scoliosis part 1...education for parents

So, we met with Children's Hospital Orthopedics specialist, Dr. Miller on Monday.  It was somewhat dismal to say the least.  Here's basically what I got from it. She has a serious condition of scoliosis.  She can do a brace with a 12% chance that things won't get worse.  She can go to a clinic in Ft. Collins for treatment that has only been around 7 years and doesn't have much research.  We can spend a lot of money and get her back stapled. But, we should just plan on her eventually having surgery to correct the scoliosis.  

So, I cried, and then I laughed and now I'm getting down to educating myself.  Travis is doing the same.  Surgery isn't such a bad outcome.  It's definitely better than being twisted and crippled, so we'll do it when the time comes, if it comes.  

But in the meantime, we are scheduling an MRI to make sure there is nothing neurological going on.  Then, we will look into braces and into the non-invasive treatment in Ft. Collins.  It's an hour drive, but they say that it could reduce her curve by 10 degrees and work at maintaining.  

Maintaining is what I pray for.  At this point in time, she has no pain, no complaints and doesn't look twisted at all.  If we can keep her like this, she would be just fine as an adult.  That is the key.  

So, it's not cut and dry.  They don't know what causes it.  They don't know how to fix it.  They just give us options and tell us to look into it all and go from there.  So, that's what we are doing.

Thanks to my "research assistant" Amy C, we have this great article that is a good description of scoliosis as a whole.  Take a read.  If you know of anyone with scoliosis, send them my way.  I need some education!  

http://www.shrinershospitalsforchildren.org/CareAndTreatment/Orthopaedics/Scoliosis.aspx

Scoliosis and Other Spine Conditions

Scoliosis is a musculoskeletal disorder that causes an abnormal curve of the spine or backbone. From the Greek word skolios, meaning crooked, scoliosis is a medical condition where the spine is curved from side to side sometimes resembling an “S” or a “C” rather than a straight line.

There are different types of scoliosis including:

• Idiopathic scoliosis is the most common type. The cause is unknown; generally the condition occurs in children after the age of 10. Girls have a greater likelihood to develop idiopathic scoliosis.
• Juvenile idiopathic scoliosis affects children between the ages of 3 and 10.
• Infantile Idiopathic scoliosis occurs in children under age 3.

Symptoms of Scoliosis

Scoliosis can be hereditary and it is recommended that a child who has a parent or sibling diagnosed with idiopathic scoliosis receive regular check-ups for early detection.

Children and teens with scoliosis rarely exhibit symptoms and sometimesthe condition is not obvious until the curvature of the spine becomes severe. Sometimes you may notice that your child’s clothes are not fitting correctly or that hems are not hanging evenly. In some cases your child’s spine may appear crooked or their ribs may protrude. Some markers to watch for in a child who has scoliosis are:

• One shoulder may appear higher than the other
• One shoulder blade may stick out further than the other
• One hip may appear higher than the other
• Their head is not properly centered over their body
• When bending from the waist, the ribs on one side are higher
• Their waistline may appear flat on one side

Diagnosing Scoliosis

Several factors are used in diagnosing scoliosis in children and adolescents.

• Medical history: When confirming a diagnosis of scoliosis, a doctor will confer with you and your child while also reviewing your child’s medical records to determine any current medical conditions contributing to the curved spine such as birth defects, syndromes or additional disorders associated with scoliosis. Questions regarding muscle weakness, numbness, tingling, pain or any problems controlling the child’s bowel or bladder will be asked and reviewed to determine a diagnosis.
• Physical Examination: A full examination of your child’s back, chest, feet, legs, pelvis and skin will be performed. The doctor will also check that your child’s shoulders are level; whether their head is centered and if the opposite sides of the body appear even. Your child’s back muscles will be checked while they are bending forward to determine if one side of the rib cage is higher than the other. If there is any significant asymmetry between opposites side of the body, the doctor may order an X-ray evaluation.
• X-ray Evaluation: Should the patient’s medical history or physical examination suggest possible scoliosis, a series of two X-rays will be taken; one X-ray from the back and the other from the side. Each X-ray captures the entire spine and occasionally the doctor may need additional tests if there are other issues.
• Curve Measurement: If your child requires an X-ray evaluation, the doctor will measure the curve on the X-ray. For curves showing a curve greater than 20 degrees, treatment is required. Doctors classify curves of the spine by location, shape, pattern and cause.
• Location: To accurately identify the curve’s location, the doctor locates the apex of the curve, or the vertebra within the curve that is the most off-center.
• Thoracic Curve has its apex in the thoracic area, the area of the spine where the ribs attach.
• Lumbar Curve has its apex in the lower back.
• Thoracolumbar Curve has its apex where the thoracic and lumbar vertebrae join.
• Curve: The types of idiopathic curves in scoliosis are usually C-shaped, one curve; or S-shaped, two or more curves.
• Pattern: Studies in scoliosis patients show that curves frequently follow specific patterns. The larger the curve, the more it will progress depending upon how much the patient is likely to grow. Curves in the thoracic area often make the shoulders and wing bones of the upper back, also known as the scapula, appear uneven. Curves in the lumbar area may cause one hip to stick out more than the other and even make a pants or skirt hem seem crooked.

