Scoliosis�is an abnormal, side-to-side, curvature of the spine. The spinal curve may develop as a single�curve (shaped as C) or as two curves (shaped as S). In children and teenagers, scoliosis often does not have any noticeable symptoms and may not be noticeable until the curve has progressed significantly. The two most common forms of scoliosis aredegenerative scoliosis�and�idiopathic scoliosis�(adolescent).

Treatment decisions for idiopathic scoliosis are primarily based on the skeletal maturity of the patient as well as the degree of curvature.

Causes

Four out of five cases of scoliosis are idiopathic, meaning that the cause is unknown. Idiopathic scoliosis tends to run in families; genetic screening has identified several different patterns of genetic transmission. In some families, idiopathic scoliosis is transmitted in an autosomal dominant pattern, while in others the mode of inheritance is X-linked. Children with idiopathic scoliosis appear to be otherwise entirely healthy and have not had any bone or joint disease early in life. Scoliosis is not caused by poor posture, diet or carrying a heavy book-bag exclusively on one shoulder.

Idiopathic scoliosis is further classified according to age of onset:

• Infantile. Curvature appears before age three. This type is quite rare in the United States, but is more common in Europe
• Juvenile. Curvature appears between ages three and 10. This type may be equivalent to the adolescent type, except for the age of onset
• Adolescent. Curvature appears between ages of 10 and 13, near the beginning of puberty. This is the most common type of idiopathic scoliosis
• Adult. Curvature begins after physical maturation is completed

Causes are known for three other types of scoliosis:

• Congenital scoliosis�is due to congenital birth defects in the spine, often associated with other organ defects
• Neuromuscular scoliosis�is due to loss of control of the nerves or muscles that support the spine. The most common causes of this type of scoliosis are cerebral palsy and muscular dystrophy
• Degenerative scoliosis�may be caused by degeneration of the discs that separate the vertebrae or arthritis in the joints that link them

Scoliosis causes a noticeable asymmetry in the torso when viewed from the front or back.

Scoliosis Treatment

The surgical procedure for scoliosis is called�spinal fusion, because the goal is to straighten the spine as much as possible and then to fuse the vertebrae together to prevent further curvature. The skeletal maturity of the patient and the degree of spinal curvature are three essential factors that determine scoliosis treatment options for adolescents. The scoliosis curvature is measured on x-rays by what is known as the�Cobb method. Scoliosis treatment for patients with progressing curves, or curves over 30 degrees in a skeletally immature patient, is usually centered on use of a back brace.

Back Braces

A brace will not permanently correct curves that are already there. A brace for scoliosis is meant to hold the spine in place so the curve doesn't get any worse. Some braces are made to be worn only at night and others are designed to be worn both day and night. If you need a brace, your doctor can discuss which type would be best for you. Braces are meant to be used while the spine is still growing, especially when it grows very fast during the "adolescent growth spurt." Therefore, a kid with scoliosis will spend less time in the brace as he or she gets older and gets closer to adult size. After the spine finishes growing, braces are no longer effective.

There are two types of commonly used scoliosis braces: a thoracolumbar sacral orthosis (TLSO)�and a�Charleston bending brace.

The�TLSO�is a custom molded back brace that applies three-point pressure to the curvature to prevent its progression. It can be worn under loose fitting clothing and is usually worn 23 hours a day. This type of scoliosis brace can be taken off to swim or to play sports.

A�Charleston bending back brace�applies more pressure and bends the child against the curve. This type of scoliosis brace is worn only at night while the child is asleep.

Surgical Treatment

Some children who have scoliosis eventually need an operation. During the operation, the orthopedic surgeon fuses the bones in the spine together so that they can no longer continue to curve. The surgeon also uses metal rods, hooks, screws and wires to correct the curve and hold everything in line until the bones heal. The rods are then used to reduce and hold the spine while bone that is added fuses together. The metal parts are placed deep under the spine muscles and in most cases can't be felt and do not hurt. They are meant to be left in the back permanently.

Once the bone fuses, the spine does not move and the curve cannot progress. The rods are used as a temporary splint to hold the spine in place while the bone fuses together and after the spine is fused the bone holds the spine in place. These rods are generally not removed since this is a large surgery and it is not necessary to remove them. On the event of an irritation occurs the rod will be removed.

The duration of the operation depends on the severity of the curve and the number of bones to be fused. The child will be able to walk the very next day and can resume some basic activities in a month. The child can usually go back to school about a month after surgery, then return to some activities in 3 or 4 months and most normal activities after 6 to 12 months. But keep in mind that each patient's surgery and recovery might be different, depending on the type of surgery and the patient's age.

Th metal rod holds the spine in place during healing. The kid can still move to pet the dog, swim laps, or shoot hoops and do basic sports. Earlier, they used metal rods; a kid would have to wear a body cast for up to a year to keep the spine in place during the recovery period.

The other Spine Surgery Procedures are:

• Anterior Lumbar Interbody Fusion
  
• Artificial Disc Replacement Surgery
  
• Microsurgical Discectomy
  
• Peripheral Nerve Surgery
  
• Spinal Fusion
  
• Cervical Disectomy�� etc

Few Major Hospitals for Scoliosis Corrective Surgeries are:

• Wockhardt Hospitals
  
• Apollo Hospitals
  
• Max Healthcare
  
• Piyavate Hospital
  
• Florence Nightingale Hospital
  

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