Adolescent Idiopathic Scoliosis (AIS) is a lateral (side) curvature of the spine that can occur in children aged 8 to maturity. The spine may curve to the right, left or both. Sometimes AIS may start at puberty or during an adolescent growth spurt.
Idiopathic means the abnormal curve develops for unknown reasons. There is undoubtedly a genetic pre-disposition for some adolescents to develop AIS. Three to five percent of adolescents will be found to have some form of scoliosis. Girls are affected 9:1 more than boys in which curves may be more progressive.
Symptoms of scoliosis include back pain, leg length discrepancy, an abnormal gait, and uneven hips. Patients with AIS may have one shoulder higher than the other, a “prominent” shoulder blade and rib cage when bending forward, and visible curving of the spine to one side. Often the first indication of AIS is when an adolescent or parent notices that clothes no longer fit correctly (for example, the legs of pants may seem uneven).
It is important to seek treatment for AIS because progressive scoliosis, left untreated, can result in significant deformity. The deformity can cause marked psychological distress and physical disability, especially among adolescent patients. Additionally, the deformity can have serious physical consequences, as well as an impact on them socially.
As the vertebrae (spinal bones) rotate, the rib cage is affected, which in turn can cause heart and lung compromise (i.e. shortness of breath). When progressive scoliosis affects the lumbar spine the pain can be debilitating.
A chiropractor’s assessment of the child’s condition will include medical history, physical and neurological exam, and diagnostic tests.
Medical history may include questions about the parent’s genealogy. Are there other family members with scoliosis? If so, how did the scoliosis progress and what treatment was provided? Is there an underlying condition predisposing the child to this? In addition, the patient’s age, onset of puberty, and age at which a young woman has her first period, will help the physician 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, however these cases are usually addressed well-before this angle is reached.
During the physical and neurological examinations the chiropractor will learn about the patient’s health and general fitness. These exams provide the physician with a “baseline” from which future curve progression can be measured. A typical examination may include the following:
–Physical assessment – The physician looks for asymmetry of the trunk such as uneven shoulders or hips, humpback, or listing to one side. If the curve is significant, cardiopulmonary testing of the function of the heart and lungs will be required.
Adam’s Forward Bending Test – The patient bends forward at the waist, with arms extended forward. The physician looks for an asymmetric thoracic prominence (such as a shoulder blade), or a lumbar prominence.
Leg length – Both legs are measured to determine if they are of equal length.
Plumb line – A plumb line is “dropped” from the C7 vertebra (in the neck) and is allowed to hang below the buttocks. In scoliosis the line does not hang between the buttocks.
Range of motion – This measures the patient’s ability to perform flexion, extension, bending, and rotation movements.
Palpation – The chiropractor “feels” for abnormalities. Perhaps the ribs are more prominent on one side.
Neurological assessment – In addition to testing reflexes, the chiropractor will want to know if the patient’s symptoms include pain, numbness, tingling, extremity weakness or sensation, muscle spasm, and bowel/bladder changes.
Diagnostic Test Description
Scoliometer – A scoliometer is used to measure a rib hump while the patient is bent at the waist.
X-rays (radiographs) – X-rays include an upright front-to-back view of the spine.
Cobb Angle Measurement – This test uses an x-ray to calculate the angle of the curve(s).
Risser Sign – An x-ray to provide information about skeletal maturation. The Risser Sign looks at the iliac crest growth plate, a fan-shaped part of the pelvis. The crest fuses with the pelvis at maturity.
As chiropractors, we look to correct the cause of such problems after they are fully evaluated. This is where the differences between medical treatment and chiropractic treatment differ the most. Even today, it seems that the medical profession fails to respond to this problem until it gets so bad that body-braces are required They assume a “wait-and-see” approach, which according to any chiropractor is a dereliction of duty. If the cause can be addressed at an early age, the benefits can be quite substantial in reducing the curve the child is left with.
Chiropractors will address and attempt to correct this condition as soon as possible. There is a saying that states, “As the twig is bent, so grows the tree.” Such is the case with childhood scoliosis if left untreated. Treatment programs are typically longer and involve compliance on the patients part in the form of maintaining treatment schedules as well as home exercises. As mentioned, this is a condition that can potentially worsen if left untreated, eventually resulting in bracing or even surgery.
Medical (orthopedic) treatment breaks these conditions down by severity:
Small curves (those less than 15-20 degrees) are observed for possible progression over a period of time. At this stage, MD’s do not intervene, but rather wait and monitor the progress.
Large curves (those between 20-40 degrees) will require bracing to prevent further progression of the curve. If vital organs are compromised, surgery is even possible, but usually not until angles of 45 degrees or greater are found. (Below is an x-ray of a surgical correction using contoured Harrington rods and pedicle screws.)