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Devils Lake Journal - Devils Lake, ND
  • Dr. Jeff Hersh: How serious is a curved spine?

  • Q: My 11-year-old nephew was just diagnosed with a curved spine. They do not think he will need surgery, but they are going to keep a close eye on him. How serious is this?

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  • Q: My 11-year-old nephew was just diagnosed with a curved spine. They do not think he will need surgery, but they are going to keep a close eye on him. How serious is this?
    A: Our spine is made of block-like vertebrae symmetrically stacked one on top of the next, giving amazing strength while maintaining some flexibility. 
    When viewed from the side, the spine normally curves a bit backward from the neck to the top of the chest area then forwards down to the lower back, and then slightly backwards and forwards again making two gentle curves.
    However, viewed from the front or back, the spine normally has less than a 10-degree variation (Cobb angle) from straight in the left-right direction. Scoliosis is an abnormal curvature in this left-right axis, often accompanied by a “twist” of the spine, creating an “S” like curvature. Scoliosis usually progresses most rapidly during periods of most rapid growth.  
    Scoliosis can be caused by congenital spine issues if the tissues that connect the vertebrae are abnormal or if the vertebrae themselves develop asymmetrically. It can also be caused by muscular or neurological conditions asymmetrically “pulling” on the spine. However, the most common cause, accounting for almost 90 percent of cases, is idiopathic scoliosis, where the cause of the curvature is unknown (this is more common in people with a family history of it).
    Idiopathic scoliosis is further characterized as infantile for those younger than 3, juvenile for those between 4 and 9 and adolescent idiopathic scoliosis for those 10 and older (accounting for over 80 percent of all idiopathic cases).
    Scoliosis is common, affecting about 5 in every 1,000 people, girls twice as frequently as boys. The severity of scoliosis depends on the cause, the age at which it manifests and the severity of the curvature. Thankfully, 90 percent of cases of AIS are not severe and do not require treatment, stabilizing as the child enters adulthood and their spine stops growing.
    Most adolescents with AIS do not have symptoms, although they may note the asymmetry or rarely experience back pain from it. Instead, AIS is usually identified on routine screening. In many states, this is done as a school-based program, or it may be noted during a normal well-child exam. 
    Once scoliosis is identified, the degree of curvature may be measured using a scoliometer (a device like a carpenter’s level to assess the amount of rotation), and if a larger amount of curvature is a concern, then by taking X-rays.
    All kids with a trunk rotation over 7 degrees or a rapidly worsening Cobb angle (as noted on follow up measurements) –– girls with a Cobb angle over 20 degrees and boys with a Cobb angle over 30 degrees, since girls with scoliosis often progress more than boys –– should be referred to a pediatric orthopedist. Some experts recommend referral for all kids with an angle over 20 degrees.
    Page 2 of 2 - The specialist will evaluate the specific child to see what treatment is best for them. Most kids with AIS have non-severe curvatures and no treatment is required.
    Those with more serious amounts of curvature, especially those with significant amounts of growth still to occur, may require intervention.
    For some kids, a brace may be used to stabilize their spine as they finish their growth. There are different kinds of braces, ones that contour to the body going up to under the arms –– these are often less noticeable under the child’s clothing, but are not helpful for curvature in the higher levels of the spine –– and ones that include a neck ring, going all the way up to under the chin.
    Some patients with severe scoliosis require surgery to straighten and stabilize their spine. The most common surgery is spinal fusion, where various techniques may be used to connect some of the vertebrae to each other so they no longer move independently.
    Surgical techniques have improved, minimizing the rate of surgical complications; neurological injuries have decreased from 1 per 1,000 to 1 per 7,000, although less severe types of complications still occur in as many as 5 percent of all patients.
    Overall, the prognosis of AIS is good; most patients do not require intervention and are able to lead healthy, productive lives. Those with more severe curvature, or whose curvature worsens despite interventions, may develop complications, such as breathing problems, back pain or other problems.
     
    Jeff Hersh, Ph.D., M.D., can be reached at DrHersh@juno.com.
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