Many people may wonder exactly what scoliosis is. Scoliosis is a sideways curvature of the spine that is greater than ten degrees. Mild scoliosis ranges from ten to twenty degrees. Intermediate scoliosis ranges from twenty to seventy degrees, and severe scoliosis is any curve greater than seventy degrees. Though cases of scoliosis are found equally among both male and females, females scoliosis tends to be more severe (Board). Scoliosis can be present at birth, congenital. There are a few different types of scoliosis; functional, structural, and idiopathic structural.
In functional scoliosis the problem does not originate the spine.
The curvature in functional scoliosis is flexible, and the curve is normally caused by uneven legs or muscle spasms caused by pain (Board). Functional scoliosis will go away when the underlying problem is corrected. For example in the case of uneven legs orthopedic shoes can be worn. In structural scoliosis the curvature is not flexible it is a fixed curvature in the spine.
There could be an underlying problem with the brain or spinal cord. In structural scoliosis there could also be an underlying problem with nerves or muscles (Board). Most scoliosis patients have idiopathic structural scoliosis. Eighty percent of all scoliosis cases are idiopathic structural scoliosis. The cause of idiopathic structural scoliosis is unknown, but symptoms are present.
Scoliosis can have several symptoms. It can cause uneven body parts such has the shoulders or waist. Scoliosis victims may lean to the side or become fatigued. Back pain and difficulty breathing are also some of the symptoms but normally are only seen in severe scoliosis cases (Board).
Though there are some known causes, most causes for scoliosis are unknown. Congenital scoliosis is considered to be a birth defect. It may occur with other problems such as heart and kidney abnormalities. Spinal cord and brainstem abnormalities are also a possibility (Board). The way scoliosis is diagnosed is called the Cobb Method.
The Cobb Method requires the most tilted vertebrae to be identified. A line is then drawn along the ends of these vertebrae to measure the curve. The patient is then asked to bend forward to check for bumps which may be a sign of scoliosis. Finally, an x-ray helps determine the type of scoliosis the patient has (Board). Scoliosis can come with some health risks. In severe scoliosis, the curvature is so great that it could cause the ribs to press against the heart or lungs. This in turn can cause breathing problems. If the curve is greater than one hundred degrees it could cause physical damage to the heart or lungs. Scoliosis can also cause chronic back pain or arthritis of the spine in adults (Board).
There are several ways scoliosis can be treated. If the patient is a child that is still growing with a curve of twenty to thirty degrees a back brace can be used. There are two different types of back braces. The underarm or low profile brace is close fitting which makes it almost invisible under clothes. This brace fits under the arms, and around the ribcage, lower back and hips. The underarm brace is a custom made brace fit specially to the patient (Board). The Milwaukee brace is a full torso brace used for upper spine curves. It has a neck ring with rests for the chin and for the back of the head (Board). For curves greater than forty degrees, surgery may be needed. There are a few different types of scoliosis surgery. Spinal fusion is the most common type of scoliosis surgeries. This surgery works by releasing some ligaments and joints around the spinal cord and attaching a rod. A posterior or anterior approach is used to reach the spine.
Hook or screws are inserted into the vertebrae to hold the rod in place, and the joints between vertebrae are removed. The rod is pulled tight and a bone graft is placed (Board). Another type of spinal fusion uses thoracoscopy. The procedure is viewed on a monitor while tiny tools are inserted through small incisions. These tools are used to help attach the metal rod to the spine. This method is usually used for curvatures in the chest region that are moderately large (Board). The growing spine system is used for young children who are still growing but are not helped by a back brace. The metal rod that is used to support the spine is adjustable. The procedure is similar to spinal fusion but the joints are not removed and the spine will not fuse. With this system surgery is needed about ever six months to change the length of the rod as the patient grows (Board).
Clinical Trials
“A Multicenter Prospective Study of Quality of Life in Adult Scoliosis,” is a trail that tests the effectiveness of non-operative and operative treatments of scoliosis. The trial is currently not open for recruitment. The primary goal of this trail is to compare the outcomes of surgery and non-operative treatments of scoliosis. The study will be done on patients aged forty to eighty with ASLS defined as a lumbar curve with a coronal Cobb measurement that is thirys degrees or greater. The secondary goal of this trial is to evaluate the impart of patient factors and co-morbidities (Multicenter). In order to be eligible for this study the patient must be between the ages of 40-80 years, have a double major or thoracolumbar/lumbar scoliosis measure thirty degrees or greater, and a SRS score of 4.0 or less in pain, activity and or appearance. The estimated enrollment is three hundred patients. This trial will be conducted by Washington University School of Medicine. It is scheduled to start in July 2009 and estimated to end in December 2015 (Multicenter). “Phase IV Comparing Rods of Yield Strengths to Correct Adolescent Idiopathic Scoliosis,” is a trail that tests titanium rods vs. ultra strength stainless steel rods for better correction of scoliosis.