Scoliosis Treatments Offered

Some children with mild spinal curves may require no treatment. For those who do need treatment, your primary pediatrician may refer you to an orthopaedic spine specialist, and they will recommend the best plan of treatment based on your child’s age; how much more they are likely to grow; the degree and pattern of the curve and the type of scoliosis.

Shriners Hospitals for Children® offers the following treatment plans based on the severity of the scoliosis:

Observation

If the child’s idiopathic curve measures less than 25 degrees, doctors follow patients through observation and examine them every four to six months while the patient is growing. At this point, no treatment is needed other than the follow-up examinations.

Bracing

Most physicians recommend their patients to be fitted for a brace to prevent a curve from worsening when the patient meets the following criteria:

• The child is still growing and has an idiopathic curve greater than 25 degrees
• The child is expected to have significant growing, has an idiopathic curve between 20 and 40 degrees
• If the child is a female, and has not had her first menstrual cycle.
• The child is still growing and shows an idiopathic curve between 20 and 29 degrees and is not improving.

As the child nears the end of their growing period, the specific indicators for bracing will depend upon how the curve affects their physical appearance, if the curve is getting worse and the size of the curve.

Bracing Options

The type of brace is dictated by the type of curve and if the child will adhere to the doctor’s directions as to how many hours per day the brace is to be worn.

Braces can be custom-made or created from a pre-fabricated mold. The braces are prescribed to prevent a curve from progressing and must be worn every day for the allotted time until the child stops growing.

Milwaukee Brace: Also known as a cervico-thoraco-lumbo-sacral orthosis (CTLSO) is a type of brace is used to correct any curve in the spine. It is a full torso brace that extends from the pelvis to the base of the skull. The Milwaukee brace has a neck ring and is most often prescribed when the apex of the curve is between 25 and 40 degrees. The brace is intended to minimize further progression.

Boston Brace: Also known as a Thoraco-Lumbo-Sacral-Orthosis (TLSO) brace, it is usually prescribed for curves in the lumbar or thoraco-lumbar section of the spine. An underarm brace, fitting under the arm, extending around the rib cage, lower back and hips it is worn under clothes.

Providence Brace: ATLSO brace, the Providence Brace is used for nighttime only and can be worn up to 8 hours while the patients are sleeping.

Surgical Options

Fusion Surgery: It is recommended for patients to undergo fusion surgery to either correct a curve of prevent it from getting worse. Fusion surgery involves attaching rods, hooks, wires or screws to the curve and small pieces of bone are placed over the spine. The bone pieces will grow together with the spinal bone, fusing it in the proper position.

Children who are candidates for fusion surgery usually must fill the following requirements:

• The child is still growing and at least 10 years-old
• The curve is greater than 45 degrees
• The curve is getting worse
• Patients who are done growing and have curves greater than 50 degrees

Fusionless Surgery Options

At Shriners Hospitals for Children there are several fusionless options that can be used alone or in tandem with other treatments. These fusionless options include:

Vertebral Body Stapling (VBS): VBS is spinal stapling for children who are continuing to grow and either cannot or do not wear a brace long-term. This procedure serves as an “internal brace” and can help with growth modulated curve correction.

Growing Systems

Shriners Hospitals for Children offers expandable devices that are used in growing children diagnosed with scoliosis and they include:

VEPTR™ or Titanium Rib: This device is used for growing children who have a chest wall deformity caused with or without a scoliosis diagnosis. It is a titanium rod curved to fit the back of the chest and spine and is designed to grow with the child, helping to correct spinal deformity and allow for the development of the chest and lungs.

Hybrid Growth Rod: Similar to the titanium rib, the hybrid growth rod is attached to the child’s ribs at one end and vertebrae at the other end. This device is used to for straighter spine growth.

Growing Rods: Growing rods allow for continued and controlled spine growth. This is done as an outpatient through the back of the spine where the rods are attached to the spine both above and below the curve with hooks or screws. The child then returns every six months to have the rods lengthened to parallel their growth.