Most cases of sco­l­io­sis have no root cause

The Tribune (SLO) - - Sports & Weather - BY EVE GLAZIER, M.D., and EL­IZ­A­BETH KO, M.D.

Dear Doc­tor: Can you please ex­plain sco­l­io­sis? My 11-year-old daugh­ter was re­cently di­ag­nosed with it, and though it’s mild, we’re very worried. Why did she get it? Will she need surgery?

Dear Reader: Sco­l­io­sis is a con­di­tion in which the spine grad­u­ally takes on a lat­eral curve in the shape of either an S or a C. It can oc­cur at any age, but sco­l­io­sis is most com­mon in young peo­ple be­tween the ages of 10 to 14. It’s es­ti­mated that be­tween 2 and 4 per­cent of youths will de­velop sco­l­io­sis dur­ing the growth spurt that ac­com­pa­nies the on­set of ado­les­cence. And while the con­di­tion is equally com­mon in boys and girls, girls are 10 times more likely than boys to de­velop more se­vere spinal cur­va­ture.

Most cases of sco­l­io­sis are mild and re­quire only on­go­ing mon­i­tor­ing of the ex­ist­ing cur­va­ture, mak­ing sure it doesn’t es­ca­late. In more se­vere cases, treat­ment with a brace or surgery is of­ten re­quired.

When some­one has or is de­vel­op­ing sco­l­io­sis, it be­comes vis­i­ble in their pos­ture. Signs of the con­di­tion in­clude un­even shoul­ders, vis­i­ble dif­fer­ences in arm length, a shoul­der blade that be­comes more prom­i­nent than its part­ner, a tilted waist­line, or un­even hips. In se­ri­ous cases, the curv­ing spine may cause the torso to ro­tate or twist. Since this af­fects pos­ture, the con­di­tion can re­sult in the rib cage press­ing against the lungs and heart, which can in­ter­fere with breath­ing and car­diac ac­tiv­ity. For adults who had sco­l­io­sis as chil­dren, chronic back pain can be­come a prob­lem later in life.

The con­di­tion de­vel­ops grad­u­ally and with­out pain, so it can be dif­fi­cult to iden­tify. Di­ag­no­sis typ­i­cally be­gins with a neu­ro­log­i­cal exam to as­sess strength and re­flexes, and to check for numb­ness that oc­curs due to pinched nerves. This is fol­lowed by imag­ing tests to visu­al­ize the spinal struc­ture.

The type of treat­ment de­pends on mul­ti­ple fac­tors, in­clud­ing the age and sex of the pa­tient, and the lo­ca­tion and pat­tern of the curve. For chil­dren with amild curve and who are still grow­ing, like your daugh­ter, “watch­ful wait­ing” may be the most ap­pro­pri­ate ap­proach. In some cases, to pre­vent the con­di­tion from wors­en­ing, they may be fit­ted with a cus­tom-made brace. In se­vere cases, when the spinal cur­va­ture is pro­gress­ing rapidly or is caus­ing pain or dys­func­tion, surgery may be re­quired.

As for what causes sco­l­io­sis, the an­swer re­mains un­clear. It has been as­so­ci­ated with neu­ro­mus­cu­lar con­di­tions like mus­cu­lar dys­tro­phy and cere­bral palsy, can be a birth de­fect, and may oc­cur as a re­sult of spinal in­jury or in­fec­tion. But the ma­jor­ity of cases are con­sid­ered id­io­pathic, which means the root cause is un­known.

Eve Glazier, M.D., MBA, is an in­ternist and as­so­ciate pro­fes­sor of medicine at UCLA Health. El­iz­a­beth Ko, M.D., is an in­ternist and as­sis­tant pro­fes­sor of medicine at UCLA Health. Send your ques­tions to ask­the­do­c­[email protected]­, or write: Ask the Doc­tors, c/o Me­dia Re­la­tions, UCLA Health, 924 West­wood Blvd., Suite 350, Los An­ge­les, CA, 90095. Ow­ing to the vol­ume of mail, per­sonal replies can­not be pro­vided.

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