Scoliosis Research Paper
Scoliosis, what is it? Not many people know exactly what it is. This disease has been around for a long time. Scoliosis is something this student thinks more people should know about and get checked frequently for too. This writer is diagnosed with scoliosis and doing this paper has helped her learn more about her own condition. The main focus of this paper is to help inform and educate people in society about scoliosis. Because of a tough schedule, this author had to rely on the Internet for all of her research. There is a months worth of research put into this paper. All together nine hours were spent at home researching on the Internet. Ten lunch hours were spent on the Internet at work. This student conducted eleven surveys
…show more content…
over the Internet. Everyone’s spine has natural curves, but there are people who have spines that curve from side to side. This side-to-side curve is known as scoliosis. The meaning of scoliosis is a lateral curvature of the spine. Scoliosis affects the entire skeletal system including the spine, ribs, and pelvis. It impacts upon the brain and central nervous system and affects the body’s hormonal and digestive systems. It can deplete the body’s nutritional resources and damage its major organs including the heart and lungs. Cerebral palsy, muscular dystrophy, birth defects, and Marfan syndrome are just some things that can cause scoliosis. Scoliosis usually develops in the thoracic spine (upper back) or the thoracolumbar
2
area of the spine, which is between the thoracic spine and lumbar spine (lower back).
It may also occur just in the lower back. The curvature of the spine from scoliosis may develop as a single curve (shaped like the letter C) or as two curves (shaped like the letter S). About four percent of the population has scoliosis.
There are four main types of scoliosis. There is congenital scoliosis, juvenile scoliosis, idiopathic scoliosis, and degenerative scoliosis. Congenital scoliosis is a relatively rare form of congenital malformation of the spine. These patients will often develop scoliotic deformities in their infancy. Juvenile scoliosis is another uncommon form is the development of scoliosis in childhood. Idiopathic scoliosis (also referred to as adolescent scoliosis) is by far the most common form of scoliosis, which develops in adolescents and progresses mostly during the adolescent growth spurt. Degenerative scoliosis can also develop later in life, as joints in the spine degenerate and create a bend in the back. This condition is sometimes called adult …show more content…
scoliosis. Scoliosis is discovered by the Adam test, also known as the forward bend test. What the child does during this test is take off their shirt, stands up straight with their feet together. The examiner will check the shoulders, shoulder blades, and hips. Then they must bend forward. In a child with scoliosis, bending forward will reveal an asymmetry of the back or posterior chest wall causing an elevation of one side of the back, or a rib hump. The next step is to have x-rays
3
taken. These x-rays will determine the degree of the curve. It is very important that you keep getting x-rays done to determine if the curve is getting better. The degree helps to figure out what treatment should be used. Children with progressive curves or curves that are above 30 degrees will need to have treatment. The main treatments are bracing and surgical correction, although surgery is usually reserved for children with curves over 45 to 50 degrees, or which don’t respond to bracing. There are five different types of bracing. The types of braces are the Thoracolumbo sacral orthosis, the Charleston bending brace, the Milwaukee brace, the Boston Brace, and the Copes Brace. The Thoracolumbo sacral orthosis brace is custom molded, fits beneath clothing, and is worn for most of the day and night. The Charleston bending brace is usually used for single lumbar curves and is worn at night. The Milwaukee brace extends up to the neck and isn’t used very much anymore. The Copes brace is custom-cast, custom-fitted, and custom-fabricated to the exact body dimensions of each patient. It is designed to fit skin tight to the patient. Bracing doesn’t always help. The other option is to have surgery. Posterior spinal fusion is the most common surgical procedure that is used. Rods are permanently placed in your back, they don’t cause any problems. There are some things that you should consider before surgery. First remember complication of surgery can include: hooks becoming dislodged, fracture of the
4
rods, skin protrustion of the upper end of the rods, pseudarthrosis (spine did not fuse), and pain where there once was none (neurological problem). Younger patients are susceptible to crankshaft phenomenon (worsening of the rotation and rib deformity). Scoliosis affects the entire skeleton (i.e. rib deformities) and impacts on neurological and hormonal systems. Surgical rods do nothing to address the wide range of bodily structures and systems affected by the disease. Initial average loss of spinal correction post-surgery is 3.2 degrees in the first year and 6.5 after two years with continued loss of 1.0 degrees per year throughout life. Congenital scoliosis is associated with congenital heart disease, genitourinary abnormalities, and defects of the spinal column. Children and adults with congenital scoliosis should be closely followed. Congenital scoliosis is usually only discovered on a MRI, but sometimes they can be seen on an x-ray. Bracing is the only non-operative treatment. Bracing has a limited value when it comes to congenital scoliosis. Exercises, biofeedback, chiropractic, acupuncture, and electrical stimulations are other types of non-operative treatment, but they don’t work. Brace treatment is designed only to delay surgery until a more optimal age, usually the onset of the pubertal growth spurt. Braces for congenital scoliosis are not intended to prevent surgery as they are in idiopathic scoliosis.
