Side-bending X-rays may also be taken to assess the flexibility of the curve or curves. Sometimes these images reveal two curves: the first curve to appear in the spine the primary curve and the compensatory curve that the patient develops through his or her effort to maintain an erect posture.
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Treatment for adolescent idiopathic scoliosis determined by the degree of the curve at diagnosis and anticipated progression of the curve. For curves measuring less than 25 degrees, the orthopedist may recommend frequent monitoring to see if additional intervention becomes necessary.
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Young people with curves between 25 and 45 degrees may be candidates for treatment with bracing. Bracing is considered a success when progression is halted and maintained within 6 degrees of the original measurement of their curve. Candidates for bracing are generally prepubescent and skeletally immature as measured on the Risser test a staging system that measures maturation of the hip bone. A measurement of 0 to 2 indicates that the growth is expected to continue. Skeletal maturity is achieved in female patients who reach a level of 4 and in male patients who have reached a level of 5.
The absence of any change in height over a period of 6 to 12 months is another indicator of skeletal maturity. In most cases, patients wear a brace for 22 to 23 hours a day, removing it only for hygiene and sports activities. However, some patients may only require the use of a brace at night. A variety of braces are available and selection is based on how many curves are present and where on the spine the curve or curves are.
Some models provide support at the pelvis, front, back, and neck, where others provide support throughout the torso and underarms. While many braces are rigid, flexible braces have been developed in recent years. This type of brace, which is only appropriate in patients with single curves, is worn as a vest and allows the patient to participate in some sports activities [Figure 6]. Figure 6: A patient wearing a rigid, flexible brace, allowing participation is some sports activities. Patients continue to wear the brace until skeletal maturity is reached.
A weaning process follows in which the number of hours the brace is worn per day is gradually reduced over a period of six months to a year. This allows the supportive muscles in the back and trunk to become stronger after a period of inactivity.
Physical therapy is also recommended, both during bracing and weaning. Patients with curves that continue to progress beyond 50 degrees, either with or without bracing, generally require surgical intervention. The most common type of surgery is a posterior spinal fusion with instrumentation artificial implants. In this procedure, the orthopedic surgeon makes an incision from the back and essentially "welds" the vertebrae together using bone chips. These chips may be:.
Hooks, screws, or other instrumentation is used to hold the spine in alignment during the healing process, which takes 6 to 12 months in an adolescent. Depending on the nature of the curve and its location, the orthopedic surgeon may need to perform a fusion from the front anterior , the back posterior or both.
What are the Common Adolescent Spinal Injuries?
When both approaches are needed, the procedure may be performed as a single operation or in stages. Some patients may also be candidates for thoracoscopic surgery, in which incisions are made from the side of the torso.
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As with the posterior and anterior approaches, instrumentation corrects the curve and the rotation of the spine. Boachie explains. Thoracoscopic surgery is appropriate primarily for larger and rigid thoracic curves that require anterior release to increase flexibility.
But, Dr. Spinal fusion does result in some loss in range of motion.
What are the Common Adolescent Spinal Injuries?
The extent of that varies depending on the section of spine corrected and the number of vertebrae fused. Rare complications can include infection and spinal cord abnormalities or injury. However, at HSS, multiple precautions are taken during surgery to protect the patient, including administration of antibiotics during surgery to help guard against infection and continuous monitoring of sensory and motor function of the spinal cord. Pain medication is continued for a few weeks and the majority of young people are back in school within 4 to 6 weeks. Some exercise, such as swimming and low-impact aerobic exercise, may be resumed within three months and patients may return to full activity within six months.
My year-old daughter has just been diagnosed with idiopathic scoliosis. The doctor measured the curve on X-ray to be 20 degrees and said her bones are nearly fully grown. Nonoperative Treatment for Scoliosis.
The Operative Management of Scoliosis. Kyphosis and Lordosis. Back Matter Pages About this book Introduction As modern science and medical technology increase the life span of man, the human skeleton is required to function for longer periods of time. These may be congenital problems or acquired problems due either to a child's environment or to some injury sustained during the growth years. Adolescents today are extremely active; many sports and hobbies subject them to an infinite array of traumatizing episodes that may result in injuries and diseases.
When I wrote the first edition of The Adolescent Spine in , I felt it pertinent to produce a work which would help medical students and practitioners alike. That edition was extremely successful, not only in this country, but also in many foreign countries. This new edition has been revised and considerably expanded with this audience in mind. Four chapters have been contributed by authorities with special expertise. Keim 1 1. Buy options.