Spinal Fusion for the Treatment of Idiopathic Scoliosis in Children: Orthopedic Surgery to Treat Curvature of the Back in Children and Teenagers
Edited By: Kit M. Song, M.D.
Last updated Thursday, October 20, 2005
Review of the conditionCharacteristics of idiopathic scoliosis Scoliosis usually appears as a bump on the chest or muscle adjacent to
the spine. This bump is caused by the rotation of the spine as the
curve increases. Internal organs are, in general, not damaged by
worsening scoliosis. However, sometimes curves located in the chest can
affect the lungs and cause difficulty in breathing. This happens when
a curve in the chest or upper spine area becomes extremely large. The
effects of this curvature are generally seen in the mid to late adult
years. There has been some concern that large spinal deformities in the
lower portion of the spine (“lumbar”) may lead to degenerative changes
of the lower back over a period of 40 to 50 years.Types Idiopathic scoliosis means that the scoliosis does not have a definite
cause. Children with idiopathic scoliosis are otherwise normal. The
only subtypes of this condition are related to age.
This condition is classified as either “early onset” or “late onset”
scoliosis. Early onset is recognized in children under 8 years
old while late onset starts after the age of 8. Children who develop
large curves at a young age may experience adverse lung development and
growth that can lead to an early death due to breathing difficulties. Similar conditions Other types of scoliosis are congenital and neuromuscular
scoliosis.
In congenital scoliosis, patients have malformed bones that
grow crookedly over time. Children are born with this condition and the cause
is unknown. The management of these patients is very different from those with
idiopathic scoliosis. Surgery is
generally needed to correct or control these deformities.
Children with neuromuscular scoliosis will have associated,
underlying abnormalities, such as cerebral palsy, muscular dystrophy, or many
other neurologic or genetic syndromes that may affect the scoliosis. It is important when evaluating children to exclude
other associated conditions by a careful medical and developmental history and
physical examination. Incidence and risk factors Idiopathic scoliosis affects approximately 2 to 3 percent of
all children under the age of 16. It is
estimated that about 1 in 1,000 people will experience significant progression
of their scoliosis. The frequency of small curves in girls and boys is
equal. For curves that are progressive,
however, statistically girls out number boys 7 to 1.Diagnosis Idiopathic scoliosis can be diagnosed through a careful
physical examination by a physician. This examination involves the patient
bending forward while he or she is standing in front of the physician and
leaning either toward or away from the physician. A key sign of this condition
is asymmetry of the ribs or surrounding muscles due to rotation of the
spine. This presents as a bump along the
spine and can be easily recognized when the child bends forward. X-rays of the spine can confirm whether or
not scoliosis is present.
Medications No. Medication has not been shown to affect the
progression of scoliosis.Exercises To date no exercise regimen or program has been shown to
affect the likelihood of curve progression for scoliosis. Muscle strengthening
or generalized conditioning may help mechanical back pain problems.
However, some patients, particularly younger patients, with
curves that are not severe can be treated with a brace. There is some
controversy about this, but there are some studies that have shown this to be
effective when used in the appropriate patients. Non-operative intervention,
such as massage, physical therapy, chiropractic manipulations, exercise
programs, and electric stimulation do not adversely affect the spine, but have
not been shown to stop or prevent the progression of scoliosis. Possible benefits of idiopathic scoliosis Spinal fusion has been shown to be very effective in
correcting the deformity and preventing further progression of scoliosis.
Spinal fusion is generally recommended if other non-operative methods of
controlling scoliosis have failed.Surgery for Idiopathic Scoliosis at the University of Washington If you are interested in making an appointment to discuss this procedure, you can request an appointment using our online referrals website. To request a referral online, please click here. You can also call 206-598-4288 (outside the Seattle area: 800-440-3280) to make an appointment.
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