This trial is currently recruiting. The goal of this trial is to figure out whether titanium rods or ultra strength stainless steal rods are better for the correction of scoliosis. Surgeons have noticed that the screw construction has been increasing while the strength of the rod has not. The rod is now the weak part of the construction. This brings the need for newer, stronger rods (Phase). Patients must 10-20 years of age, have progressive lenke type 1A, N or idiopathic adolescent scoliosis measuring greater than forty-five degrees. The estimated enrollment for this trial is one hundred patients. This trial will be conducted by Queen’s University in Canada. The trial started September 2008 and is estimated to be complete by September 2011 (Phase). “Surgical Outcomes Using Variable Rod Diameters in the Treatment of Idiopathic Scoliosis,” is a trail to test the difference in a rod with a diameter of 5.5mm vs. one with a diameter of 6.35mm. This trial is currently recruiting.
The primary goal of this trail is to discover which diameter of rod is more successful in correcting scoliosis in children. Surgeons use the specific rods based on their preference. There is no proof as to which diameter of rod works better. It is a question that needs to be put to the test (Surgical). Patients must be 11-18 years of age, have scoliosis, and be anticipating a spinal fusion surgery. The estimated enrollment is three hundred patients. This trail is being conducted by Shriners Hospital for Children in Tampa. The starting date was May 2007 and it is estimated to end in May 2010 (Surgical). The purpose of “The Idiopathic Scoliosis and Its Treatment (Orthopedic and Surgery): Effect of the Severity, Orthosis and the Arthrodesis on the Gait (scoliosis),” trial is to test the effects of the treatment of scoliosis. This trial is currently recruiting. The primary goal is to compare locomotion parameters in treated scoliosis patients. The secondary goal is to evaluate the effects of the frontal curve’s severity of the AIS (Adolescent Idiopathic Scoliosis). Another goal that is hoped to be achieved is comparing the effects of treatment on the gait parameters (Idiopathic).
Patients must be 12-18 years of age and female to participate. Both healthy and patients diagnosed with scoliosis by x-ray are needed. The estimated enrollment for this trial is fifty patients. It will be conducted by Cliniques Universitaires Saint-Luc-Universite Catholique de Louvain in France. The start date for this trial was January 2009 and it is expected to be over by September 2009 (Idiopathic). “Influence of Leg Length Discrepancy on the Spinal Shape and Biomechanics in Functional and Idiopathic Scoliosis Patients,” is a trial that was created for motion analysis of scoliosis patients. The trial is not yet open for recruitment. The primary goal is to investigate the effects of correction of Leg Length Discrepancy (LLD). LLD is defined as a condition in which paired limbs are unequal in length (Influence) LLD may lead to lumbar scoliosis.
It is thought that if LLD is taken care of it can cure the scoliosis. To be eligible for this trial the patient must have functional lumbar scoliosis combined with LLD or idiopathic lumbar scoliosis without LLD. The estimated enrollment for this trial is thirty patients. The trial will be conducted by National Taiwan University Hospital. There are no available dates for this trial (Influence). The trial “Comparing Two Instrumentation Systems for the Treatment of Adolescent Scoliosis” was created to test the Moss Miami Spine Instrumentation System and the Universal Spine Instrumentation System. This trial has been completed. The primary goal was to compare the quality of life, functional outcome, cosmetic result, and the correction of spinal deformity of the two instrumentation systems (Comparing). Patients had to be 8-18 years of age, have idiopathic scoliosis requiring posterior instrumentation and fusion, scoliosis and a finding of conus less then L1-2 disc level, scoliosis and a finding of a small syrinx (non-progressivie and does not require neurosurgical treatment), and non-progressive spondylolysis.
