Scoliosis : one case report

Scoliosis in teenagers is a condition where the spine develops an abnormal sideways curvature, most commonly during the rapid growth spurt just before or during puberty. Here’s a clear and concise overview for you, Rob, suitable for teaching or patient education:

What is it?

Scoliosis is defined as a lateral curvature of the spine greater than 10 degrees, often with rotation of the vertebrae. It most often presents in adolescents between 10–18 years old and is called Adolescent Idiopathic Scoliosis (AIS)—“idiopathic” meaning the cause is unknown.

Causes

In most teenage cases (around 80–90%), it’s idiopathic. However, other causes include:
• Neuromuscular conditions (e.g. cerebral palsy, muscular dystrophy)
• Congenital vertebral malformations
• Connective tissue disorders (e.g. Marfan syndrome)

Signs and Symptoms

Often subtle and painless early on:
• Uneven shoulders or hips
• One shoulder blade more prominent
• Ribs sticking out on one side when bending forward (Adam’s forward bend test)
• Clothes not hanging evenly
• Rarely: back pain

Diagnosis
• Physical exam (including Adam’s forward bend test)
• Scoliometer to measure angle of trunk rotation
• X-ray for Cobb angle measurement, which quantifies curve severity

Severity (Cobb angle)
• less than 20°: mild
• 20–40°: moderate
• 40–50°: severe (may need surgery)

Management

Depends on curve size, age, and skeletal maturity:
• Observation for mild cases (regular monitoring)
• Bracing for moderate curves in growing teens to prevent progression (not correct the curve)
• Surgery (spinal fusion) for severe or progressive cases

Prognosis

Most mild scoliosis does not worsen and does not cause long-term health issues. However, more severe cases can lead to back pain, respiratory issues, or visible deformity if left untreated.

Surgical treatment for scoliosis in teens is considered when the spinal curve is severe (typically over 40–50° Cobb angle) or progressive despite bracing. Here’s a detailed, clear explanation suitable for education or clinical understanding:

When is surgery indicated?
• Curve 45–50° and still growing (high risk of progression)
• Curve greater than 50° after skeletal maturity (likely to worsen in adulthood)
• Progressive curvature despite bracing
• Significant cosmetic deformity or postural imbalance
• Rarely: severe back pain or compromised lung function

Surgical Goals
• Prevent curve progression
• Correct spinal alignment as much as safely possible
• Stabilize the spine
• Preserve as much function and growth as possible

Main Procedure: Spinal Fusion

The most common surgery for scoliosis is posterior spinal fusion using rods, screws, and bone grafts.

Steps:
1. Incision is made down the back over the spine.
2. Instrumentation: Metal rods are attached to the spine with screws, hooks, or wires to straighten and support it.
3. Fusion: Bone graft (from the patient or donor) is placed to fuse vertebrae together, creating one solid bone over time.
4. Correction: The surgeon gently manipulates the spine to reduce the curvature.