Scoliosis is a term you may have heard but, unless a friend or loved one is affected, you may not know much about it. Scoliosis is a lateral curvature of the spine of greater than 10 degrees with vertebral rotation, or a “twisting” that can occur at any level of the spine. Collectively, this causes a 3-dimensional malformation of the spine, which can lead to imbalance, postural problems, and health complications. Adolescent Idiopathic Scoliosis (AIS) is a type of scoliosis found in adolescents and has an unknown cause. Treatment of AIS includes observation, orthotic intervention (bracing), or surgical intervention depending on the severity of the scoliosis.
AIS affects approximately two to three percent of adolescents, with only a fraction needing orthotic intervention. Girls are more likely to require a brace than boys. There are several different physical characteristics of AIS, including an asymmetry in shoulder height or waistline. There may be a trunk shift, or “decompensation”, where the child’s shoulders are shifted in relation to their hips. Asymmetric shoulder blades may be seen and an uneven “rib hump” can become visible when the child is bent over to touch their toes. Back pain has been associated with this form of scoliosis; however, it is not a clear indicator and may have no direct link to the spinal curvature.
There are several factors that come into play when finding the optimal time for orthotic treatment. If the curve has progressed to a 25-40 degree angle and the patient has not reached skeletal maturity, the child is a candidate for a spinal orthosis. Most orthotic treatments require full-time wear and are used until skeletal maturity. There are several orthoses available for scoliosis including the Gomez Orthotic System, which makes use of CAD-CAM technology to create total contact orthoses that address all three planes of the curve. No matter the technique, the orthotic goals remain the same: to shift the spine to the central sacral line, to keep the curves within non-operative parameters, to maintain sagittal alignment, and to promote balance.
Balance is the key to the orthotic management of AIS. With the use of the Gomez Orthotic System, we focus on the balance and alignment of the body in relation to the spine. This focus begins at the initial evaluation and is an ongoing and thorough process until the child has reached skeletal maturity. Photo-documentation, measurements of the corrected position and CAD-CAM technology are combined to make a spinal orthosis that not only corrects the curve, but also corrects the twisting of the spine.
Upon initial evaluation of the patient, the orthotist will gather a relevant medical history and examine the radiographs of the child’s spine. A series of photographs are taken to gather information on the physical presentation of the curves. The child’s spinal flexibility is also taken into consideration and measurements are recorded when the spine is in its most correctable position. After fabrication of the orthosis, an appointment is made for the child to be fit. Photographs are taken with the orthosis donned and a wearing schedule will also be discussed. The child is highly involved in the fitting process and is instructed to actively correct their posture while wearing their orthosis. This promotes the creation of balance in addition to what the orthosis provides. After receiving the orthosis the patient is asked to return for follow up appointments, ranging from two weeks initially to three months with time. These are important since it is necessary for the orthotist to track the curve’s correction and make any adjustments to make the orthosis more functional and comfortable.
Utilizing an orthosis to treat scoliosis can be a scary and embarrassing idea to an adolescent; however, the spinal orthosis can be worn discretely underneath clothing and cannot be seen by others. The child may still participate in sports and other recreational activities while going through orthotic treatment. Catching the curve early is very important because the most correction can be done while the child is still growing. The progression of scoliosis can be prevented with proper orthotic management, preventing surgery in the short-term as well as reducing the likelihood of long-term spinal issues.
CPO provides orthotic and prosthetic care to patients throughout Central Illinois. Their Bloomington office is located at 908 N. Hershey Road, 309-664-6930. CPO also houses an on-site fabrication department where custom orthoses and prostheses are designed and created for each patient. Visit the website at www.cpousa.com.
Photo courtesy Comprehensive Prosthetics & Orthotics