The term scoliosis is used to describe an abnormal curvature of the spine, but it is not in itself a disease or a diagnosis. The curvature of the spine from scoliosis is from side to side and may develop as a single curve or as two curves Scoliosis usually develops in the upper back (thoracic spine) or area between the upper back and lower back (the thoracolumbar area of the spine) It may also occur just in the lower back (lumbar spine).
There are several common physical symptoms that may indicate scoliosis. Any type of back pain is not usually considered a scoliosis symptom.
Most typically, symptoms of scoliosis may include one or several of the following:
One shoulder is higher than the other
One shoulder blade sticks out more than the other
One side of the rib cage appears higher than the other
One hip appears higher or more prominent than the other
The waist appears uneven
The body tilts to one side
One leg may appear shorter than the other
Early detection is essential for scoliosis treatment to be most effective. In general, people with a family history of spinal deformity are at greater risk for developing scoliosis. Physician’s exam. The clinical evaluation with the physician will usually include a physical exam, during which the physician will also test to make sure that there are no neurological deficits. Neurological deficits due to scoliosis are uncommon but necessary to check for because there are rare causes of scoliosis that may have spinal cord involvement. X-ray. The x-ray is ordered to both confirm the scoliosis diagnosis and check on the magnitude of the spinal curvature. The x-ray will also give some indication as to the skeletal maturity of the patient which may influence treatment decisions.
Decision for scoliosis treatment decisions are primarily based on two factors:
- The skeletal maturity of the patient (or rather, how much more growth can be expected)
- The degree of spinal curvature.
Bracing is designed to stop the progression of the spinal curve, but it does not reduce the amount of angulation already present. The majority of curve progression happens during a child's growth phase, and once the growth has ended, there is little likelihood of progression of a curve. Therefore, bracing is continued until the child is skeletally mature and finished growing. Types of Scoliosis Braces
There are several types of commonly used scoliosis braces:
- Thoraco-Lumbo-Sacral-Orthosis (TLSO)
The most common form of a TLSO brace is called the “Boston brace”, and it may be referred to as an “underarm” brace. This brace is fitted to the child’s body and custom molded from plastic. It works by applying three-point pressure to the curvature to prevent its progression.
- Cervico-Thoraco-Lumbo-Sacral-Orthosis (known as a Milwaukee brace)
The Milwaukee brace is similar to the TLSO described above, but also includes a neck ring held in place by vertical bars attached to the body of the brace. It is usually worn 23 hours a day, and can be taken off to swim, play sports or participate in gym class during the day. This type of brace is often prescribed for curves in the thoracic spine.
- Charleston Bending Brace
This type of brace is also called a “nighttime” brace because it is only worn while sleeping. A Charleston back brace is molded to the patient while they are bent to the side, and thus applies more pressure and bends the child against the curve. This pressure improves the corrective action of the brace.
This type of brace is worn only at night while the child is asleep. Patients can go to school and participate in sports normally without their friends even knowing they have scoliosis and wear a brace, avoiding any potential negative stigma.
Many studies have shown that the Charleston Night time brace is as effective as the above-described 23-hour-a-day brace wear.
Curves must be in the 20 to 40 degree range and the apex of the curve needs to be below the level of the shoulder blade for the Charleston brace to be effective.
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