A side curvature of the spine that occurs at birth and is associated with an abnormal architecture.
The exact cause of scoliosis is unknown but given that the condition runs in families, the cause is most likely genetic.
- Combination of Bars and Hemivertebra
In some cases, a spine may develop with an un-segmented bar on one side and a hemivertebra on the other resulting in an increased curvature of the spine.
- Compensatory Curves
A spine with a scoliosis curve will sometimes develop other curves in the opposite direction above or below the affected area to compensate for and balance out the scoliosis curve.
- Failure of Separation of the Vertebrae
During development, the spine initially forms as a single tissue which later divides into segments that develop into the vertebrae. If the segments fail to separate it results in partial or complete fusion of two or more vertebrae. The un-segmented bar prevents the spine from growing straight and results in a spinal curve.
A section of a vertebra fails to develop typically resulting in a wedge shape. The wedge shaped hemivertebra creates a sharp angle in the spine which causes the spine to curve as the child grows.
- Neuromuscular Issues
Disorders that affect the nerves and muscles (ex: cerebral palsy, muscular dystrophy, spina bifida, etc.) and cause muscle weakness, poor muscle control, or paralysis can result in or occur in association with scoliosis.
The first step in checking for scoliosis is taking a family history to see if other family members have had scoliosis. Next, questions are asked to determine if the scoliosis causes pain, numbness, or tingling. Finally, the child is observed and physically examined. As a part of the exam, children may be made to perform the Adam’s forward bend test where they are asked to stand and bend forward while the doctor observes the evenness / unevenness of the shoulders, shoulder blades, and rib cage. An MRI and/or x-ray may be requested if a noticeable amount of unevenness is noted.
The severity of the scoliosis curve is measured in degrees and based on the angle of the curve in the spine shown on X-rays.
- 20 degrees or less is a mild curve
- 20-40 degrees is a moderate curve
- 40 degrees or more is a severe curve
There is also a genetic test that utilizes the saliva of a young patient to determine if a mild to moderate case of scoliosis will progress further. While the test has limited use and application it is sometimes performed to aid in determining a treatment plan.
Mild non-progressive curves caused by hemivertebra are typically treated non-surgically and just observed. However, bracing has proven ineffective in managing hemivertebra.
Surgical treatment of a hemivertebra involves removal of the deformed vertebra and can be performed on children ranging in age from infants to adolescents. Under general anesthesia, an incision is made on the back, the hemivertebra is removed, and the vertebrae above and below are fused together. The child may have to wear a brace after surgery until the spine heals.