5
Majority of the type patients with congenital scoliosis will need to have surgery done. Surgeons must stop the imbalance growth with a spine fusion. There are four major operations for congenital scoliosis: posterior spine fusion, combined anterior and posterior fusion, growth-arrest surgery (epiphysiodesis), and hemivertebrae excision. Each have their place and it is the responsibility of the surgeon to select that operation which is best for the individual child based on the curve pattern, the anomalies present, the rate of progression and the age. In congenital scoliosis it is very important that you do not delay surgery until the end of growth because by then the damage will have been done. Degenerative scoliosis comes about as the result of degeneration in the disc space and paired facet joints posteriorly (in the back of the spine). As the joints degenerate they turn and create a bend in the back, resulting in the classic scoliotic curve. Degenerative scoliosis can cause back pain to someone who has it. There are conservative care treatment options for a patient with degenerative scoliosis. These treatment options are medications, epidural injections or facet injections, physical therapy, pool therapy (water therapy), chiropractic or osteopathic manipulation, weight loss, and bracing. Medications that you can take are NSAID’s (such as ibuprofen, Vioxx or Celebrex) can help reduce inflammation. Acetaminphen (e.g. Tylenol) is also an excellent pain reliever.
6
Epidural injections or facet injections and injections, in which an anti- inflammatory medication and/or numbing agent is injected directly into the affected area, can be used to decrease acute inflammation in the back. Physical therapy helps because it is important to keep the soft tissues and joints limber, and a physical therapy program can provide an appropriate stretching routine. Pool therapy is great because in water there is no gravity creating stress across the facet joints, so stretching and exercising will create less discomfort but still provide conditioning for the patient. Chiropractic or osteopathic manipulation adjustments and manipulation can keep the facet joints mobile and help reduce pain. Weight Loss helps decrease stress across the facet joints. Bracing may be required to help eliminate motion in the back to decrease stress across the facet joints. Using one or more of these treatments can help decrease the back pain.
Surgery of course is your other option when it comes to degenerative scoliosis. The main goal in surgery is not to prevent deformity as much as it is to treat the pain. Adults with degenerative scoliosis are more as risk when it comes to surgery. Some of these risks include excessive blood loss, the rods breaking or the hooks dislodging (especially if the patient is osteoporotic), infection, cerebrospinal fluid leak, failure of the spine to fuse, continued postoperative pain, and neurological injury. It usually takes about three to twelve months to improve. It is very important that you consider all your options before deciding
7
on surgery. Idiopathic scoliosis is a multifaceted disease. It compromises five of the body’s systems. The five systems are digestive, muscular, hormonal, neurological, and bones. Idiopathic scoliosis is the most common of them all. It usually begins on adolescents between the ages of 10 and 14. There is no known cause of this type of scoliosis, although it tends to occur in families. Significant curvature of the spine is much more prevalent in girls than in boys. It is important that you know idiopathic scoliosis results in spinal deformity. The degree of curvature and the skeletal maturity of the patient is what helps decide what type of treatment will be needed. When is comes to idiopathic scoliosis there is three treatment options. Those options are observation, bracing, and surgery. Observation is only used if the degrees of the curve if less than 20. Anything more than 20 degrees should be checked by an orthopedic surgeon for treatment. Then comes the use of bracing, it is mainly to stop any type of progression of the spinal curve. It will never reduce your degree. The types of braces used for idiopathic scoliosis are the thoracolumbar sacral orthosis and the Charleston bending brace.
