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Scoliosis and spine disorders

Scoliosis and spine disorders

Scoliosis and spine disorders

Scoliosis is one of the more common spinal disorders, in which the vertebrae rotate, causing an abnormal curve of the spine; curves are often S-shaped or C-shaped. The most common type is idiopathic scoliosis, which means “cause is unknown,” but is thought to be genetic. Scoliosis can occur in otherwise perfectly healthy children. Because scoliosis may appear at any time during the growing years, it is essential that the spine be checked regularly by your doctor until growth is complete. The curvature may progress considerably during the rapid teenage growth spurt.

There are currently no medications to treat scoliosis, nor can its onset be prevented. The treatment prescribed for scoliosis varies with the individual patient. Treatment for scoliosis is based on the patient’s age, future growth potential, and the severity and location of the curve.

Treatment options

  • Observation: If the child’s curve measures less than 20 degrees, periodic observation to watch for signs of further progression is generally recommended. Our spine team will follow the patient’s curve progression and examine the patient every four to six months while they are growing.
  • Bracing: Most physicians recommend their patients be fitted for a brace to prevent a curve from worsening while the child is growing, and has an idiopathic curve greater than 20 degrees.

As the child nears the end of their growing period, the specific indicators for bracing will depend upon how the curve affects the child's physical appearance, if the curve is getting worse and, the size of the curve.

There are several types of braces. The type of brace will depend on the patient’s age and severity of the curve. Braces can be custom made or created from a prefabricated mold. The braces are prescribed to prevent a curve from progressing and must be worn every day for the allotted time, until the child stops growing.

Types of braces:

    • Milwaukee brace (also known as the cervico-thoraco-lumbo-sacral orthosis (CTLSO): This 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 brace is intended to minimize further progression. This is a custom-fitted brace that fits under clothes.
    • Boston brace (also known as a thoraco-lumbo-sacral orthosis (TLSO): This is a brace usually prescribed for curves in the lumbar or thoraco-lumbar section of the spine. It is an underarm brace, fitting under the arm, extending around the rib cage, lower back and hips. It is worn under clothes.
    • Providence brace: a brace is used at nighttime only, it can be worn up to eight hours while the patient is sleeping.
    • Charleston brace: This brace is often recommended for lower back curves in the lumbar spine. It is a bending brace to “untwist” the spine and is worn only while sleeping.
  • Casting: This option is usually reserved for our youngest patients and used in place of bracing. Application of the casts requires special techniques and equipment developed for infantile forms of scoliosis. It is often used to delay or prevent the need for surgery.
  • Scoliosis specific exercises: This 3-D treatment approach pioneered by Katharina Schroth, is a curve-specific and comprehensive conservative treatment program for children diagnosed with adolescent idiopathic scoliosis.
  • Surgery:
    • Fusion surgery: Fusion surgery is recommended to correct a curve or prevent it from getting worse. 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. Children who are candidates for fusion surgery usually must meet the following requirements:
      • The child is still growing and at least 10 years old
      • The curve is greater than 45 degrees
      • The curve is getting worse
      • If the curve is greater than 50 degrees, the patient is done growing
    • Fusionless surgery options: At Shriners Hospitals for Children — Spokane, there are several fusionless options that can be used alone or in tandem with other treatments. These fusionless options include vertebral body stapling (VBS). VBS is spinal stapling for children who are continuing to grow and either cannot or do not wear a brace long-term. This procedure serves as an “internal brace” and can help with growth modulated curve correction.
    • Growing systems: Shriners Hospitals for Children — Spokane offers expandable devices that are used in growing children diagnosed with scoliosis and include:
      •  Growing rods: Growing rods allow for continued and controlled spine growth. They require a surgical procedure through the back, where the rods are attached to the spine both above and below the curve, with hooks or screws. The child then returns every six months to have the rods lengthened to parallel their growth. Some rods are able to expand on their own, eliminating return trips to the operating room.
      • Hybrid growth rod: Similar to the titanium rib, the hybrid growth rod is attached to the child’s ribs at one end and vertebrae at the other end. The device is used to assist straighter spine growth.
      • Vertical expandable prosthetic titanium rib (VEPTR or titanium rib): This device is used for growing children who have a chest wall deformity, with or without a scoliosis diagnosis. It is a titanium rod curved to fit the back of the chest and spine and is designed to grow with the child, helping to correct spinal deformity and allow for the development of the chest and lungs.

