Adolescent Idiopathic Scoliosis NYC | Jonathan R. Stieber, MD

Causes, Signs, and Why Early Care Matters Understanding Scoliosis

Every spine has specific natural curves. These curves round one’s shoulders and give the lower back a slight arch. However, some people’s spines also curve from side to side. This is not a function of poor posture, and these curves can’t be fixed by simply standing up straight. The condition of side-to-side spinal curvature is called scoliosis. On an x-ray, these spines with scoliosis look more like an “S” or a “C” than a straight line. The spinal column with scoliosis may also have rotated slightly, making the person’s waist or shoulders appear uneven.

A specific cause is not found in more than 80% of scoliosis cases, and such are termed idiopathic, meaning “of undetermined cause.” This is especially true among the type of scoliosis seen in adolescents, where three to five percent will be found to have some form of scoliosis. Approximately 70% of AIS patients are girls, and their curves tend to be more progressive. A genetic predisposition exists for some adolescents to develop AIS, and this is currently being studied.

People must seek AIS treatment because progressive scoliosis may result in significant deformity if left untreated. This deformity can cause significant psychological distress as well as physical disability, especially among adolescent patients. The deformity from scoliosis can have dangerous physical consequences. As the spine rotates, the rib cage is affected, leading to severe heart and lung problems. If progressive scoliosis affects the lumbar spine, the resulting pain can be very debilitating.

Symptoms

Scoliosis in young patients is not usually painful, although it can cause considerable emotional distress. Many cases of AIS are discovered during routine medical exams or at school health screenings.

Normal spine (left) – Scoliosis (right)

Signs and symptoms of AIS include:

A “prominent” shoulder blade or rib cage when bending forward
One shoulder that appears higher than the other
Uneven hips
One leg that appears shorter than the other (leg length discrepancy)
Backaches
Curving of the spine to one side (usually to the right in the upper back; to the left in the lower back)
Fatigue in the lower back after prolonged sitting or standing
Abnormal walking gait
Clothing that no longer fits correctly (a typical example is when the legs of pants may seem uneven)

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Diagnosis

Dr. Stieber’s assessment includes a medical history, physical and neurological exam, and diagnostic testing with x-rays and other methods. The medical history may include questions about the parent’s genealogy and whether other family members have scoliosis. Dr. Stieber will check for underlying medical conditions that might otherwise be causing scoliosis. Additionally, the patient’s age, the onset of puberty, and growth history will help us determine the number of years that remain before the child reaches skeletal maturity. At skeletal maturity, curve progression may stop as long as the curve is less than 40-45 degrees. The curve may continue to progress throughout adulthood if the curve exceeds 40-45 degrees.

Non-Operative Treatment

Some cases of AIS can be treated non-surgically, and others require surgical intervention. Small curves (those less than 15-20 degrees) are usually observed for possible progression over some time. At this stage, no specific treatment is needed. In adolescents, larger curves (those between 20-40 degrees) may require bracing to prevent further curve progression.

Some patients find wearing the brace 16 to 23 hours every day difficult.

Braces can be uncomfortable, unattractive, hot, and make a child self-conscious even though well disguised under clothing. However, when bracing works and surgery is avoided, the commitment required is worthwhile.

Unfortunately, not all curves respond to bracing. Cervicothoracic curves (from the middle of the back up into the neck) and curves more significant than 40 degrees tend to respond poorly to bracing.

Older patients who are closer to skeletal maturity may also have a limited response to bracing.

Surgical Treatment

Surgery may be recommended for curves of certain types and severity (degrees). Rapidly-progressing curves or curves that are associated with neurologic problems may also require intervention. Surgery may be performed for smaller curves if the appearance of the curvature is bothersome to the patient or for other symptoms associated with scoliosis. The goals of surgical treatment are to correct the curve and to prevent curve progression. This is usually performed by placing metal implants into the spine attached to rods that correct the spinal curvature and hold it in the corrected position until fusion when the spinal elements mend together. Dr. Stieber uses various surgical procedures to treat AIS. The overall goals of the procedure are the same, but the techniques and instrumentation used will vary from case to case.

Dr. Stieber may perform the procedure from the front (anterior) or the back (posterior). The most common approach to adolescent idiopathic scoliosis is the posterior (back) approach. In the past, using hooks for fixation, patient activities were often restricted for at least six months after surgery. With recent medical advances, pedicle screws have been applied to the spine allowing for better correction. Pedicle screws provide substantial fixation, allowing patients to return to activities within 2-3 months after surgery. A curvature of 50° is often brought down to under 10° with these techniques.

A 16-year-old male diagnosed with adolescent idiopathic scoliosis, treated with a posterior approach utilizing pedicle screws and rods.

A 16-year-old male diagnosed with adolescent idiopathic scoliosis, treated with a posterior approach utilizing pedicle screws and rods.

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NYC Adolescent Idiopathic Scoliosis