STORY BYWe’ve seen the thin, prepubescent children wearing back braces from chin to thigh. Whatever it is, it looks tortuous. The condition is called idiopathic adolescent scoliosis—a mouthful to say. Fortunately, pain usually does not accompany this physical condition. And two treatments can make dramatic changes in the course of this deformity.
For reasons yet to be discovered, scoliosis—curvature of the spine—affects children. (If adults develop scoliosis, it usually is a complication associated with arthritis.)
While up to three children per 100 might have a spinal curve of 10 degrees or more, many are small children who will outgrow the problem. Boys and girls seem to be equally affected in the early years. With a curvature of 30 degrees or more, only 1.5 to 3 per 1000 are affected.
In adolescent scoliosis patients, only one in nine will be males. “But, in those who have the condition, it is generally more aggressive,” says Rex Marco, M.D., assistant professor in the Department of Orthopaedic Surgery and chief of Spine Surgery and Musculoskeletal Oncology at The University of Texas Medical School at Houston.
Early detection is the most important element in treatment and likely to be first diagnosed by the school nurse or a pediatrician. “In a very young child, it’s usually seen on an X-ray ordered for something else, such as a chest X-ray,” Marco says. “There’s a simple standard test for scoliosis that school nurses or pediatricians use. It requires only that the patient bend from the waist. With the child in this position, most curves can be seen.”
He adds that newer braces are much less visible, a psychological advantage over older models--the awkward devices made memorable by a half dozen teen movies. Scoliosis may develop during a time of social development, striking just before a growth period such as the start of adolescence. “Newer braces are not as big and bulky, and they pull and retrain muscles to support the back,” says Marco.
One of the newest additions in this field is the Spine Cor brace that was recently introduced with great success in England and Montreal and premiers in the U.S. at the UT Spine & Scoliosis Center. It promises more freedom of movement for sports such as gymnastics and recreational activities like dancing.
“With early detection, we can stop the advancement of the curvature. While the brace will not repair the damage, it halts the progression of the deformity,” Marco says.
Thoracoscopic procedures have allowed less invasive surgical treatment. While surgeons still sometimes use the older “Harrington Rod” method, with hooks at each end that stretch and straighten the spine, newer procedures employ screws or hooks at each vertebra in the area of the deformity to better control correction. With thoracoscopic surgery, small incisions are made through the side of the rib cage and from the back. With older methods, the incision and resulting scars were much larger. Compared to earlier methods, thoracoscopic surgery patients generally spend less time in the hospital, are home within five to seven days and are soon walking.
Yet, one form of scoliosis in which the space between the vertebrae collapses and puts pressure on the nerves may be caused by osteoarthritis and generally strikes adults over 50.
As with children, this form of scoliosis manifests as asymmetry at the waistline. While in children the condition is not generally accompanied by pain, adults experience pain in the legs and back from nerve compression in the spine.
When the space between the vertebrae collapses, the discs bulge, the ligament in the spinal canal thickens and the nerves in the spinal column are compressed or “pinched.”
Marco says that the first form of treatment in both children and adults is observation. The next stage might be bracing, followed by surgery. “Newer braces may, in theory, help the body adapt, help the patient move, and potentially correct the size of the curve,” he says. Marco adds that surgery is restricted to young people who have curves of more than 40 to 50 degrees and mature patients whose curvatures exceed 50 degrees. “Surgery usually halts the progress of the deformity, and we can usually correct the curve by 40 to 50 percent.”
With early detection followed by appropriate evaluation and treatments, the damage of scoliosis can be halted and in many cases diminished.
To maintain a healthy back, Dr. Marco suggests that you follow some simple health advice:
UPDATED: 7-30-2006
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Dr. Rex Marco is an assistant professor in the Department of Orthopaedic Surgery at the UT Medical School.
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Children 6 months up to 9 years of age getting a flu vaccine for the first time will need two doses of vaccine the first year they are vaccinated. If possible, the first dose should be given in September or as soon as vaccine becomes available. The second dose should be given 28 or more days after the first dose. The first dose "primes" the immune system; the second dose provides immune protection. Children who only get one dose but who need two doses can have reduced or no protection from a single dose of flu vaccine. Two doses are necessary to protect these children. If your child needs two doses, begin the process early, so that children are protected before influenza starts circulating in your community. Be sure to follow up to get your child a second dose if they need one. It usually takes about two weeks after the second dose for protection to begin.
Because flu viruses change every year, the vaccine is updated annually. So even if you or your children got a flu vaccine last year, you both still need to get a flu vaccine this season to remain protected. If October and November slip by, and you haven’t gotten your children or yourself vaccinated, get vaccinated in December or later.
