We're gonna talk about scoliosis.
It's an important topic, you're gonna see it
commonly, you're gonna talk about it a lot.
So let's talk about it because scoliosis
is a structural alteration of the spine.
It's a curvature of the spine
and it can happen without a cause
or we can know that it's due
to other underlying causes.
Let's start by saying, we're gonna define a curve
by the lateral curvature in the coronal plane.
And we're gonna define it by the
curvature, not by the rotation,
even though you'll have both of
them existing side by side.
So a lot of times people will call it rotoscoliosis
because you have a side bending and rotation
but we're worried mostly about the apparent
finding which is the side bending rotation.
So when you have a curve of the spine that's
greater than 10 degrees, we call it scoliosis.
If it's less than 10 degrees, we just call
it a spinal curvature or an asymmetry
that may go away with use,
and may not be something to worry about
on a regular basis as far as treatment
and the long term history is a lot different
if it doesn't progress past 10 degrees.
Scoliosis is gonna be named
for the side of the concavity.
So if it pushes out on the right side,
we're gonna call it a dextroscoliosis.
If it pushes out on the left,
we call it a levoscoliosis.
And it's important to know that a scoliosis
is gonna start from one vertebrae
and the top of the range is where you
want to focus and pay attention.
Because that's where we have the most deviation
and the most rotation from the midline.
And that's when you have to monitor to
see what's gonna happen in the future.
In the sagittal planes,
we call the curves kyphotic or lordotic,
just to know a way of naming it.
And while you can have
three planes involved,
we tend to focus on just the two
planes that are most common
and typically just the one plane as towards the
left or right sided side bending of the spine.
You can have significant deformity
that gets worse during a growth phase.
So we worry about scoliosis severely worsening
when a child starts to grow through puberty.
For a girl, 10 to 12,
for a boy, about 13 years of age.
That's when you're gonna see a worsening
and identifying scoliosis before them
is something we strive to do.
The range of people who have scoliosis is
estimated at half a percent to five percent.
And most of this darts and starts to get
bad between 10 and 15 years of age,
when kids start to grow.
That's also why we start screening programs
at this age in elementary schools.
In that way we can
and even though scoliosis is
initially considered asymptomatic,
there are gonna be vague symptoms.
Often times our outpatients come to the office
saying they've got sharp, burning pain.
It hurts and then it goes away.
And those are the kids I
typically find scoliosis in
They're not long standing symptoms, they're
not decreased in the ability to function.
There aren't things they can't do.
They just have some mild symptoms
saying something is not a hundred percent.
So, schools have instituted
scoliosis screening programs
in order to identify students
who are gonna have it.
And then they send them to the
doctor if they have questions
or feel there's a need
for further evaluation.
What they do is called the forward bending
test or the Adams forward bending test.
We basically stand in front of
the patient or the student,
have them bend forward and
see if there's a hump that develops
or that looks symmetrical bilaterally.
If it looks symmetrical bilaterally, even if there
appear to be a 5-10 degree curve beforehand,
we tend to ignore that as
something that people may outgrow
and doesn't require any further treatment.
If you do see a hump develop,
that's the sign that the student or the child
has or is at risk for a worsening
of a scoliosis, of a curvature.
So, let's say it's about a
half of a percent that we know
we're gonna have curvature
related clinical abnormality.
Something that is notable on x-ray,
can be monitored, can be measured.
In girls, it's more likely to progress earlier
because they are going to grow earlier.
And during periods of rapid growth,
the curvature change is gonna be greater.