This trial had an estimated enrollment of one hundred and twenty-six patients. It was conducted by The Hospital for Sick Children in Canada. The study was received January 4, 2006 (Comparing) The Moss Miami system and the Universal Spine systems provided similar quality of life and curve correction (Comparing). “Continuous Local Infusion of Anesthetic at the Incisional Site for Scoliosis Surgery,” is a trial for testing the drugs Bupivacaine and normal Saline. This trial is currently recruiting. The primary goal is to evaluate effects of continuous local anesthetic delivery on the immediate post-operation recover of patients undergoing spinal fusion surgery (Continuous). The eligibility for this trial is 8-18 years of age, clinical diagnosis of congenital scoliosis, clinical diagnosis of idiopathic scoliosis, and anticipated spinal fusion surgery. The estimated enrollment is sixty patients. The trial is being conducted by Shriners Hospital for Children in Tampa.
The trial started May 2007 and is estimated to end January 2010 (Continuous). The trial “Analgesic Effects of Gabapentin After Scoliosis Surgery in Children” was created to test the drugs Gabapentin and Placebo. This trial is currently recruiting patients. The primary goal is to determine whether the use of Gabapentin will improve postoperative analgesia and reduce opioid consumption and side effects in children undergoing corrective spinal surgery for idiopathic scoliosis (Analgesic). The secondary goal is to evaluate whether use of Gabapentin reduces pain scores, decreases postoperative nausea and vomiting, decreases persisting pain and improves patient satisfaction (Analgesic). Scoliosis surgery can cause sever pain after the surgery is over so a way to control this pain is needed. Patients must be 10-17 years of age, scheduled for elective surgical correction of scoliosis, and able to operate a patient-controlled analgesia (PCA) pump. The estimated enrollment is thiry-six patients.
This trial is being conducted by The Hospital for Sick Children in Canada. The start date for this trial was May 2008 (Analgesic). “Effect of Early Morphine Administration on the Development of Acute Opioid Tolerance During Pediatric Scoliosis Surgery” is a completed trial that tested the drugs Morphine and Saline. The primary goal was to examine if morphine administered by bolus before initiating Remifentanil by infusion decreases the incidence of acute postoperative opioid tolerance (Effect). To be eligible for this trial the patient had to be 11-18 years of age, unpremedicated, ASA physical status 1 or 2, and be scheduled for posterior instrumentation for correction of idiopathic scoliosis. This trial had an enrollment of thirty-seven patients. The groups were demographically similar. No differences were observed between groups in the initial 24-hr morphine consumption, NRS pain scores, sedation, nausea, or vomiting (Effect).
“VEPTR Implantation to Treat Children With Early Onset Scoliosis Without Rib Abnormalities” is a recruiting trial that tests unilateral or bilateral VEPTR devices. The primary goal of this trial is to evaluate the use of unilateral or bilateral VEPTR devises for preventing further progression of the angle, allowing for spinal growth and improving pulmonary function in the treatment of children with scoliosis (VEPTR). To be eligible for this trial, patients must be 18 months-10 years of age, have progressive scoliosis, and have a curve beyond 45 degrees. The estimated enrollment is two hundred and fifty patients. This study is being conducted by Shriners Hospital for Children in Tampa. The start date was January 2008 and it is estimated to be over by January 2016 (VEPTR).
“Effectiveness of Bracing in Preventing Scoliosis in Children With Spinal Cord Injury” is an active trial that tests Thoraco-Lumbar-Sacral-Orthosis (TLSO)/Flex-Foam. The primary goal is to determine whether full-time high dose prophylactic bracing is more effective then low dose bracing (12 hours/day) in preventing or delaying spinal curve progression (Effectiveness) Patients must be 5-16 years of age, have C5 to L2 SCI, ASIA impairment levels A, B, or C, single structure curve smaller than forty degrees or double curve smaller than forty degrees where the largest curve is less than twenty-five degree bending film, risk for paralystic scoliosis, and the ability to follow simple instructions. The estimated enrollment is eighty-eight patients. This trial is being conducted by Shriners Hospital for Children in Tampa. The trial started June 2005 and is estimated to be over by December 2010 (Effectiveness).
“Shilla Growth Permitting Spinal Instrumentation System for Treatment of Scoliosis in the Immature Spine” is a active trial that tests the Shilla growth permitting spinal procedure. The Shilla growth permitting spinal procedure is very similar to the growing spine system but requires fewer surgeries. The primary goal is to retrospectively review patients who have undergone this technique looking at age of the patient, magnitude of the curve preoperatively, postoperatively and over time, diagnosis, pulmonary function, surgical procedures, complications, and spinal growth (Shilla). To be eligible for this study the patient must be 1-10 years of age, have sever, progressive scoliosis unresponsive to bracing, or have severe, progressive scoliosis but cannot tolerate bracing. The estimated enrollment for this trial was fifty patients. It is becing conducted by Arkansas Children’s Hospital Research Institute. The start date for this trial was April 2005 and it is expected to be complete by April 2015 (Shilla).
