Adolescent Idiopathic Scoliosis (AIS)
What is it?
Scoliosis is an abnormal lateral curvature with torsion of the spine and chest as well as a disturbance of the sagittal profile, with a Cobb angle (a measure of the curvature of the spine) at least of 10°. More specifically the adolescent idiopathic scoliosis is a deformity of the spine of unknown cause and multifactorial etiology, that appears in late childhood or adolescence. It is the most common form of scoliosis and usually worsens before skeletal maturity. Early identification and effective treatment of mild scoliosis could slow or stop curvature progression before complete growth , thereby improving long-term outcomes in adulthood. This pathological condition is more prevalent in female adolescents. The incidence in general population is 2–3% with different severity. The prevalence of curvatures greater than 20° (mild scoliosis) is between 0.3 and 0.5%, while curvatures greater than 40° Cobb (severe scoliosis) are found in less than 0.1% of the population.
Which are the symptoms?
Adolescent idiopathic scoliosis generally does not result in pain or neurologic symptoms. On the other hand there are many visible symptoms associated with AIS. One of the most common is a prominence on the low back or a rib hump secondary to the rotational aspect of the scoliosis. Also is possible to observe shoulders height asymmetry, in which one shoulder appears higher than the other. A shift of the body to the right or to the left can occur especially when there is a single curve in the thoracic (chest-part) or the lumbar (lower back) of the spine without a second curve to help balance the patient. Waistline asimmetry is present, resulting in one leg appearing taller than the other. In the most severe conditions also a pulmonary involvement with reduction of lung respiratoty capacity could be seen.
- Rib hump
- Coronal inbalance
- Shoulder asimmetry
- Leg asimmetry
- Waistline asimmetry
- Reduction of lung respiratory capacity
How is it diagnosed?
Typical exams to define an adolescent idiopathic scoliosis are radiographic images that include a standing long-cassette X-ray of the entire spine looking both from the back (PA radiograph), as well as from the side (lateral radiograph). Further radiographs can be performed to determine the flexibility of the curvature . These flexibility radiographs can be done in several ways. For instance, X-rays can be taken in which the patient lays on the table and bends to the right and then to the left . Traction films are taken with the patient's arms and legs pulled to stretch the spine out. A fulcrum- bend radiograph is taken with a padded roll placed at the apex of the curve to improve the curve correction. These radiographs are most often taken in the planning of surgical treatments. Magnetic resonance imaging (MRI) study of the spine is not routinely obtained for patients with AIS. A MRI is specifically used to review other things in addition to the bones of the spine, for instance to viewthe spinal cord to ensure there are no abnormalities or to detect abnormal curves, or more frequently in order to plan a surgical treatment.
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How is it treated?
Treatment of adolescent idiopathic scoliosis falls into three main categories (observation and physical therapy, brace and surgery) and is based on the severity of the curvature and the risk of curve progression.The treatment of idiopathic scoliosis usually starts with nonoperative intervention when a curve reaches 20°-25° in magnitude. Prior to this magnitude of the curve it is necessary monitoring the patient with radiographs and clinical evaluations, associated with physical therapies. First conservative options are casting and bracing. In general, bracing is used for skeletally immature idiopathic scoliosis patients with a curve magnitude of 20–40°. In some instances, bracing can be worn earlier than 20°, especially if a patient has a high likelihood of curve progression. There are several types of braces available but all of them work in the same fashion. All braces are worn under the clothes and cannot be seen by others. Surgical treatment is used for patients whose curves are greater than 40° while still growing or greater than 45° when growth has stopped. The goal of surgical treatment is two-fold: first of all, to prevent curve progression and secondly to obtain some curve correction. Spinal instrumentation provides the correcting force for scoliosis, whereas fusion techniques, including bone grafting, provide the enduring benefits.
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Where do we treat it?
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