Surgery for idiopathic scoliosis is only recommended for patients with curves that are greater that 40 degrees and continuing to progress, or most curves greater than 50 degrees. The main objective is to fuse the spine so that the curve
8
will not continue to progress into adulthood. Surgery also ca reduce the amount of deformity. Most of the time fifty percent correction is obtained with surgery. The posterior surgical approach is done through a long incision on the back of the spine (it goes the entire length of the thoracic spine). The muscles are then stripped off the spine to allow the surgeon access to the bony elements. The spine is then instrumented and the rods are used to reduce the deformity. Bone is than added (either the patients own bone or cadaver bone), which in turn incites a reaction that results in the spine fusing together. This fusion process usually takes about 3 to 6 months, and up to 12 months. Anterior surgical approach are for curves that are mainly at the thoracolumbar junction (T12-L1), the surgery can be done entirely as an anterior approach. This requires an open incision and the removal of a rib (usually on the left side0. Through this approach the diaphragm can be released from the chest wall and spine, and excellent exposure can be obtained for the thoracic and lumbar spinal vertebral bodies. The discs are removed and this loosens up the spine. Screw can then be placed in the vertebral bodies and a reduction of the curvature obtained and held with a rod. Surgery risks are infection, cerebrospinal fluid leak, continued progression of the curve, rods breaking or hooks or screws dislodging, and failure of the spine to fuse. Generally the patient will be monitored with intermittent examinations and x-rays for 1 to 2 years. Once the bone is solidly fused no further treatment is required.
9
Out of all the interviews conducted 54% were diagnosed with scoliosis between the ages of 11 and 14.
When it comes to the type of treatment they receive 72% have had surgery. Of the interviewees who have had surgery 75% say that their surgery has helped them. Only 36% say that family, friends, or strangers treated them differently. This interviewer asked everyone this question, what advise would you give to someone who has just been diagnosed with scoliosis? Out of 11 interviews only one had very good advice. She said, “Find a reputable orthopedic surgeon. Listen to the range of options available to you, and then get a second (or even a third) opinion. For younger patients, bracing is often a difficult situation to overcome. But scoliosis does not go away. The best case scenario is that it does not get any worse-and it is not a good idea to ignore your condition and hope that your case is a lucky one. Finally, a scoliosis diagnosis is not the end of the world. It’s relatively common, and we are blessed with good treatment
options.”
This author has learned a lot more about her own condition. She has learned that there are so many more people in the world who has scoliosis. Also, that there is more then just one type of scoliosis. Surgery is not always the best option. This student hopes that you have learned as much from her paper as she has.
over the Internet. Everyone’s spine has natural curves, but there are people who have spines that curve from side to side. This side-to-side curve is known as scoliosis. The meaning of scoliosis is a lateral curvature of the spine. Scoliosis affects the entire skeletal system including the spine, ribs, and pelvis. It impacts upon the brain and central nervous system and affects the body’s hormonal and digestive systems. It can deplete the body’s nutritional resources and damage its major organs including the heart and lungs. Cerebral palsy, muscular dystrophy, birth defects, and Marfan syndrome are just some things that can cause scoliosis. Scoliosis usually develops in the thoracic spine (upper back) or the thoracolumbar
2
area of the spine, which is between the thoracic spine and lumbar spine (lower back).
It may also occur just in the lower back. The curvature of the spine from scoliosis may develop as a single curve (shaped like the letter C) or as two curves (shaped like the letter S). About four percent of the population has scoliosis.
