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Conditions

Adolescent Idiopathic Scoliosis

Adolescent idiopathic scoliosis (AIS) is an abnormal curvature of the spine to the left or right. Scoliosis changes the shape of the spine and its appearance from the front, back, and side. The illustration below depicts scoliosis from a posterior (back) view.

AIS effects 1% to 3% of adolescent children aged 10 to 16 years.1 It may start at puberty or during a growth spurt. Idiopathic means the cause of scoliosis is not known. Research shows there is a genetic predisposition for some adolescents to develop AIS.2 Girls are more likely than boys to develop AIS. It is a progressive disorder—meaning the abnormal curvature increases in size with time, unless treated.

How do I know

Sometimes you don't. Sometimes adolescent idiopathic scoliosis is suspected by a teacher at school, found during a routine physical examination, or you may begin to notice some physical changes in your child's appearance.

Signs and symptoms related to AIS include:

  • Leg-length difference
  • Abnormal gait
  • One shoulder higher than the other
  • A prominent shoulder blade or rib when bending forward
  • Visible spinal curve
  • Uneven hips
  • Hemlines or trouser lengths uneven
  • Clothing does not fit correctly
  • Back pain

AIS and deformity

AIS is a progressive type of scoliosis and, left untreated, it can cause significant deformity. Spinal deformity can cause your child to look and feel different from his or her peers; this can cause psychological distress. Physically, the consequences of deformity can be serious.

AIS can cause the vertebral bodies to rotate (turn), which affects the rib cage and can cause shortness of breath (heart, lung problems). In an attempt to balance itself, the spine may develop a compensating curve above or below the AIS curve.

Accurate diagnosis

The spine specialist's examination includes your child's medical history, physical and neurological examination, and imaging studies.

Medical history reviews your child's past and present medical history and delves into some family history; for example, does anyone in the family have (had) scoliosis?

Physical examination provides the doctor with a general health and spinal assessment baseline to help estimate the possibility for the curve to progress.

  • Heart and lung function
  • Uneven shoulders, hips, leg length, humpback, listing to one side
  • Heart and lung function
  • Palpation: feel the spine through the skin on the back
  • Range of Motion: flexion, extension, bending, rotating
  • Adam's Forward Bending test: bending forward at the waist with the arms extended forward; the doctor checks for shoulder blade, rib, or other prominence
  • Scoliometer measures rib prominence
  • Plumb Line: a plumb line is suspended from the neck (C7) and allowed to hang. Scoliosis may be found when the plumb line does not hang between the patient's buttocks

Neurologic examination is an assessment of the patient's reflexes and tests for muscle weakness, loss of feeling, and signs of neurological injury.

Imaging studies often include x-rays taken while standing (front, back and side) and bending. Special measurement techniques are used to calculate the curve angle(s), degree of vertebral rotation, type of scoliosis, and patient's skeletal maturity.

Non-operative treatment

Some cases of adolescent idiopathic scoliosis do not require spine surgery and are treated by observing the curve for progression or bracing.

Observation: Small curves—less than 15 to 20 degrees—are observed for possible progression over a period of time. During this time, no treatment is necessary. Larger curves—between 20 to 40 degrees—require bracing to prevent curve progression.

Spinal bracing: Your doctor may prescribe a special brace for your child to wear 16 to 23 hours every day. Wearing a brace is a big commitment and some (probably most) find it difficult. Bracing can be uncomfortable, unattractive, hot, and make a youngster self-conscious, even when the brace is well-disguised beneath clothing. When brace treatment is successful, surgery is avoided and the difficult commitment is made worthwhile.

Scoliosis surgery

Unfortunately, not every scoliosis is best treated by bracing. Sometimes spine surgery is recommended to treat scoliosis. The goal of spine surgery is to stop the curve from progressing, manage deformity, and stabilize the spine. This involves spinal instrumentation and fusion. Your child may be a candidate for a minimally invasive spine surgery. There are different ways the surgery can be performed, and your surgeon explains the possible benefits and risks associated with his surgical recommendations.

Suspecting or learning your child has adolescent idiopathic scoliosis is troubling. We hope this information about AIS has answered some of your immediate questions. Remember, your doctor is your most valuable source to answer your questions about symptoms and your child's spine health.

References:

  1. Weinstein SL, Dolan LA, Cheng JC, Danielsson A, Morcuende JA. Adolescent idiopathic scoliosis. Lancet. 2008 May 3;371(9623):1527-37. Abstract available at www.ncbi.nlm.nih.gov/pubmed/18456103
  2. Ward K, Ogilvie J. Argule V, Nelson L, Meade M, et al. Polygenic inheritance of adolescent idiopathic scoliosis: a study of extended families in Utah. Am J Med Genet A. 2010 May;152A(5):1178-88. Abstract available at www.ncbi.nlm.nih.gov/pubmed/20425822
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Neurosurgeon, is Board Certified
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