“Recombinant Human Erythropoietin Compared to Autologous Pre-Donation Prior to Scoliosis Surgery in Children” is a completed trial that tested recombinant human erythropoietin (rHuEpo). This procedure was created to decrease the need for blood transfusions during surgery. The primary goal of this trial is to establish whether rHuEpo is as effective as PAD in increasing red bell mass prior to surgery (Recombinant). Patients had to be 12-18 years of age and require scoliosis repair to be eligible. The estimated enrollment for this trial was twenty patients. The trial was conducted by the University of British Columbia. The start date was October 2004 and the trial ended December 2007 (Recombinant). The use of rHuEPO preoperatively and the use of PAD are not cost-effective although both techniques remain clinically effective tools (VEPTR).
“Effects of Lateral Trunk Support in Spinal Alignment in Spinal Cord Injured Persons” is a completed trial that tested lateral trunk support of wheelchair seating. Different types of seating is used to help with patients posture but it was unknown if it helped with the scoliosis curve. The primary goal is to examine the effects of lateral trunk supports in special seating on the spinal alignment of spinal cord injured subjects with scoliosis (Effects of).
Patients had to be 18-60 years of age, have C4-T12 SCI, sit on the wheelchair more then four hours a day, have thoracic lumbar scoliosis, and flexible scoliosis. The estimated enrollment for this trial was twenty patients. The trial was conducted by the National Taiwan University Hospital. The trial started September 2002 and ended November 2004 (Effects of). The radiographic findings demonstrate improved scoliotic spinal alignment in the frontal plane and reduced lumbar angles in the sagittal plane in persons with SCI when seated in a special seat and using LTS (Effects of).
“The Use of Intraoperative Intrathecal Morphine Versus Epidural Extended Release Morphine for Postoperative Pain Control in Pediatric Patients Undergoing Posterior Spinal Fusion (IT Morphine)” is a recruiting trial that tests the drug DepoDur. The primary goal of this trial is to learn more about preventing pain in children who are having posterior spinal fusion surgery (Use). Patients must be 8-17 years of age and need a fusion of a minimum of five and maximum of thirteen levels, including at least L1 or lower. The estimated enrollment is eighty patients. The trial will be conducted by The Children’s Hospital in Denver. It started December 2008 and is estimated to end December 2010 (Use). Foundations and Grants
The Scoliosis Care Foundation was founded by Gary Deutchman in 2001. The foundation helps with improving education, treatment and diagnosis of scoliosis. Gary Deautchman disliked the watch and wait approach to diagnosing scoliosis. He thought this approach was harming the future well-being of children. The Scoliosis Care Foundation has a program called the Scoliosis Awareness Program which is designed to catch early scoliosis so it does not progress (Scoliosis).
The National Scoliosis Foundation is a patient-led nonprofit organization dedicated since 1976 to helping children, parents, adults, and health-care providers to understand the complexities of spinal deformities such as scoliosis (24). The National Scoliosis Foundation helps with all aspects of support. The main focus is promoting the awareness of scoliosis and providing information (National).
The Small Exploratory Grant is designed for new investigators who have a preliminary concept they would like to develop into a research project (Research). The maximum grant rewarded for this category is $10,000. The maximum duration of research is one year (Research).
The New Investigator Grant is designed for new investigators. Candidates who have received the Small Exploratory grant are eligible as long as they have not received any other previous funding from national granting organizations. The maximum award is $25,000, and the duration of the research can last up to two years (Research).
The Standard Investigator Grant is awarded a maximum of $50,000 a year. The duration can last up to two years with the maximum total being $100,000. These grants are for any type of spinal deformity but there is additional money if it is going towards scoliosis (Research). The Continuation or Extension Grant is for on-going projects, which have previously been funded by the Scoliosis Research Society. In order to receive these grants a report of the progress is required (Research).
Scoliosis is a fairly common disorder and it effects it’s victims in different ways. Scoliosis can do more then just cause the victim deformities. It can cause pain, breathing problems, and a number of other things. It could even get so bad that it could paralyze it’s victims. Scoliosis is nothing that should be left alone. Though in most cases the cause of scoliosis is unknown, it does not mean that it is not treatable. There are already several ways to treat scoliosis and more research is being done to develop more ways to treat this unexpected life roller coaster known as scoliosis.
