None — Scoliosis
When viewed from the side of the body, the spine has two natural curves. The top curve (in the chest area) bends back, while the bottom curve (at the waist) bends forward. When viewed from the back, the spine should run in a straight line. In a person with scoliosis, the spine curves sideways, looking more like a "C" or "S" shape. The condition causes some of the vertebrae to twist and the ribs to protrude. One shoulder or hip may appear higher than the other. The chest may appear sunken and the person may lean more to one side. By definition, scoliosis is the presence of a spinal curve of 10 degrees or more.
According to the National Scoliosis Foundation, about 2 to 3 percent of Americans have scoliosis. The most common type is adolescent idiopathic scoliosis, which is typically diagnosed between 10 and 16. The cause is unknown, but it often runs in families.
Treating Scoliosis
In many cases, scoliosis curves are mild and cause no problems. However, as children grow, the curves can worsen. Those with severe curves may have pain, activity limitations and issues with self-esteem.
There is no way to predict which patients will experience curve progression. For patients with mild curves (generally less than 20 degrees) and those who are close to skeletal maturity (when the bones stop growing), doctors may decide to monitor the patient and recheck the spine every three to six months. If the child has a curvature of 25 to 45 degrees and is still growing, a brace may be recommended. A brace is a tightly fitted appliance that holds the spine in place to prevent the curves from becoming worse. If the curve is more than 45 degrees and the child is still growing, surgery may be recommended. There are several different surgical techniques for scoliosis. Generally, screws and rods are placed in the spine to hold it in the desired position until the vertebrae in the affected areas are fused (form a solid unit).
Predicting Progression
Researchers report progression of scoliosis curves typically occurs just before or during puberty. There is currently no way to determine which patients will experience progression, so doctors may be more aggressive with treatment than necessary. According to the National Scoliosis Foundation, annually, about 30,000 children with scoliosis are fitted for a brace and 38,000 undergo surgery.
Now there's a new test for helping doctors predict which patients with adolescent idiopathic scoliosis will have curve progression. It's called the ScoliScore™ AIS Prognostic Test. A sample of the patient's saliva is sent to a laboratory for DNA analysis. Daniel Green, M.D., Pediatric Orthopedic Surgeon with the Hospital for Special Surgery in New York City, explains the lab screens for over 50 genetic markers related to curve progression in adolescent idiopathic scoliosis and rates the results on a risk score, ranging from 1 to 200. The higher the score, the greater the risk for progression. Green says a patient with a low risk score may need to be monitored less frequently. On the other hand, those with a high score may need frequent monitoring to check curve progression. In some cases, a high risk score may lead to earlier treatment interventions to reduce the risk of curve progression.
The ScoliScore AIS Prognostic Test is recommended for children between 9 and 13 who have mild scoliosis (less than a 25 degree curvature). The test has only been validated in Caucasian children. Researchers are now working to validate the test in African American and Asian children. For information about the ScoliScore™ AIS Prognostic Test, click here.
For general information on scoliosis:
American Academy of Orthopaedic Surgeons American Academy of Pediatrics National Institute of Arthritis and Musculoskeletal and Skin Diseases Scoliosis Association, Inc. Scoliosis Research Society