What is Adolescent Idiopathic Scoliosis?
Adolescent idiopathic scoliosis (AIS) is a type of scoliosis that’s most common in children between 10 and 18 years old. The term ‘idiopathic’ means that we don’t know the exact cause, and it’s not directly related to any specific syndrome or condition, whether it’s present at birth (congenital) or affects the nerves and muscles (neuromuscular). Treatment can involve monitoring the condition without active intervention (conservative management), using a brace, or in some cases, surgery.
What Causes Adolescent Idiopathic Scoliosis?
Idiopathic scoliosis is a type of scoliosis that doesn’t have a known cause. It’s only diagnosed once other types of scoliosis have been ruled out. There are a number of theories about what might cause it, including hormonal imbalances, uneven growth, muscle imbalances, and genes. In fact, about 30% of people with a condition known as Adolescent Idiopathic Scoliosis (AIS) have a family member who also has scoliosis.
Risk Factors and Frequency for Adolescent Idiopathic Scoliosis
Adolescent idiopathic scoliosis (AIS) affects about 1% to 3% of the population. It is more common in females and often results in a curvature to the right side. To be classified as scoliosis, the curve of the spine must be at least 10 degrees. Only about 0.1% of cases involve curves larger than 40 degrees, which are usually the ones that need surgical treatment.
- AIS affects 1% to 3% of people.
- It is more common in females and usually causes a right-sided curvature.
- To be categorized as scoliosis, the spine’s curve must be at least 10 degrees.
- Approximately 0.1% of cases have curves larger than 40 degrees, which typically require surgery.
Signs and Symptoms of Adolescent Idiopathic Scoliosis
When a doctor is trying to identify the cause of scoliosis in adolescents, a detailed medical history and physical examination are necessary. It’s important to take note of the child’s development to identify possible causes of the scoliosis. Certain factors like the age when a girl first gets her period and the Risser classification, which is a measure of the child’s bone maturation, can give clues about the child’s skeletal maturity.
Interestingly, most teens with idiopathic scoliosis, which is scoliosis without a clear cause, don’t have severe back pain because of the curve in their spine. Many of these adolescents are very physically active, participating in activities like sports or cheerleading, and are generally healthy children.
During the physical examination, the doctor will also assess the patient’s neurological health and the specifics of the spinal curve, like its shape, form, and flexibility. It’s crucial to maintain the privacy and sensitivity of the patient during this evaluation, given their age group.
To monitor the progression of the scoliosis and the results of any possible surgical procedures, photographic documentation of the patient’s spine, while they’re standing upright and bending over, is essential. The observation of scoliosis shouldn’t be limited to the spine alone. Other factors like the visibility of the ribs, the symmetry of the waistline, and the height difference of the shoulders also need to be looked at.
Testing for Adolescent Idiopathic Scoliosis
Usually, the initial evaluation for potential issues can take place during a school check-up, a sports coach’s assessment, or a visit to your child’s doctor. If further investigation is needed, your doctor may order specific x-ray tests. These might include a standing front-view x-ray, a side-view x-ray, and x-rays of the left and right bending positions.
The Risser classification, which is a way to assess the maturity of the hip bone and thereby gauge the progression of a curvature of the spine, can usually be worked out from the front-view x-ray. It’s generally agreed that there’s no need for a CT scan or MRI in most instances. However, for certain types of surgery, preoperative or intraoperative CT imaging may be needed, but this is down to the surgeon’s and the technology’s specific requirements.
If a person is being considered for surgery, they will need to have some routine laboratory tests. These include a complete blood count (CBC), basic metabolic panel (BMP), tests to monitor blood clotting (INR/PTT), urinalysis (a test of urine), as well as a pregnancy test for all females. Pulmonary function tests, which measure how well the lungs are working, may also be necessary.
Treatment Options for Adolescent Idiopathic Scoliosis
In simple terms, people with curves less than 10 degrees do not get diagnosed with AIS, a type of scoliosis. Some researchers even dispute the benefit of school screenings for this condition.
