Introduction

When the body is viewed from behind, a normal spine appears straight without much deviation from side-to-side. However if the spine is observed to have a lateral or side-to-side curvature, the person might have a condition called scoliosis. This disorder often gives the appearance of the person leaning to one side though it should not be confused with poor posture. Scoliosis is a complicated deformity that is characterized by both lateral curvature and rotation of the vertebra often causing a characteristic rib hump in the mid or thoracic spine. This is caused by the vertebrae in the area of the major curve rotating toward the concavity and pushing their attached ribs posterior causing the characteristic rib hump seen in thoracic scoliosis. If the thoracic curve and rib rotation is severe, greater than 70 degrees, pulmonary and cardiac function can be impeded. This amount of curve and subsequent cardiac and pulmonary changes are often seen later in life in untreated severe idiopathic infantile and juvenile scoliosis patients and present a threat to life.

Anatomy

If one is to observe the trunk from a side view, the spine will demonstrate four normal curves, the cervical, thoracic, lumbar and sacral. The thoracic or chest area has a normal round back called a kyphosis, while in the lower spine there is a swayback, or lordosis. Increased kyphosis in the thoracic area is correctly called hyperkyphosis while increased swayback is termed hyperlordosis. Changes from normal on a side view frequently accompany scoliosis changes. Some round back deformities are simply due to bad posture can often being corrected with postural exercises. A small percentage of patients with kyphosis have more rigid deformities than the postural type, which are associated with vertebral deformity. This type is called Scheuermann's kyphosis and is much more difficult to treat than postural kyphosis. Its cause is unknown.

A layman can even help to identify a child or person with scoliosis by simply observing the person in the standing position, preferably with out a shirt and in their underpants, and observing the following:

1. One shoulder may be higher than the other.
2. One scapula (shoulder blade) may be higher or more prominent than the other.
3. With the arms hanging loosely at the side, there may be more space between the arm and the body on one side.
4. One hip may appear to be higher or more prominent than the other.
5. The head is not centered over the pelvis.
6. When the patient is examined from the rear and asked to bend forward until the spine is horizontal, one side of the back appears higher than the other.

Once identified, the child should be sent to a health-care professional such as a chiropractor for further evaluation.

There are many different causes and varieties of scoliosis but by far the most common is Idiopathic scoliosis and accounts for about 85 % of all cases. "Idiopathic" means no known cause and is seen with equal frequency in boys and girls in the mild or low curve magnitudes. This disorder can be sub classified into infantile, juvenile and adolescent types, depending upon the age of onset. Idiopathic scoliosis frequently runs in families and may be due to genetic or hereditary influences. However girls, for unknown reasons, are five to eight times more likely than boys to have their curves increase in size and require treatment. The most frequent time for the development of Idiopathic scoliosis is during adolescence when children are completing the last major growth spurt. At this age young people are reluctant to allow their bodies to be seen by parents and other adults so it is very important to have this age group examined on a regular basis.

If a scoliotic curve is found in the growing adolescent, it is very important that the curves be monitored for change by periodic examination and some times standing X-rays. In ninety percent of cases, the scoliosis are mild and do not require active treatment though increases in spinal deformity require evaluation to determine if brace or other treatment is required. In a small number of patients, surgical treatment may be needed.

Brace treatment (orthosis) is recommended for both juvenile and adolescent children observed to be increasing with their scoliosis or kyphosis and newly identified cases of moderate scoliosis or abnormal kyphosis. There are many types of braces, all designed to prevent curves from increasing by acting as a buttress for the spine to prevent the curve from increasing during active skeletal growth. Braces will not usually make the spine perfectly straight, and cannot always keep a curve from increasing. However, bracing is effective in halting curve progression in a significant percentage of skeletally immature adolescents.

There is no simple solution for scoliosis. The majority of cases though often monitored are not actively treated. The standard medical treatment for moderate cases is a brace where the severe cases are sometimes corrected surgically.

Besides bracing many other methods have been used including specialized exercise, electric stimulation of spinal muscles, nutritional programs, and chiropractic treatments. It seems that the best results have been maintained with a multifactorial approach to the management of this condition.

There are chiropractors that are specializing in these cases though most chiropractors are familiar with the scoliosis cases.