Adolescent Idiopathic Scoliosis
Adolescent idiopathic scoliosis (AIS) is a lateral (sideways) curvature of the spine that occurs in adolescents from 10 to 18 years of age. The spine may curve to the left or to the right. Sometimes, AIS may begin to appear during puberty or adolescent growth spurts. Idiopathic scoliosis is an abnormal curvature of the spine of unknown origin. Three to five percent of adolescents have some degree of scoliosis. Most of them are girls, and the curvature may be progressive.
Idiopathic scoliosis symptoms in adolescents?
Symptoms of adolescent idiopathic scoliosis include unequal shoulder heights on both sides, leg length discrepancies, abnormal gait, and uneven waist and hip patterns. The scapula and thorax “bulge” when the patient bends forward and the spine is clearly curved to one side.
How is adolescent idiopathic scoliosis diagnosed?
A spine surgeon will usually take a history, perform a physical and neurological examination and perform imaging to diagnose the spinal disorder in order to differentiate it from other conditions. Taking a history may include whether other family members have scoliosis, the patient’s age, the onset of puberty, and the age of menarche will help us determine how many years the adolescent has until skeletal maturity. At skeletal maturity, the curvature may stop progressing as long as the curvature is less than 40 to 45 degrees. If the curvature is greater than 40-45 degrees, the curvature may continue to develop throughout adulthood.
What is the purpose of an x-ray?
To get a preliminary idea of the type of scoliosis, whether idiopathic, congenital or other; to measure the size of the scoliosis, currently the common measurement is Cobb’s angle, the larger the angle, the heavier the scoliosis; to assess the balance and flexibility of the scoliosis; and to provide an objective basis for comparison at follow-up.
What imaging tests should be done for scoliosis?
A formal x-ray is a full spine view of the patient in the standing position, including frontal and lateral views, and left and right scoliosis views in the coronal position of the spine. If necessary, CT or MR exams are also required for differential diagnosis and to help understand the vertebral structures and intracanal conditions.
What is Cobb’s angle?
The severity of scoliosis is often assessed by measuring the lateral bending angle on radiographs, most often using the Cobb’s angle method. The radiograph used for this measurement is an orthogonal image of the standard full length of the spine. The method is shown in the figure to the right.
What are the risks associated with scoliosis?
Because scoliosis occurs mostly in the thoracolumbar region, it affects the heart and lungs: pulmonary dysfunction may occur when the Cobb’s angle exceeds 60°; most scoliosis above 90° has restrictive ventilatory impairment due to severe chest deformity, and cardiac dysfunction may occur as scoliosis worsens; some scoliosis patients have significant trunk deviation and shoulder inequality, which seriously In general, idiopathic scoliosis is very unlikely to cause paralysis, but only when its Cobb’s angle exceeds 100°.
How is adolescent idiopathic scoliosis treated?
There are three main approaches to the treatment of scoliosis: regular follow-up: those with a Cobb’s angle of 20° or less at the time of initial diagnosis usually do not require special treatment and are followed up every 3 or 6 months depending on their age, with continued observation if the angle does not increase significantly. Brace treatment: If the Cobb’s angle is 20°~35° at the time of initial diagnosis, or if it increases more than 5° within one year of follow-up, brace treatment can be considered. Surgical treatment: The indications are mainly for scoliosis greater than 40°. Surgery should also be considered for scoliosis with trunk imbalance or unequal shoulders, sometimes with faster progression with retrognathism or flat back, and a Cobb’s angle of 35° or more.
How does adolescent idiopathic scoliosis develop?
The degree of progression depends on the growth potential and the type of scoliosis. The common rule is that the earlier the onset of scoliosis, the greater the likelihood of progression; the greater the risk of progression before menarche; the lower the Risser’s sign (an indicator of bone maturity) at onset, the greater the likelihood of progression; bicurved scoliosis is more likely to progress than unicurved scoliosis. Scoliosis is more likely to progress than unicurved scoliosis; (e) the greater the degree of scoliosis at the time of detection, the more likely it is to progress;
How do braces treat scoliosis in adolescents?
Bracing is different from bracing in that it corrects scoliosis by applying support in the direction of the scoliosis. Once brace treatment is started, it should be worn 23 hours a day until skeletal maturity, usually 17-18 years for males and 15-16 years for females. If scoliosis is found to worsen during brace treatment, then surgery will need to be considered.
Does adolescent idiopathic scoliosis require immediate surgery?
In most cases, adolescent idiopathic scoliosis is a benign lesion that develops slowly. Patients who are detected early can have their development corrected or controlled with bracing, while most patients who need surgery can be treated with elective surgery, when the child is on summer or winter break, and after about four weeks of post-operative recovery, they can continue their schooling to avoid delaying their studies.
What are the risks of scoliosis surgery?
The risk of surgery is generally related to the angle of scoliosis, and the likelihood of post-operative paralysis is usually almost zero for scoliosis below 90°. The incidence of other complications, such as wound infection, is only 0.1%. Some parents worry too much about the surgery and delay treatment, so that a scoliosis that was originally about 40° develops to 120°, along with cardiopulmonary dysfunction. Seeking medical attention at this time not only increases the difficulty and risk of surgery, but also makes the prognosis worse.
What are the surgical options for adolescent idiopathic scoliosis?
The most common approach to adolescent idiopathic scoliosis is the posterior approach (back). In recent years, pedicle screws have been applied to the thoracic and lumbar spine to achieve correction and restoration of spinal balance. The use of pedicle screws has also allowed for firm spinal fixation, allowing patients to resume various activities up to 3 months after surgery.
Does scoliosis surgery bleed a lot?
The average bleeding during surgery for simple thoracic or lumbar curvatures is about 200-400 ml, and most do not require blood transfusion. Blood transfusion can also be avoided by taking blood from your own body before surgery and collecting blood back from your own body during surgery.
Does adolescent scoliosis recover quickly after surgery?
Patients with adolescent scoliosis can be on the floor 3 to 4 days after surgery and are discharged from the hospital within 1 to 2 weeks. With current medical technology, most patients can do exercises such as swimming 4-6 weeks after surgery, jogging in 3 months, and non-contact confrontational sports activities in about a year.