Defining Curvature of the Spine
The human spinal column is naturally shaped as an S-curve. This type of curve is normal and healthy, allowing balance of one’s body. However if the curves are the side of a child’s body instead of from front to back they are abnormal. This side to side curve condition is referred to by doctors as scoliosis. There are three types of spinal curvature disorders:
- Lordosis
Lordosis is a secondary curve of the spine. The cervical spine and lumbar spine regions have lordotic curvature – neck and lower back respectively. If the lordotic curve is increased in the lower back, the layman’s term is “sway back”.
Symptoms of lordosis may include: back pain, problems/pains with certain movements, swaying of the back, buttock appearing more pronounced.
Treatment for lordosis may include: medications, exercises to work on strengthening and flexibility, bracing, weight reduction and possibly surgery.
Loss of lordosis is considered “flat back”. This can result due to an injury resulting in or causing muscle spasms. This may also present as pain due to muscle spasms.
- Kyphosis
The primary curve of the spine is the kyphotic curve. This curve is located in the thoracic spine or middle back. When this curve is increased, the person may have a rounded upper back appearance; hence the terms “round back” and/or “hunch back.”
Symptoms of kyphosis may include: humping or rounded back, head appearing to be bent more forward in relation to the body and/or pain and stiffness.
Causes of kyphosis can include:
1) Bones being formed abnormally during development – birth defects,
2) Poor posture,
3) Diseases or conditions that cause the bones of the spine to be shaped abnormally,
4) Softening of the bones – osteoporosis,
5) Arthritis,
6) Infections,
7) Tumors, and
8) Trauma, injuries and/or cancer (including the treatment of cancer).
There are people that are at a higher risk of developing kyphosis: pre-teenage girls with poor posture, boys between the ages of 10-15 can develop Scheuermann’s kyphosis, older adults with osteoporosis and people with connective tissue disorders.
Complications of kyphosis may include: back pain, difficulty with breathing and/or being self- conscious regarding how one looks.
Diagnostic testing may be recommended to further evaluate kyphosis. This may include x-rays, CT scan, MRI, nerve testing and lung testing. X-rays are used to evaluate the curvature and detect any deformities that may be present. CT scan provides a more detailed description of the spine structures. MRI provides a more detailed description of the bone and soft tissue structures. Nerve testing evaluates how well the nerves are functioning from the origin in the spinal cord to arms/legs.
Lung function testing measures the amount of air your lungs can hold and the amount of time needed to empty the air from the lungs.
Treatment for kyphosis may include: medications, exercises to increase strength and flexibility, bracing and possibly surgery.
- Scoliosis
Scoliosis is an abnormal curvature of the spine. This abnormal curvature may be “S” shape or a “C” shape curve.
Adolescent Idiopathic Scoliosis (AIS) is the most common cause of scoliosis. This is a persistent lateral curvature of the spine of more than 10 degrees in the standing position. There can also be a rotational component of the spine.
There are three types of scoliosis, also known as a curved spine, that affect children. These include infantile scoliosis, juvenile scoliosis and adolescent scoliosis. Some of these types of curvature pose more risk than others do.
Infantile scoliosis refers to cases that occur before age three. This type of curvature is seen more frequently in boys. While some cases involve neurologic processes, many resolve spontaneously. Others; however, may progress to cause severe deformity.
Juvenile scoliosis is most frequently observed in girls between three and ten. This particular form of scoliosis has a high risk of progression. Often, the doctor will recommend surgical intervention in these cases.
After age ten but before the skeleton reaches maturity, there is the chance of adolescent idiopathic scoliosis. AIS may begin at puberty or become apparent as the adolescent has a growth spurt. It is also a greater risk for females and may require surgery if the curvature cannot be halted by noninvasive treatments.
Congenital scoliosis means that it was caused by a defect in the vertebrae discovered when the child was born. Idiopathic scoliosis, such as AIS occurs without a known cause. Regardless of the source of the curvature, the treatment may be much the same.
It is important that children be checked for scoliosis with regular medical checkups. In addition, parents should watch for potential problems. Left untreated, scoliosis may leave a permanent abnormal curve to the body with the spinal column stiff or even rigid. This makes the condition difficult to treat and the risk of serious complications even greater.
A medical doctor will begin by discussing the family and medical history of the child. In addition, he will determine if there is an underlying medical condition that might be responsible for the symptoms. These should be noted in the patient’s chart.
Other factors to consider are the child’s current age and the onset of puberty in order to determine the time remaining that the bones will continue to grow. This helps to project when the progression of the curve should stop.
When scoliosis is expected, the child should have a thorough physical exam. This can form a baseline from which the treatment is measured. In addition, the doctor should observe the patient for any abnormalities in the ribs, shoulders, pelvis or waist.
How Much Growing is Left
One of the most important questions is the amount of growth left before the bones reach maturity. This is often used in determining the amount of progression likely and if more invasive procedures are needed. There is a fan shaped part of the pelvis known as the iliac crest that fuses with the pelvis on maturity. The doctor may order x-rays to observe this crest and gain information on skeletal maturation.
In severe cases a curved spine may cause problems with the heart and respiration. Early diagnosis can allow intervention to prevent progress of the condition. By keeping the curve from growing worse, it is possible to limit its further complications.