There are four main types of scoliosis. There is congenital scoliosis, juvenile scoliosis, idiopathic scoliosis, and degenerative scoliosis. Congenital scoliosis is a relatively rare form of congenital malformation of the spine. These patients will often develop scoliotic deformities in their infancy. Juvenile scoliosis is another uncommon form is the development of scoliosis in childhood. Idiopathic scoliosis (also referred to as adolescent scoliosis) is by far the most common form of scoliosis, which develops in adolescents and progresses mostly during the adolescent growth spurt. Degenerative scoliosis can also develop later in life, as joints in the spine degenerate and create a bend in the back. This condition is sometimes called adult …show more content…
scoliosis. Scoliosis is discovered by the Adam test, also known as the forward bend test. What the child does during this test is take off their shirt, stands up straight with their feet together. The examiner will check the shoulders, shoulder blades, and hips. Then they must bend forward. In a child with scoliosis, bending forward will reveal an asymmetry of the back or posterior chest wall causing an elevation of one side of the back, or a rib hump. The next step is to have x-rays
3
taken. These x-rays will determine the degree of the curve. It is very important that you keep getting x-rays done to determine if the curve is getting better. The degree helps to figure out what treatment should be used. Children with progressive curves or curves that are above 30 degrees will need to have treatment. The main treatments are bracing and surgical correction, although surgery is usually reserved for children with curves over 45 to 50 degrees, or which don’t respond to bracing. There are five different types of bracing. The types of braces are the Thoracolumbo sacral orthosis, the Charleston bending brace, the Milwaukee brace, the Boston Brace, and the Copes Brace. The Thoracolumbo sacral orthosis brace is custom molded, fits beneath clothing, and is worn for most of the day and night. The Charleston bending brace is usually used for single lumbar curves and is worn at night. The Milwaukee brace extends up to the neck and isn’t used very much anymore. The Copes brace is custom-cast, custom-fitted, and custom-fabricated to the exact body dimensions of each patient. It is designed to fit skin tight to the patient. Bracing doesn’t always help. The other option is to have surgery. Posterior spinal fusion is the most common surgical procedure that is used. Rods are permanently placed in your back, they don’t cause any problems. There are some things that you should consider before surgery. First remember complication of surgery can include: hooks becoming dislodged, fracture of the
4
rods, skin protrustion of the upper end of the rods, pseudarthrosis (spine did not fuse), and pain where there once was none (neurological problem). Younger patients are susceptible to crankshaft phenomenon (worsening of the rotation and rib deformity). Scoliosis affects the entire skeleton (i.e. rib deformities) and impacts on neurological and hormonal systems. Surgical rods do nothing to address the wide range of bodily structures and systems affected by the disease. Initial average loss of spinal correction post-surgery is 3.2 degrees in the first year and 6.5 after two years with continued loss of 1.0 degrees per year throughout life. Congenital scoliosis is associated with congenital heart disease, genitourinary abnormalities, and defects of the spinal column. Children and adults with congenital scoliosis should be closely followed. Congenital scoliosis is usually only discovered on a MRI, but sometimes they can be seen on an x-ray. Bracing is the only non-operative treatment. Bracing has a limited value when it comes to congenital scoliosis. Exercises, biofeedback, chiropractic, acupuncture, and electrical stimulations are other types of non-operative treatment, but they don’t work. Brace treatment is designed only to delay surgery until a more optimal age, usually the onset of the pubertal growth spurt. Braces for congenital scoliosis are not intended to prevent surgery as they are in idiopathic scoliosis.
5
Majority of the type patients with congenital scoliosis will need to have surgery done. Surgeons must stop the imbalance growth with a spine fusion. There are four major operations for congenital scoliosis: posterior spine fusion, combined anterior and posterior fusion, growth-arrest surgery (epiphysiodesis), and hemivertebrae excision. Each have their place and it is the responsibility of the surgeon to select that operation which is best for the individual child based on the curve pattern, the anomalies present, the rate of progression and the age. In congenital scoliosis it is very important that you do not delay surgery until the end of growth because by then the damage will have been done. Degenerative scoliosis comes about as the result of degeneration in the disc space and paired facet joints posteriorly (in the back of the spine). As the joints degenerate they turn and create a bend in the back, resulting in the classic scoliotic curve. Degenerative scoliosis can cause back pain to someone who has it. There are conservative care treatment options for a patient with degenerative scoliosis. These treatment options are medications, epidural injections or facet injections, physical therapy, pool therapy (water therapy), chiropractic or osteopathic manipulation, weight loss, and bracing. Medications that you can take are NSAID’s (such as ibuprofen, Vioxx or Celebrex) can help reduce inflammation. Acetaminphen (e.g. Tylenol) is also an excellent pain reliever.
6
Epidural injections or facet injections and injections, in which an anti- inflammatory medication and/or numbing agent is injected directly into the affected area, can be used to decrease acute inflammation in the back. Physical therapy helps because it is important to keep the soft tissues and joints limber, and a physical therapy program can provide an appropriate stretching routine. Pool therapy is great because in water there is no gravity creating stress across the facet joints, so stretching and exercising will create less discomfort but still provide conditioning for the patient. Chiropractic or osteopathic manipulation adjustments and manipulation can keep the facet joints mobile and help reduce pain. Weight Loss helps decrease stress across the facet joints. Bracing may be required to help eliminate motion in the back to decrease stress across the facet joints. Using one or more of these treatments can help decrease the back pain.
