Adolescent Idiopathic Scoliosis (AIS)

Scoliosis refers to an abnormal side-to-side curvature of the spine (lateral curvature). AIS typically starts in puberty or during an adolescent growth spurt and may occur on either the left or the right side

About 1% to 3% of children between the ages of 10 and 16 have some degree of scoliosis and AIS is progressive, meaning that it gets worse with time.

Girls are more likely than boys to be affected with AIS.

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Causes

Genetic related factors a possible cause of this disease profile.

Terminology

Adolescent idiopathic scoliosis (AIS):

Idiopathic- is a medical term that simply means “for unknown reasons / unknown causes.”

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Symptoms

Children with AIS may not experience any pain but may show signs of having the condition.

Commonly reported signs and symptoms are:

  • Legs of different length
  • Abnormal gait
  • One shoulder higher than the other
  • A prominent shoulder blade or rib cage when bending forward
  • Visible curvature of the spine to one side
  • Uneven hips
  • Hemlines or trouser lengths uneven
  • Clothing does not fit correctly
  • Back pain, if it occurs, may range from mild to severe.

AIS can result in significant deformity therefore it is important to seek treatment for AIS because if left untreated. The deformity can cause marked psychological stress, especially among adolescents, and lead to permanent disability.

  • AIS deformity can have lifelong physical consequences:
  • As the vertebrae (spinal bones) rotate with scoliosis, the rib cage is affected, which, in turn, can restrict this area and cause heart and lung problems, a symptom of which is shortness of breath.
  • When progressive scoliosis affects the lumbar (low back) spine, the pain can be quite severe, even debilitating.
  • Patients with AIS can expect pain levels to worsen as long as the condition is untreated.

Diagnosis

If scoliosis is suspected particularly in a child or adolescent, prompt and expert medical attention must be sought.

The Neuro Spinal Hospital is the leading hospital where accurate diagnosis will be made for this type of disability. Patients will undergo a full physical and neurological examination once the Doctor has taken a full medical History.

  • Medical history will include :
  • Patient’s medical history,
  • Medical history of the patient’s parents,
  • Signs and symptoms that the patient is experiencing.
  • Female patients will be asked about their age at their first period.
  • Skeletal maturity is an important consideration in the diagnosis.( In some cases, skeletal maturity may cause scoliosis to stop particularly if the curve is less than about 45 degrees). This is less likely in patients whose scoliosis curve is more than 45 degrees.
  • During the examinations the doctor learns about the patient’s health and general fitness and both exams provide the doctor with a baseline from which future curve progression can be estimated.

The table below describes some of the physical tests involved in an AIS diagnostic examination.

Examination Description
Physical assessment The doctor looks for trunk asymmetry:·         Uneven shoulders or hips,·         Humpback, or leaning to one side.
Cardiopulmonary Testing heart and lung function.
Adam’s forward bending test The patient bends forward at the waist, with arms extended forward.The doctor looks for asymmetric thoracic prominence, such as a shoulder blade, or a lumbar prominence.
Leg length Both legs are measured to assess that both are of equal length.
Plumb line A plumb line is suspended from the C7 vertebra (neck area) and allowed to hang below the buttocks.The plumb line does not hang between the buttocks if the patient has scoliosis.
Range of motion The doctor evaluates the patient’s ability to perform:Flexion, extension, bending, and rotational movements.
Palpation The doctor feels (“palpates”) the spine for abnormalities, checking if the ribs are more prominent on one side.
Neurological assessment Reflexes are tested.The presence of pain, numbness, tingling, extremity weakness or sensation, muscle spasm, and bowel/bladder changes are noted.

Other diagnostic tests required to confirm the diagnosis / and measure the extent of scoliosis are shown in the table below.

Diagnostic Test Description
Scoliometer A scoliometer measures rib prominence while the patient bends forward at the waist.
X-rays X-rays :standing side view (lateral) of the spinePatient will bend.
Cobb Angle Measurement A full-length front-to-back (anterior-posterior) X-ray is taken to calculate the angle(s) of the curves.
Risser Sign An x-ray test to measure skeletal maturity.The test evaluates the iliac crest growth plate in the pelvis;The crest fuses with the pelvis at physical maturity.
Nash-Moe This test measures vertebral rotation.Rotation of the vertebral pedicle is measured by dividing the vertebral body into segments.
Classification Doctors primarily use one of two classification schemes to describe scoliosis:·         King-Moe or Lenke.·          Both describe the rates and the degree or severity of the scoliosis.

 

Treatment

  • Some cases of AIS do not require spinal surgery and can be treated by applying a brace.
  • In such cases, the patient should be closely monitored by expert physicians to assure progress and adjust therapy, as needed.
  • In some cases, specialized individual exercise programs may be recommended.
  • Small curves (less than 15-20 degrees):
    • No specific treatment is needed. Patient to be closely observed for progress.  .
  • Larger curves (between 20-40 degrees):
    •  Require fitted brace to prevent curve progression.
    • Some adolescents find wearing a brace 16 to 23 hours every day difficult.
    • Braces can be uncomfortable, unattractive, hot, and make a young person feel self-conscious (even though the brace can be well-disguised under clothing.)
  • Despite these difficulties, a brace is an effective form of treatment of scoliosis and may help to avoid surgery.
    Unfortunately, some curves do not respond to bracing. As a rule of thumb, these curves are less likely to respond to bracing:
  • Cervical-thoracic curves (those in the neck or the rib-level of the back)
    • Curves greater than 40 degrees
    • Curves, even less than 40 degrees, in children closer to skeletal maturity (older children)
    • In some cases, surgical intervention to treat AIS may be advisable. The aim of surgery is to realign and stabilize the spine.
    •  Scoliosis surgery usually involves spinal instrumentation (i.e. rods, screws) and fusion (bone graft), secure the spine to stop curve progression.
    •  Surgery does not cure scoliosis, but helps to correct and manage curve progression to prevent further deformity.

The Surgical procedure:

The Neuro Surgeons at Neuro Spinal Hospital will discuss the latest treatment options with you, including surgery, if recommended and advised. By the attending Doctor.

Techniques performed:

  • Usually performed through the front (anterior) or back (posterior) of the spine.
  • Different types of procedures are done: bone grafts and graft products, procedures, and minimally invasive techniques.

Prognosis

  • AIS can be effectively treated but requires expert medical intervention.
  • Early detection and treatment by experts in the field will assist in the management of patients with this disability and to prevent further progression.

Risk Factors

  • Genetic factors may play a role in the treatment of AIS.

Conclusion

  • AIS if left untreated, can lead to significant physical deformity, debilitating pain, and psychological distress.
  • Proper treatment of AIS can help prevent curve progression and stabilize the spine while the child grows.
  • Neuro Spinal Hospital physician can recommend the latest treatment options for AIS, which may alleviate symptoms and stop progression of the condition.