Adolescent Idiopathic Scoliosis

Scoliosis is one of those medical conditions that most people have heard of, but don’t know much about. In short, it is a condition where the spine is curved sideways, typically in the shape of an ‘S’ or a ‘C’ and effects approximately 7 million Americans. Adolescent idiopathic scoliosis (AIS) is scoliosis that occurs in patients between the age of 10 and 18 years of age and also goes by the name adolescent scoliosis. AIS occurs in 3 to 4 out of every 1,000 children.

Adolescent Idiopathic Scoliosis Cause & Locations

The term idiopathic denotes that a cause is unknown for the specific condition or disease with which it is referring. There are some forms of scoliosis with known causes, but the most common type of scoliosis that occurs in adolescents is idiopathic in that it has no known direct medical cause.

While there are no known causes of idiopathic scoliosis there are significant strides being made in research. However, the majority of patients with adolescent idiopathic scoliosis are healthy with no other medical conditions.

Some of the hypothesized causes of scoliosis include muscle imbalance, hormonal imbalance, and asymmetric growth. It is a relatively agreed upon thought by professionals that many genes will be connected to the development of scoliosis, which will be quite helpful in identifying potential scoliosis development.

There are four primary types of curves in scoliosis and are named by their location. The thoracic and lumbar curves are most commonly known. When these two are present in the same spine it is referred to as a double major curve or thoracolumbar curve. The thoracolumbar curve is a very common curve and occurs on the right-side 80 percent of the time.

Adolescent idiopathic scoliosis in the thoracolumbar region occurs more often in girls than in boys and is thought to be hereditary. Non-adolescent versions of this type of scoliosis can develop during pregnancy if some of the bones of the ribcage fuse together. Poor muscle growth and development may also lead to thoracolumbar scoliosis.

Symptoms

Scoliosis symptoms will vary from person to person based on the severity of the curve. Many patients with adolescent idiopathic scoliosis do not have a lot of symptoms, but the larger the curve the more likely symptoms will arise. Adolescents tend to be diagnosed with scoliosis after going through rapid growth stages where it is more obvious that the body is not symmetrical. Clothes beginning to fit awkwardly, or not at all, is one of the first signs that something may be going on.

Scoliosis can also lead to pain ranging in severity. The source of scoliosis pain tends to be from pressure being placed on spinal discs, but can come from other issues as well. The greater the degree of the curve the more pain may be present due to irritation and strain on the joints. The curve can also cause the nerve to become squished or stretched which can cause inflammation and increased pain. If left untreated scoliosis pain can become unbearable and life altering.

Scoliosis pain can be treated in addition to the current scoliosis treatment the adolescent is undergoing, if any. There are certain exercises the adolescent’s practitioner can prescribe. The goal of the exercises is to stretch and strengthen the muscles to bring relief to the areas being compressed. Some of the more common and effective exercises include yoga, swimming, stretching, and Pilates.

Medication can be used to bring immediate relief to the scoliosis pain while exercises and treatment are working towards long-term relief. Acetaminophen and ibuprofen are common over the counter medications that can bring some short-term relief to pain and inflammation.

Some adolescents, and even adults, have found counseling to be an effective form of pain management. Cognitive behavioral therapy (CBT) is the primary form of counseling for those with chronic pain. CBT isn’t designed to bring relief to scoliosis pain, but provides coping mechanisms and techniques for handling pain.

If nerve damage is causing the pain spinal cord stimulation may be an effective way to manage. Electrical wires are placed on the spinal cord and connected to a stimulator box. The box can be placed under the skin and controlled by a remote sending small electrical currents to the nerves to bring relief.

Spinal injection are a more aggressive approach to managing scoliosis pain. The practitioner will inject steroids into the affected spinal joints to bring relief to acute pain. A downside to spinal injections is the fact that they bring temporary relief only. They are typically reserved for patients with significant acute pain in need of immediate relief while other means of management or control are being implemented.

Scoliosis pain has a greater likelihood of going away in patients that are diagnosed and treated early. Any pain caused by permanent damage to tissues will likely be permanent. Consistent coordination with the adolescent idiopathic scoliosis practitioner is necessary to find the treatment that works best for each patient.

Diagnosis and Management

If you believe your child has adolescent idiopathic scoliosis diagnosis and management should be completed by a professional and sought as quickly as possible. Properly diagnosis will involve three or four essential steps; evaluation, history, physical, and possibly x-rays.

The initial evaluation with the adolescent idiopathic scoliosis specialist will require a thorough medical history to be taken. This history involves both the patient and as much family history as possible due to the potential for genetic connection. Roughly 30 percent of adolescent idiopathic scoliosis patients have at least one other family member with the condition as well.

