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Saturday, December 14, 2013

Patient Information from Medical Media Images: Thoracic Scoliosis (Abnormal Curvature of the Mid-Back) - Part II

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                          Thoracic Scoliosis 
      (Abnormal Mid-Back Curvature) Cont'd



What are risk factors for a Scoliosis to require worsen over time?




Here are some risk factors:

1.     Female gender
2.     Large Curvature
3.     Immature skeleton (still growing)
4.     How long a child is still expected to grow
 
 This is a Thoracic Scoliosis shown on a Color X-Ray. Notice how the Curvature goes to the left in the Thoracic Spine (mid-back) and then back to the right in the Lumbar Spine (low back). This is called a "compensation" by the Spine to keep the body as straight as possible.


                  How do you know when a child stops growing?
 
Spine specialists use something called a “Risser Grade”. This is done by taking an X-Ray of the pelvis. A growth plate of the pelvis (iliac apophysis) is used to measure how close a child is to stop growing or if growth has already stopped. The Grading system goes from 1 to 5, 5 meaning that growth has stopped.
 
 
                     How is a Thoracic Scoliosis diagnosed?
 
Spine specialists use the information from the patient history, physical examination and special tests to make the diagnosis of a Thoracic Scoliosis:
 
 1.     History
Usually the patient is brought to the spine specialist because either a parent or the school has noticed some of the changes listed just above.
 Sometimes there is a family history and the parents are concerned about the possibility of a scoliosis.
At times, children will complain about pain or tightness in the spine.
 
2. Physical Examination
Here are some physical examination techniques spine specialists may use to confirm the presence of a scoliosis:
a.Visual inspection of the spine with the patient undressed 
b. Gait testing                                                                                                          
c. Forward bending at the waist, looking for a “hump” on one side of the spine (Adam’s Forward Bend Test)                                                           
d. Touching or pushing on the spine (palpation) to feel a deformity
e. Sensation (sensory) testing in the legs
f. Strength testing (motor) in the legs
g. Reflex testing
 
3. Imaging
a.     X-Rays
The best way to confirm a scoliosis is through X-Rays. There are special “scoliosis films” which show the entire spine from head to tailbone. This allows the doctor to evaluate the whole spine. The degree of the scoliosis is usually measured (Cobb angle) and used as a means to follow the progression of the curvature as well as to make a decision for surgery.
When a scoliosis is known to exist, X-Rays are often repeated every 3-12 months to look for any changes.
 
 
This is a "Scoliosis Ray". It shows the entire Spine. The red line follows the Scoliosis. Notice the "s-shaped" curvature of the Scoliosis which is typical as the Spine tries to compensate to maintain a straight body position.
 
b.     CT-Scan 
Even though CT scans can show the bone anatomy of the spine in great detail, they are usually not used due to the high dose of radiation.
 
 
c.     MRI Scan

 
This image is an MRI scan which shows the mid-back (thoracic spine) and chest from the front. The spine is seen curving to the left, then back to the right. 
MRI scans are usually not needed to establish the diagnosis of a scoliosis. An exception is a scenario where a neuromuscular scoliosis is suspected. In this situation, the spinal cord and spinal nerves as well as the spinal muscles can be evaluated.
 
How is a Thoracic Scoliosis treated?
The majority of idiopathic adolescent scoliosis do not require any type of treatment, but rather observation and periodic X-Rays. For patients with a severe scoliosis, rapidly progressing scoliosis or who have symptoms the following are some treatments available:
 
 
 
1.     Non-Surgical
A.    Physical Therapy (PT)
There is a “Schroth Method” of specific physiotherapy and targeted exercises which has been shown to be helpful. This method has actually been shown to significantly reduce a scoliosis.
B.     Bracing is sometimes recommended in moderate-severe or worsening cases of scoliosis. It can be useful when the bones are still growing. The hope is often to avoid a surgery.
 
2.     Surgical 
Surgery is considered after the bones have stopped growing and the curvature is severe. Generally a scoliosis in the range of 45 to 50 degrees is considered a surgical condition.
 
This is an Interactive Image. Move your mouse cursor over the Image to see the Text! 
These Color X-Rays show a Scoliosis on the left and a patient who underwent a Scoliosis Correction Surgery on the right. Enjoy interacting with this Image to learn all about the Surgery.
 
 
 

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