Luv,
Emi
There’s a twist in everyone’s story. In mine, it is in my back. Ever since I was eleven years old, I have had scoliosis, a condition in which my spine is not straight. While scoliosis is not fatal, it can lead to many problems if not monitored and properly dealt with, because many steps are needed to control and/or fix it.
Scoliosis is a three-dimensional deformity of the spine and rib cage. It may develop as a single primary curve (resembling the letter C) or as two curves (a primary curve along with a compensating secondary curve that forms an S shape). Scoliosis may occur only in the upper back (the thoracic area) or lower back (lumbar), but most commonly develops in the area between the thoracic and lumbar area (thoracolumbar area). A physician attempts to define scoliosis by the shape of the curve, its location, direction and magnitude, and, if possible, its cause. The severity of scoliosis is determined by the extent of the spinal curvature and by the angle of the trunk rotation (Shah).
One of the first steps is noticing symptoms, which are most likely based on the type of scoliosis you have. In my case, I had lower back pain that bothered me, sending me to our doctor. Other symptoms can include fatigue or uneven shoulders or hips.
The next step is to determine which kind of scoliosis you have. The three general types of scoliosis are Congenital, or present at birth and due to problems while the spinal bones are developing while still in the womb; Neuromuscular, which is caused by problems such as poor muscle control or muscle weakness, or paralysis due to diseases such as cerebral palsy, muscular dystrophy, spina bifida, and polio; or Idiopathic, scoliosis of unknown cause, which is the most common type in adolescents. (Shah)
Numerous tests are performed to determine how bad the curve is. The “forward bend test” is the most common test in which the child bends forward dangling the arms, with the feet together and knees straight. The curve of structural scoliosis is more apparent when bending over, and the examiner may observe an imbalanced rib cage, with one side being higher than the other or other deformities. In a few other tests, the patient is usually requested to walk on the toes, then the heels, and then is asked to jump up and down on one foot. Such activities indicate leg strength and balance. The physician also will check for tight tendons in the back of the leg, which is usual in adolescence but may also indicate nerve root irritation or spondylolisthesis, a condition in which one vertebra has slipped forward over the other. He also will check for neurologic impairment by testing reflexes, nerve sensation, and muscle function. (Shah) An x-ray will be taken to determine the exact degree of the curve. If the physician notices anything unusual in the x-ray, or if there are any neurologic changes noted in the exam, a possible MRI may be performed.
Then comes the decision of how to treat the curve. If it is small and the child is done growing, the doctor may suggest just watching her to be sure she does not experience any more side effects revealing a larger curve. If it is small but the child is not done growing, the doctor will want to check it every six months to a year.
If the curve is severe, the doctor and the patient will have to make a more in-depth decision: brace or surgery? Both options come with major physical and emotional side effects and recovery.
For medium curves (24 – 40 degrees) bracing is most often recommended. The types of bracing include: the Milwaukee Brace, a wide flat frontal bar with two smaller ones in back that attach to a ring around the neck with rests for the chin and back of the head (Shah); the Wilmington, Boston and TLSO Braces, several styles of braces that can be worn close to the skin so that they don’t show under clothes (Shah); and the Charleston Bending Brace, a type worn only at night.
The physical downfalls to bracing are that it may decrease lung function, causing the patient to find it hard to breathe if she does not exercise right while wearing it. One small study showed that patients who performed torso flexibility exercises experienced less spinal twisting and had improved curvature. Another reported that young girls who wore the Boston
The emotional downfalls are the ways that patients may be treated while undergoing treatment via a brace. Adults who have had scoliosis and its treatments often recall significant social isolation and physical pain (Gelb). Many families indicated that establishing a daily routine was helpful in coping with wearing a brace (Walker
For the patients with curves over 45 – 50 degrees, surgery is almost always suggested. The goals of scoliosis surgery are to straighten the spine as much and as safely as possible, to balance the torso and pelvic areas, and to maintain correction. These are accomplished by fusing the vertebrae along the curve and supporting these fused bones with instrumentation (rod, screws, hooks and other devices) attached to the spine (Shah). Before the operation, a complete physical examination is conducted to determine leg lengths, muscle strength, lung function, and any postural abnormalities (Shah).
While this infirmity can be hard to deal with, the many treatment options and the dedication many doctors and hospitals in the United States
Bibliography
Cyndi Walker. OANDP. Version 4S. American Academy of Orthotists
A.D.A.M. PubMed Health. U.S. National Library of Medicine, September 17, 2009, Web. 16 Dec 2011.
Suken Shah. Nemours. Pediatric Orthopaedic and Scoliosis Surgery, 2009, Web. 16 Dec 2011.
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