Scoliosis, as many of you know, means lateral curvature of the spine. It is a structural alteration that can progress as the person grows, leading to significant deformity. Adolescent idiopathic scoliosis (AIS) is typically defined as curvature greater than 10 degrees. Curvatures that are less than 10 degrees have no long term clinical significance.
The 3 subcategories include:
- Infantile (0-3 years)
- Juvenile (4-9 years)
- Adolescent (>10 years)
So how common is AIS?
The prevalence of AIS is approximately 3% and only 10% of those adolescents require treatment. Males and females are affected equally. However, the risk for curve progression is 10 times higher in females than males. The degree of curvature is measured by Cobb angle. When considering prevalence, think about this:
So if a family member or friend has scoliosis, first appreciate their strength and uniqueness, and then ask about their angle if they wish to share. Knowing that piece, one can greatly appreciate the prevalence of their condition.
It may surprise you, but your primary care doctor can screen for scoliosis, diagnose, order the X-ray, and even start brace treatment if needed. If surgery is indicated, your primary care doctor can coordinate efficiently with an orthopedist. Point is, don't run to an orthopedist the minute you hear about scoliosis. This diagnosis, like any other diagnosis, requires a conversation.
What does having scoliosis mean? Do I have to have surgery? What are the post surgical challenges I may encounter as I am recovering? Even after treatment, what should I worry about? What about pregnancy? What about sports or even contact sports? Is this genetically linked that I need to have my kids screened? What about working out - any precautions I should take?
So, what does all this mean in adulthood?
Regardless of getting treatment or not, there definitely are clinically significant concerns one may face as they enter adulthood. Even when the spine is corrected to midline with surgery, individuals must be cautious when weight training, aerobic activity, and may have chronic back pain. The muscles that support the spine have to adjust and may be prone to strain. Rotation is largely limited in the surgically treated spine, so one may not be able to participate in some activities.
Mental health studies have yielded conflicting results based on surveys. My opinion is that this only reminds us that diagnoses are perceived differently by each one of us. I argue that your perception of your diagnosis, whatever it may be, is facilitated by your team of doctors. As physicians, we have a duty to treat illness, but also to be a coach, a friend, and most importantly a partner in any journey that requires chronic management. Positive thinking and supportive behavior has shown study after study to improve outcomes - that is the job of the physician. Be a true advocate and partner.
After surgical correction, pulmonary function improves, but skeletal alignment may still have long lasting joint pains.
In those patients where surgical correction is not done, the curvature can progress and cause more pain with pulmonary issues. As our bones get weaker with age, the spine may slump even more leading to alteration of your gait.
Surgical correction at times requires repeat operations, scar healing, and hospitalizations can be prolonged. Thus, the sooner we can screen and treat, the better outcomes we get. Self-image might be an issue in adolescents. Wearing a brace or having visible scars after surgery may leave keloids that challenge an adolescents self image.
Scoliosis is a condition that must be identified early, have a management plan, and must be included in long term management. This is not, like any other diagnosis, something that is "repaired" and forgotten.
Build a relationship with your primary care physician to be at your side as you enjoy the many blessings life has given you. Nothing is impossible. We just have to make some adjustments with the challenges that are thrown our way.
Please help me raise awareness about scoliosis and I hope I taught you something new about this condition that you may not have known before.
To your health and our community,
"He who studies medicine without books sails an uncharted sea, but he who studies medicine without patients does not go to sea at all."