Frequently Asked Questions (FAQs)

The doctor talks to the patient and the patient's parent or parents and reviews the patient's records to look for medical problems that might be causing the spine to curve, for example, birth defects, trauma, or other disorders that can be associated with scoliosis.

The doctor looks at the patient's back, chest, pelvis, legs, feet, and skin. The doctor checks if the patient's shoulders are level, whether the head is cantered, and whether opposite sides of the body look level. The doctor also examines the back muscles while the patient is bending forward to see if one side of the rib cage is higher than the other. If there is a significant asymmetry (difference between opposite sides of the body), the doctor will refer the patient to an orthopaedic spine specialist (a doctor who has experience treating people with scoliosis). Certain changes in the skin, such as so-called café au lait (coffee-with-milk-colored) spots, can suggest that the scoliosis is caused by a birth defect.

Patients with significant spinal curves, unusual back pain, or signs of involvement of the central nervous system (brain and spinal cord) such as bowel and bladder control problems need to have an x ray. The x ray should be done with the patient standing with his or her back to the x-ray machine. The view is of the entire spine on one long (36-inch) film. Occasionally, doctors ask for more tests to see if there are other problems.

The doctor measures the curve on the x-ray image. He or she finds the vertebrae at the beginning and end of the curve and measures the angle of the curve

To identify a curve's location, doctors find the apex of the curve (the vertebra within the curve that is the most off-centre); the location of the apex is the "location" of the curve. A thoracic curve has its apex in the thoracic area (the part of the spine to which the ribs attach). A lumbar curve has its apex in the lower back. A thoracolumbar curve has its apex where the thoracic and lumbar vertebrae join

The curve usually is S- or C-shaped

Curves frequently follow patterns that have been studied in previous patients. The larger the curve is, the more likely it will progress (depending on the amount of growth remaining).

Does Scoliosis Have To Be Treated and what are the treatments

Many children who are sent to the doctor by a school scoliosis screening program have very mild spinal curves that do not need treatment. When a child does need treatment, the doctor may send him or her to an orthopaedic spine specialist. The doctor will suggest the best treatment for each patient based on the patient's age, how much more he or she is likely to grow, the degree and pattern of the curve, and the type of scoliosis. The doctor may recommend observation, bracing, or surgery.

Observation--Doctors follow patients without treatment and re-examine them every 4 to 6 months when the patient is still growing (is skeletally immature) and has an idiopathic curve of less than 25 degrees.

Bracing--Doctors advise patients to wear a brace to stop a curve from getting any worse when the patient:

is still growing and has an idiopathic curve that is more than 25 to 30 degrees;

has least 2 years of growth remaining, has an idiopathic curve that is between 20 and 29 degrees, and, if a girl, has not had her first menstrual period; or is still growing and has an idiopathic curve between 20 and 29 degrees that is getting worse.

a child nears the end of growth, the indications for bracing will depend on how the curve affects the child's appearance, whether the curve is getting worse, and the size of the curve.

Surgery--Doctors advise patients to have surgery to correct a curve or stop it from worsening when the patient is still growing, has a curve that is more than 45 degrees, and has a curve that is getting worse.

Where Did the Term Scoliosis Come From

Hippocrates, an ancient Greek physician known as the "father of medicine," named the condition on the basis of the Greek word for CROOKED

Are There Other Ways To Treat Scoliosis?

Some people have tried other ways to treat scoliosis, including manipulation by a chiropractor, electrical stimulation, dietary supplements, and corrective exercises. So far, studies of the following treatments have not been shown to prevent curve progression, or worsening:

• Chiropractic manipulation
• Electrical stimulation
• Nutritional supplementation

Exercise:(Studies have shown that exercise alone will not stop progressive curves. However, patients may wish to exercise for the effects on their general health and well being.)

Which Brace Is Best?

The decision about which brace to wear depends on the type of curve and whether the patient will follow the doctor's directions about how many hours a day to wear the brace. There are two main types of braces. Braces can be custom made or can be made from a pre-fabricated mold. All must be selected for the specific curve problem and fitted to each patient. To have their intended effect (to keep a curve from getting worse), braces must be worn every day for the full number of hours prescribed by the doctor until the child stops growing.

Milwaukee brace: Patients can wear this brace to correct any curve in the spine. This brace has a neck ring. Thoracolumbosacral orthosis (TLSO): Patients can wear this brace to correct curves whose apex is at or below the eighth thoracic vertebra. The TLSO is an underarm brace, which means that it fits under the arm and around the rib cage, lower back, and hips.

What are the consequences of scoliosis?

The degree of scoliosis ranges from mild to severe. In many cases, scoliosis may be barely noticeable. Scoliosis may result in excessive fatigue and lower back pain. As the curvature becomes more pronounced, scoliosis can have significant cosmetic effects -- an individual may appear stooped or deformed, and clothes will not fit properly. In extreme cases, the curvature may become so severe that it interferes with the normal functioning of the heart and lungs.