there is a one week break before having the next cast put on.

Bracing

Curves of moderate size (between 25 and 40 degrees) or curves that are progressing, are considered for bracing. Braces are used in an attempt to prevent the curve from getting worse. Braces do not improve scoliosis or cause it to go away. The brace is usually worn until the bones reach maturity and the likelihood of curve progression is less. Bracing is not always effective and sometimes the curve increases despite using a brace. In this instance, surgery may be necessary.

The type of brace is dictated by the type of curve and if the child will adhere to the doctor’s directions as to how many hours per day the brace is to be worn. Braces can be custom made or created from a pre-fabricated mold.

Milwaukee brace: Also known as a cervico-thoraco-lumbo-sacral orthosis (CTLSO) is a type of brace used to correct any curve in the spine. It is a full torso brace that extends from the pelvis to the base of the skull. The Milwaukee brace has a neck ring and is most often prescribed when the apex of the curve is between 25 and 40 degrees. The brace is intended to minimize further progression.

Boston brace: Also known as a thoraco-lumbo-sacral-orthosis (TLSO) brace, is usually prescribed for curves in the lumbar or thoraco-lumbar section of the spine. An underarm brace, fitting under the arm, extending around the rib cage, lower back and hips is worn under clothes.

Providence brace: A TLSO brace, the Providence brace is used for nighttime only and can be worn up to eight hours while the patients are sleeping.

Surgical options

If the curve has progressed despite bracing, or is too advanced for bracing to be effective (greater than 40 degrees), surgery is needed. Large curves that continue to progress are at an increased risk of interfering with normal heart and lung function if nothing is done to prevent the progression. Typically, surgery will be recommended for curves around 50 degrees or greater.

Growing rods

Growing rods are two telescoping rods that can be lengthened every six months to maintain correction as the child grows. Growing rods allow for continued growth of the spine while maintaining a controlled and better alignment.

MAGEC rods

Shriners Hospitals for Children — Greenville is proud to be the first hospital in the Carolinas to offer a new, state-of-the-art procedure for young children with scoliosis, a curvature of the spine which increases as the child grows. The MAGEC (MAGnetic Expansion Control) Spinal Bracing and Distraction System is composed of two magnetic, telescoping rods that can be gradually lengthened from outside of the skin, guiding a young child’s curved spine, straight. With the MAGEC System, the child undergoes an initial surgery to implant the rods and then the system can be gradually lengthened from outside of the skin, in an exam room, avoiding the need for general anesthesia and an incision.

Fusion surgery

The intent for surgery is to fuse the spine, preventing further progression, as well as to gain correction. Fusion surgery involves attaching rods, hooks, wires or screws to the curve and small pieces of bone are placed, over the spine. The bone pieces will grow together with the spinal bone, fusing it in the proper position. Although the spine may not be made completely straight, the curve will be less than it was before surgery.

Why choose us?

Shriners Hospitals for Children —Greenville is fortunate to have four expert pediatric orthopaedic surgeons who specialize in spine care. Our extended medical team includes physician assistants, nurse practitioners, physical therapists, nurses, a respiratory therapist, care managers, social workers and child life specialists, each of whom play an essential role in our multidisciplinary approach to care. X-rays can be taken on site, in our radiology department where staff specialize in the care of children and adolescents. Should your child require bracing or therapy, you may choose to receive these services from our in-house orthotics provider and rehabilitation department. All of these services are located under one roof in an effort to coordinate your child’s spine care in the best and most efficient way.

Pediatric and adolescent expertise and experience

Innovative technologies and advanced treatments

  • The Greenville Shriners Hospital is the only hospital in South Carolina to offer the cutting-edge 3D precision and low dose radiation of the EOS 3D micro-dose imaging system.
  • The Greenville Shriners Hospital is the first hospital in the Carolinas to offer infantile scoliosis patients the innovative MAGEC rods that are magnetically lengthened with an exterior device, eliminating the need for repeated surgical lengthening.
  • The Greenville Shriners Hospital also offers the state-of-the-art vertical expandable prosthetic titanium rib (VEPTR or titanium rib) as a treatment option for patients with thoracic insufficiency syndrome, whose lung development is being hindered by deformities of the spine, chest and ribs.

Quality and patient safety outcomes data for surgical spine procedures 2016

  • 0.4% surgical site infection rating (per 100 cases)
  • Average length of stay: 2.3 days
  • Unplanned re-admissions: 4 out of more than 1,200 surgical procedures

Recipient of the 2016 Press Ganey Pinnacle of Excellence Award in patient satisfaction       

The Press Ganey Pinnacle of Excellence Award recognizes the three top-performing facilities that consistently achieve 95th percentile performance in patient satisfaction based on three full years of data from May 2013 – April 2016.

Meet our patients

The specialists at Shriners Hospitals for Children — Greenville perform more than 130 spine surgeries every year, apply more than 200 Mehta casts and are caring for hundreds of children at various stages in the treatment process. Most patients return to normal activities and sports in their schools and communities.

Please meet some of our patients:

Mehta casting

Bracing

Surgery

   
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