Those with moderate curves, between 10 and 25 degrees, usually undergo regular x-ray check-ups. These check-ups ma take place every three, six, or twelve months to monitor the progression of the condition.
For individuals with curves more significant than 25 degrees, but less than 40 to 45 degrees, the recommendation is usually to wear a brace. A significant study funded by the NIH has shown that wearing a brace can be effective for adolescents. However, braces are uncomfortable and not always worn as recommended, so their overall effectiveness remains a topic of debate.
If the curves are more than 40 to 45 degrees in those who are still growing, the usual course of action is surgery. The most common surgical procedure involves fusing the spine, using a method that installs screws and rods. However, the decision to operate, and which specific procedure to use, depends on a variety of factors, including the patient’s age, the specifics of their spinal curvature, and their overall health. Alternative surgeries that do not involve fusion are being explored as well.
Surgery for scoliosis is a major undertaking and is not without risks and potential complications. These complications can sometimes be more disabling than scoliosis itself.
Other treatments, like physical therapy, electrical stimulation, nutrition assessment, and spinal manipulation, haven’t been shown to effectively manage scoliosis.
It’s important to note that these are general guidelines, and a patient’s individual circumstances, their stage of growth, how fast their scoliosis is getting worse, personal factors, and the experience of the surgeon play key roles in deciding the best treatment approach.
What else can Adolescent Idiopathic Scoliosis be?
It’s important to make sure that scoliosis isn’t being caused by other health issues. These can include conditions related to the nervous system, muscle disorders, birth defects, or certain syndromes.
What to expect with Adolescent Idiopathic Scoliosis
Untreated adolescent idiopathic scoliosis can gradually worsen into adulthood, typically progressing at a rate of around 0.5 to 1 degree per year once a 50-degree curve has been reached. In general, curves in adults tend to be stiffer and more stubborn than those in teenagers, which often calls for more intensive and invasive surgical approaches.
In the long run, regardless of whether they’ve been treated or not, patients with scoliosis have been found to have a higher likelihood of developing arthritis and a negative self-perception of body image. Moreover, if a surgical procedure involves entering the chest wall, it could lead to pain and a decrease in lung function.
Possible Complications When Diagnosed with Adolescent Idiopathic Scoliosis
If scoliosis is not treated, it can get worse over time. This can lead to issues like back pain, nerve pains in the lower back (lumbar radiculopathy), cosmetic problems, and nerve damage. It can even cause problems with the heart and lungs. For example, people with a curve of more than 80 degrees in their spine may start to feel out of breath frequently.
While surgery for treating scoliosis usually has lower risks compared to other types of spinal surgeries, there are still some potential complications. According to one nationwide survey:
- About 0.9% of patients had neurological injuries
- About 2.8% of patients had respiratory issues
- About 0.8% of patients had issues with their hearts
- About 0.5% of patients developed infections
- About 2.7% of patients had gastrointestinal problems
Sometimes, patients may also have delayed infections in the surgical hardware that is used during the procedure.
The expertise of the surgeon and how many surgeries they perform can also significantly affect the outcome and cost of the procedure.
Recovery from Adolescent Idiopathic Scoliosis
After surgery, patients are usually cared for in the Intensive Care Unit (ICU). Depending on how extensive the surgery was, some individuals may need to stay in the ICU for a longer period of time.
Those who have had surgery for adolescent idiopathic scoliosis, a type of spine condition common in teenagers, can generally expect to go home after surgery. However, the length of their hospital stay can vary and depends on factors such as the specific surgical procedure, the surgeon’s decisions, hospital policies, and other health or socioeconomic factors. After surgery, patients usually don’t need a brace as part of their recovery process.
Preventing Adolescent Idiopathic Scoliosis
There can be difficulties when it comes to managing the use of braces with some patient groups. Studies have shown that patients who follow the instructions for brace use have better health results. It’s important for patients and their support network – like family or friends – to be fully involved in the treatment process. Additionally, parents need to be well-informed about the risks of surgery, how the surgery will be done, and the goal of the surgical procedure.
