Adolescent Idiopathic Scoliosis (AIS)
What is defined as
Adolescent Idiopathic Scoliosis?
Scoliosis is a three-dimensional deformity of the spine with predominant lateral curvature.
There are various types of scoliosis. Adolescent scoliosis begins to develop mainly during a child’s growth, just before the onset of puberty, and may worsen until the end of bone growth.
Although scoliosis can also be caused by neurological diseases or diseases that affect the function of the muscles (Neuromuscular scoliosis), or may be due to anatomical abnormalities from birth (Congenital scoliosis), most of the time the cause of the disease is unknown (Idiopathic scoliosis).
In Adolescent Idiopathic Scoliosis the causes that trigger it have not yet been identified, and for this reason, this condition is called idiopathic.
We do know, however, that there are genes that cause it, but the exact mechanism by which these genes are expressed and how exactly they create this type of scoliosis is still unknown.
It may begin approximately at the age of 10 years and appears in both boys and girls.
According to studies, the severe form of the condition appears to affect girls 8 times more than boys.
Adolescent Idiopathic Scoliosis
What are the symptoms?
Incorrect posture may indicate scoliosis. Common symptoms include:
1.
One shoulder stands higher than the other
2.
The ribs are more prominent than those on the opposite side
3.
One hip is higher than the other
4.
The waist is asymmetrical
5.
There is a hump on the back or at the waist
The forward bend test (Adam’s test) is the most common test for the appearance of overall spinal deformity.
The patient bends forward with arms towards the feet, keeping the knees straight.
In case scoliosis is present, one side of the torso protrudes more than the other (hump).
Adolescent Idiopathic Scoliosis
What are the consequences if proper diagnosis and treatment are not made?
1.
Severe deformity of the torso
2.
Early degeneration of the spine
3.
Low back pain
4.
In severe forms, development and function of the lungs and heart are affected
5.
Pressure on the nerves – leg pain during adult life
Adolescent Idiopathic Scoliosis
What is the first step upon recognizing the symptoms?
If you observe related symptoms, it is advisable to first consult the pediatrician in order to make the initial assessment and provide guidance.
If deemed necessary, you will be referred to a spine surgeon specialized in scoliosis to make an accurate diagnosis of the condition.
Each case is different and requires an individualized approach.
The doctor will inform you about the appropriate treatment.
In most cases, simple monitoring is required.
How is the diagnosis of scoliosis made?
Initially, the doctor will take the adolescent’s medical history by asking questions concerning general health and physical development.
Then, a clinical examination of the entire body will follow, and subsequently, X-rays of the entire spine will be performed in order to obtain an accurate picture of the condition and measure the scoliosis angle (Cobb angle).
Depending on the case, additional examinations such as MRI or CT scan may be needed.
If monitoring is required, the doctor will recommend a follow-up visit within a period of 3–9 months.
The first examination is particularly thorough and may last from 30 minutes to 1 hour.
No special preparation is needed; the children should simply be aware that part of the examination is conducted wearing only their underwear and that their hair must be tied up high so it does not fall on their back during the inspection.
Follow-up examinations are usually shorter in duration and are typically combined with imaging re-evaluation (plain X-ray).
How is Adolescent Idiopathic Scoliosis
treated?
Regular monitoring
Usually, the doctor monitors the progression of Adolescent Idiopathic Scoliosis with regular appointments up to the patient’s adulthood.
In this way, the health course is controlled in case of worsening.
Physical exercise
Participation in sports activities and, more specifically, trunk strengthening is recommended in Adolescent Idiopathic Scoliosis.
It has not been proven that it can improve or halt the worsening of the condition, but it can certainly function only to the benefit of one’s health.
Braces
The use of braces is for cases with mild to moderate curves (15 to 40 degrees Cobb).
Their application is recommended for 23 hours per day (minimum of 16 hours), as this makes them more effective.
They can be removed during personal hygiene, dressing, or during sports activities.
Surgical intervention
Posterior correction and spinal fusion is the most common surgical treatment of this condition.
In this way, the deformity can be corrected to the desired degree and certainly the worsening can be stopped.
Initially, a midline incision is made at the back of the torso to place screws into the bones of the spine, which are eventually connected with rods on which the scoliosis is corrected.
There are cases where the correction is done directly from the front with lateral approaches, and other, newer ones in which spinal fusion is not performed and motion between the vertebrae is allowed (VBT – ASC).
Before surgery, the surgeon will take the history, perform the necessary examinations, inform you about the procedure, the benefits, the potential risks, and the postoperative recovery.