Works Cited
1. “Analgesic Effects of Gabapentin After Scoliosis Surgery in Children.” Clinical Trials. The Hospital for Sick Children, 22 May 2008. Web. 24 Oct. 2012. . 2. Board, A.D.A.M. Editorial. “Scoliosis.” Scoliosis. U.S. National Library of Medicine, 18 Nov. 0000. Web. 24 Oct. 2012. . 3. “Comparing Two Instrumentation Systems for the Treatment of Adolescent Scoliosis.” Clinical Trials. The Hospital for Sick Children, 4 Jan. 2006. Web. 24 Oct. 2012. . 4. “Continuous Local Infusion of Anesthetic at the Incisional Site for Scoliosis Surgery.” Clinical Trials. Shriners Hospitals for Children, 25
July 2007. Web. 24 Oct. 2012. . 5. “Effect of Early Morphine Administration on the Development of Acute Opioid Tolerance During Pediatric Scoliosis Surgery.” Clinical Trials. The Hospital for Sick Children, 18 Aug. 2008. Web. 24 Oct. 2012. . 6. “Effectiveness of Bracing in Preventing Scoliosis in Children With Spinal Cord Injury.” Clinical Trials. Shriners Hospitals for Children, 16 Nov. 2005. Web. 24 Oct. 2012. . 7. “Effects of Lateral Trunk Support on Spinal Alignment in Spinal Cord Injured Persons.” Clinical Trials. National Taiwan University Hospital, 9 Sept. 2005. Web. 24 Oct. 2012. . 8. “The Idiopathic Scoliosis and Its Treatment (Orthopaedic and Surgery): Effect of the Severity, the Orthosis and the Arthrodesis on the Gait (scoliosis).” Clinical Trials. Cliniques Universitaires Saint-Luc- Université Catholique De Louvain, 10 Feb. 2009. Web. 24 Oct. 2012. . 9. “Influence of Leg Length Discrepancy on the Spinal Shape and Biomechanics in Functional and Idiopathic Scoliosis Patients.” Clinical Trials. National Taiwan University Hospital, 9 Sept. 05. Web. 24 Oct. 2012. . 10. “A Multicenter Prospective Study of Quality of Life in Adult Scoliosis (ASLS).” A Multicenter Prospective Study of Quality of Life in Adult Scoliosis. Washington University School of Medicine, 2 Mar. 2009. Web. 24 Oct. 2012. . 11. “National Scoliosis Foundation.” National Scoliosis Foundation. NSF, n.d. Web. 24 Oct. 2012. . 12. “Phase IV Comparing Rods of Yield Strengths to Correct Adolescent Idiopathic Scoliosis.” Clinical Trials. Queen’s University, 7 Oct. 2008. Web. 24 Oct. 2012. . 13. “Recombinant Human Erythropoietin Compared to Autologous Pre-Donation Prior to Scoliosis Surgery in Children.” Clinical Trials. University of British Columbia, 8 May 2006. Web. 24 Oct. 2012. . 14. “Research Areas.” National Science Foundation. National Science Foundation, n.d. Web. 24 Oct. 2012. . 15. “The Scoliosis Awareness Project.” Scoliosis Care Foundation. Scoliosis Care Foundation, n.d. Web. 24 Oct. 2012. . 16. “Shilla Growth Permitting Spinal Instrumentation System for Treatment of Scoliosis in the Immature Spine.” Clinical Trials. Arkansas Children’s Hospital Research Institute, 18 Dec. 2007. Web. 24 Oct. 2012. . 17. “Surgical Outcomes Using Variable Rod Diameters in the Treatment of Idiopathic Scoliosis.” Clinical Trials. Shriners Hospitals for Children, 31 July 2007. Web. 24 Oct. 2012. . 18. “The Use of Intraoperative Intrathecal Morphine Versus Epidural Extended Release Morphine for Postoperative Pain Control in Pediatric Patients
Undergoing Posterior Spinal Fusion (IT Morphine).” Clinical Trials. Children’s Hospital Colorado, 10 Apr. 2009. Web. 24 Oct. 2012. . 19. “VEPTR Implantation to Treat Children With Early Onset Scoliosis Without Rib Abnormalities.” Clinical Trials. Shriners Hospitals for Children, 29 May 2008. Web. 24 Oct. 2012. .
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