Scoliosis

Disease Description (Causes and Symptoms)

• Definition: A condition in which the spine curves abnormally from side to side and the vertebrae rotate (with both lateral curvature and rotation). Abnormal curvature from front to back (on the lateral view) is classified as kyphotic or lordotic abnormality, while a condition characterized by sideways curvature is called scoliosis.
• Main causes and classification:
  • Nonstructural (functional) scoliosis: Temporary deviation due to leg-length discrepancy, painful muscle tension, etc. (without spinal rotation).
  • Structural scoliosis (true scoliosis): Accompanied by structural deformity and rotation of the vertebrae. Subtypes: idiopathic (85–90% of all cases), congenital, neuromuscular (such as cerebral palsy and myopathy), and degenerative (in older adults).
  • Most cases are of unknown cause (idiopathic), and hypotheses involving complex factors such as genetics, melatonin, muscles, and balance perception exist.
• Summary of pathophysiology: As transverse deformity and axial rotation of the spine progress, deformity of the rib cage and asymmetric deformation of soft tissues may occur; during growth, progression of the deformity is accelerated.
• Main symptoms: Changes in appearance (difference in shoulder or pelvic height, unilateral prominence of the back or waist); pain is uncommon (when pain is present, an underlying structural cause should be suspected). Severe thoracic curvature may cause reduced cardiopulmonary function.

Treatment Methods

• Treatment goals: During growth, to suppress progression of the curvature; in adults, to prevent progression of the deformity and improve function and appearance. In severe cases, correction of the curvature (surgery).
• Conservative treatment
  • Observation: During growth and for small curves (generally Cobb <20°), observation at 3–6-month intervals (monitoring growth status and the Cobb angle).
  • Orthosis (bracing): Generally applied during growth (when skeletal growth remains) in the Cobb 20–40° range. Representative devices include TLSO (Boston) and Milwaukee braces. Wearing time and compliance affect treatment effectiveness.
  • Exercise and physical therapy: Supportive role in maintaining spinal flexibility and strengthening muscles (including respiratory and trunk muscles). The quantitative corrective effect is limited. There is no evidence supporting electrical stimulation.
  • Medication: Symptomatic treatment with analgesic anti-inflammatory drugs and similar medications only when pain is present.
• Surgical treatment
  • Indications: Generally a Cobb angle of ≥45–50° after growth has ended, or rapid progression and severe deformity during growth (e.g., causing respiratory problems).
  • Methods: Posterior spinal fusion and fixation with metal instrumentation (standard); depending on the case, an anterior approach, growth-friendly devices for growing children (growing rods, VEPTR), or nonfusion surgical techniques such as vertebral body tethering (VBT) instead of scoliosis fixation in selected patients (for specific indications).
  • Risk of complications: Bleeding, infection, neurological injury, implant failure or failure of fusion, adjacent segment disease, etc.
• Lifestyle management and precautions
  • Activity restrictions: Most activities (such as swimming) are possible and should be performed within the range in which activity restrictions are eased while wearing a brace. Excessive exercise restrictions are unnecessary.
  • Regular follow-up: During growth, clinical and radiographic follow-up at short intervals is necessary.
  • Immediate evaluation is needed if cardiopulmonary symptoms, neurological abnormalities (decreased sensation or strength), or worsening pain occurs.
• Prevention: There is no clearly established method of prevention (there is insufficient evidence that heavy schoolbags or posture are causes). School and home screening are useful for early detection.

Outpatient Visit Checkpoints (Preparation and Example Questions)

• Items to bring (recommended)
  • Previous radiographs (X-rays) and reports, and MRI/CT results (if available)
  • Previous medical records (including surgical and brace prescription records)
  • List of current medications and supplements, and allergy history
  • Growth-related information: age, recent height changes, and, for female students, whether menarche has begun (the timing of the start of menstruation)
  • Symptom record: When changes in appearance began, whether pain is present and its characteristics, and whether shortness of breath or exercise limitations are present
• Example questions to prepare for the outpatient visit (for patients/guardians)
  • Recent height changes (How much has the patient grown over the past 6–12 months?)
  • Whether a brace is being worn, wearing time, and whether there is any discomfort
  • Previous test results (e.g., Cobb angle and MRI abnormalities) and the pattern of progression

Examples of General Questions to Ask the Doctor

• Is treatment definitely necessary for this condition? Which do you recommend: observation or bracing?
• What is the current Cobb angle, and how high is the risk of future progression (including the amount of growth remaining)?
• What effects can be expected from wearing a brace, and how many hours per day is it recommended to wear it?
• If surgery is necessary, which surgery do you recommend? What is the expected recovery period, and what are the major complications?
• What should be taken into consideration during exercise and daily life?

Examples of Condition-Specific Questions

• If the patient is still growing and the current Cobb angle is 20–30°, how is the criterion for starting bracing determined (e.g., based on bone age and the Risser index)?
• If the thoracic curvature is severe (e.g., thoracic cavity deformity), when should cardiopulmonary function testing be performed, and how would the treatment plan change depending on the test results?

(End)