Kyphosis

Everyone has a mild rounded back (kyphosis) and a mild swayback (lordosis). If you look at a person from the side and see more “round back” than is considered normal, it is possible that the person has some type of excessive kyphosis. The degree of normal kyphosis is usually considered to be between 20 and 40 degrees. Once the curvature approaches more than 50 degrees, it is considered abnormal.

The long-term outcomes of patients with this form of excessive kyphosis is very good, unless the deformity is very large, or if pain cannot be controlled. Treatment is rarely needed, but when appropriate, bracing or surgery may be recommended.

Treatment options

Treatment goals are to stop the progression of the curve and prevent deformity. Specific treatment plans will be based on the child’s unique needs and overall medical condition.

  • Observation: For children with curves measuring less than 60 degrees, observation through examinations is recommended. The progression of the child’s curve depends upon the amount of skeletal growth, and eventually slows down and stops after the child reaches puberty.
  • Surgery: When the child’s curve measures 75 degrees or greater, surgery may be recommended to correct the curve and stabilize the spine. A metal rod can be surgically placed in the child’s back and anchors are inserted into each of the vertebrae. The anchors are used to attach the vertebrae to the metal rod.

Spondylolysis and spondylolisthesis

Spondylolyisis is a defect in the pars area of the vertebrae – the bones that make up the spine. The pars is the portion of the bone that connects the front of the vertebrae to the back. When the area of the bone is poorly developed or injured by repetitive overuse activities, it can lead to low back pain.

Spondylolisthesis is a condition that occurs when the spondylolytic defect weakens the vertebrae to the degree that it cannot maintain its appropriate position as it relates to the bones below, and may start to slip out of position. This can be progressive in rare circumstances leading to nerve injury.

Both of these conditions are among the most common causes of ongoing or chronic back pain in children. Children with these conditions, who are active in sports that require them to frequently arch their backs backwards (such as gymnasts, football players, softball pitchers, swimmers and divers, volleyball players and weight lifters), are at risk for and often contract stress fractures more than their peers.

Treatment options

  • Physical therapy: Patients work with a physical therapist who teaches them exercises to strengthen their back and abdomen, which help support the lower back.
  • Braces: In more severe cases, a brace may be necessary to lessen the back pain. The child’s doctor will recommend how long they should wear the brace.
  • Surgery: In rare cases, surgery may be required. Depending upon the severity of the child’s condition, their doctor will recommend the appropriate surgery for relief of back pain or any deformity.

Lordosis

Lordosis is a curvature in the lower back area, also known as swayback. The lordotic curve refers to the curve of the lumbar spine, just above the buttocks. Lordosis makes the buttocks appear more prominent and children with severe lordosis have a significant space under their lower back when lying on their back.

Treatment options

Shriners Hospitals for Children treatment goals are to stop the progression of the curve and prevent deformity. Specific treatment plans will be based on the child’s unique needs and overall medical condition. Treatments offered include:

  • Physical therapy: Children diagnosed with lordosis generally are treated through occupational or physical therapy. They will work with a therapist to learn how to strengthen the lower back through a series of exercises and strengthening techniques that they can do at home.

Herniated disc

Discs are small circular cushions between the bones in the spine. The bones are called vertebrae. The discs are compressible. They act as cushions for the vertebrae. A herniated disc happens when discs in the spine bulge from their proper place. This is most common in the lower spine.

Treatment options

  • Nonsurgical:
    • Physical therapy
    • Pain medications
  • Surgical: Surgery may be recommended for patients who fail to respond to other treatments. Emergency surgery may be needed in rare cases to prevent permanent nerve damage.

Post-traumatic spine disorders

Each year thousands of children sustain fractures of the vertebral column. Trauma to the spinal cord and column is a devastating injury that may be fraught with many complications including post-traumatic deformity.

Treatment options

  • Nonsurgical fracture management: Minor fractures or those with column stability are treated without surgery, often using a brace to prevent rotational movement and bending. These patients need to be stabilized sufficiently so that their upper body is appropriately supported, which allows for effective rehabilitation.
  • Surgical fracture management: The goals of operative treatment are decompression of the spinal cord canal and stabilization of the disrupted vertebral column. Your surgeon will discuss the best procedure for your child depending on the severity of the fracture.
   
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