Surgery of course is your other option when it comes to degenerative scoliosis. The main goal in surgery is not to prevent deformity as much as it is to treat the pain. Adults with degenerative scoliosis are more as risk when it comes to surgery. Some of these risks include excessive blood loss, the rods breaking or the hooks dislodging (especially if the patient is osteoporotic), infection, cerebrospinal fluid leak, failure of the spine to fuse, continued postoperative pain, and neurological injury. It usually takes about three to twelve months to improve. It is very important that you consider all your options before deciding
7
on surgery. Idiopathic scoliosis is a multifaceted disease. It compromises five of the body’s systems. The five systems are digestive, muscular, hormonal, neurological, and bones. Idiopathic scoliosis is the most common of them all. It usually begins on adolescents between the ages of 10 and 14. There is no known cause of this type of scoliosis, although it tends to occur in families. Significant curvature of the spine is much more prevalent in girls than in boys. It is important that you know idiopathic scoliosis results in spinal deformity. The degree of curvature and the skeletal maturity of the patient is what helps decide what type of treatment will be needed. When is comes to idiopathic scoliosis there is three treatment options. Those options are observation, bracing, and surgery. Observation is only used if the degrees of the curve if less than 20. Anything more than 20 degrees should be checked by an orthopedic surgeon for treatment. Then comes the use of bracing, it is mainly to stop any type of progression of the spinal curve. It will never reduce your degree. The types of braces used for idiopathic scoliosis are the thoracolumbar sacral orthosis and the Charleston bending brace.
Surgery for idiopathic scoliosis is only recommended for patients with curves that are greater that 40 degrees and continuing to progress, or most curves greater than 50 degrees. The main objective is to fuse the spine so that the curve
8
will not continue to progress into adulthood. Surgery also ca reduce the amount of deformity. Most of the time fifty percent correction is obtained with surgery. The posterior surgical approach is done through a long incision on the back of the spine (it goes the entire length of the thoracic spine). The muscles are then stripped off the spine to allow the surgeon access to the bony elements. The spine is then instrumented and the rods are used to reduce the deformity. Bone is than added (either the patients own bone or cadaver bone), which in turn incites a reaction that results in the spine fusing together. This fusion process usually takes about 3 to 6 months, and up to 12 months. Anterior surgical approach are for curves that are mainly at the thoracolumbar junction (T12-L1), the surgery can be done entirely as an anterior approach. This requires an open incision and the removal of a rib (usually on the left side0. Through this approach the diaphragm can be released from the chest wall and spine, and excellent exposure can be obtained for the thoracic and lumbar spinal vertebral bodies. The discs are removed and this loosens up the spine. Screw can then be placed in the vertebral bodies and a reduction of the curvature obtained and held with a rod. Surgery risks are infection, cerebrospinal fluid leak, continued progression of the curve, rods breaking or hooks or screws dislodging, and failure of the spine to fuse. Generally the patient will be monitored with intermittent examinations and x-rays for 1 to 2 years. Once the bone is solidly fused no further treatment is required.
9
Out of all the interviews conducted 54% were diagnosed with scoliosis between the ages of 11 and 14.
When it comes to the type of treatment they receive 72% have had surgery. Of the interviewees who have had surgery 75% say that their surgery has helped them. Only 36% say that family, friends, or strangers treated them differently. This interviewer asked everyone this question, what advise would you give to someone who has just been diagnosed with scoliosis? Out of 11 interviews only one had very good advice. She said, “Find a reputable orthopedic surgeon. Listen to the range of options available to you, and then get a second (or even a third) opinion. For younger patients, bracing is often a difficult situation to overcome. But scoliosis does not go away. The best case scenario is that it does not get any worse-and it is not a good idea to ignore your condition and hope that your case is a lucky one. Finally, a scoliosis diagnosis is not the end of the world. It’s relatively common, and we are blessed with good treatment
options.”
This author has learned a lot more about her own condition. She has learned that there are so many more people in the world who has scoliosis. Also, that there is more then just one type of scoliosis. Surgery is not always the best option. This student hopes that you have learned as much from her paper as she has.