The practitioner will then begin a physical exam to get a better grasp on the extent of the condition as well as how much more growing he or she has left. The physical exam requires the specialist to observe the child from a 360 degree manner. The primary observation will be to ensure the neck, head, and pelvis are in midline. From there they will check for symmetry in other areas including shoulders, legs, arms, hips, and more. The amount of growth remaining will change the approach to management and treatment.

There is a neurological aspect of the exam as well to determine if, and to what extent, the nervous system is involved. As the spinal cord become misshapen there is potential for interference with the spinal cord and as a result neurological implication.

This exam also requires the use of a scoliometer, a special level designed for this purpose. The asymmetry of the spine is measured by having the patient bend forward which takes any pressure off the disks allowing for more accurate measurements.

Finally, an x-ray is required to get the best possible picture to evaluate both the front and the side curvature of the spine. This portion of the diagnosis will require the child to stand as straight and still as possible while the x-ray is being completed. Cobb angles are used to measure the degree of the curve on the x-ray and determines the degrees between the most angulated vertebras within the curvature.

A calculation is then made and most scoliosis diagnosis are between 10 and 40 degrees. Subsequent x-rays can be performed to determine the adequacy of the treatment prescribed. Any change of 5 degrees or more, further, indicates progression.

Risk Factors

A number of factors place a person at risk for developing adolescent idiopathic scoliosis and are strongly related to the condition’s progression. The most common factors are age, gender, curve pattern, and skeletal maturity.

A diagnosis of scoliosis early in life increase the risk of greater curve progression simply due to length of time. However, discovering the condition early also enables the patient to begin treatment and management more quickly which can help avoid certain issues.

If diagnosed at a young age the greatest amount of curve progression will occur in the growing years through adolescence. Those with a medium curve, between 20 to 29 percent, are almost 100 percent more likely to progress as observed in a study following untreated scoliosis in children.

Girls are more likely to be diagnosed with scoliosis and are more likely to require treatment intervention due to the severity of the curve. It has been shown that when curves over 30 degrees exist the ratio of girls progressing over boys is 10:1.

Treatment Methods

Treatment for scoliosis depends on the cause and extent of the curvature and in some cases may produce scoliosis reversal, though the focus is management rather than cure. To determine the best approach to treatment children with adolescent idiopathic scoliosis should see an adolescent idiopathic scoliosis specialist.

The primary approaches to adolescent idiopathic scoliosis treatment involve various forms of therapies, bracing, exercises, and in some cases surgery.

Schroth Method

This approach to treatment for adolescent idiopathic scoliosis involves a Scroth Specialist, generally at a location where Scroth Method Physical Therapy is utilized and is focused on elongating and de-rotating the scoliotic sine. This approach is meant to slow and hopefully stop the progression of the spine curvature.

Craniosacral Therapy for scoliosis

The spinal cord runs longitudinal from the cranium to the coccyx and is made of very delicate and intricate tissues of the nervous system. There is a tube surrounding it for protection and function. The dural tube can become strained and lead to poor mobility and tension that can lead to issues in the spinal column like curves associated with scoliosis.

Craniosacral Therapy treatment for scoliosis can address any issues associated with the tissues around the spinal column caused by dural tube compromises. This form of therapy will focus on mobilization and the practitioner will determine what areas are most compromised by the viewing localized restrictions.

Observation

Curves less than 25 to 30 degrees found in children that are still growing and less than 45 degrees for patients that are done growing  may simply require observation. All patients will receive some level of observation, but for those that are not receiving any direct treatment they are watched every four years or so until growth is completed into adulthood.

Bracing

Curves ranging from 20 to 40 degrees or more may require bracing. Bracing is one of the more common treatment methods for scoliosis of all forms. There are many different types of braces. They are usually custom made for each patient and can be discretely worn under clothing. The brace should be worn the majority of the day, but typically does not prevent them from physical activity. The purpose of the brace is an attempt in halting or slowing the curve progression and preventing surgery.

Surgery

Adolescent patients that are still growing with curves greater than 40 to 45 degrees surgery may be a viable treatment option. Surgery is necessary in these cases to prevent further progression, which can lead to an increase in pain and life altering and dangerous outcomes. While the main purpose of surgery is to prevent curve progression it can also be used to provide a degree of curve correction.

Post-surgery the patient typically remains in the hospital up to a week and requires pain medicine for up to two weeks. Adolescents can return to school and regular daily activities within a month, but full participation in physical activity and other strenuous movements may need to be postponed for 3 to 6 months.

Alternative Treatments

Alternative Medicine for Scoliosis is only provided by some providers incorporating Chiropractic, Craniosacral Therapy, Pranic Healing and other unconventional approaches.