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Scoliosis, Skolios

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A recent study published by the journal, Spinal Deformities, discovered a high prevalence of vitamin D deficiency in adolescents with scoliosis who are meant to undergo spinal surgery.A total of 217 adolescents with either neuromuscular or idiopathic scoliosis were included in this study. All patients were scheduled to undergo either spinal fusion or initial growing rod placement surgery. Prior to the operation, the researchers recorded data regarding gender, age, body mass index, race, scoliosis type, spine surgery procedure and season of the year. Additionally, all individuals had serum blood draws in order to determine vitamin D status.This is what the researchers found:

  • Approximately 75% of the participants were considered vitamin D deficient (<20 ng/ml; <50 nmol/l).
  • African Americans were more likely to be vitamin D deficient than Caucasians (p < 0.0002).
  • Those who were preparing for spinal fusion also experienced a greater risk of deficiency compared to those undergoing an initial growing rod placement (p < 0.03).
  • Low vitamin D status was most common during winter compared to any other season (p < 0.005).
  • Those with neuromuscular scoliosis had significantly higher vitamin D levels compared to those with idiopathic scoliosis (p < 0.0002).

The researchers concluded,“Low [25(OH)D] levels are reported in pediatric patients with scoliosis preparing for corrective spinal surgery. Population subsets most at risk for deficiency in this limited study include African American children, those presenting for spinal fusion surgery, and patients admitted in winter season.”

Scoliosis is defined by having abnormal curves in the spine. It can be a curve side to side forming an “S” when both the mid back and low back are involved, or a “C” curve when just the upper or lower spine is involved. Scoliosis is also used when there are excessive curves front to back. A kyphosis describes a strong curve in the mid back while excessive lordosis describes a strong sway back curve in the lower back.

Scoliosis can be functional or structural. A functional curve is a curve that is due to a condition and can be corrected. An example of this is a short leg which causes a tipping of the pelvis and a resultant scoliosis of the spine. A scoliosis from the bottom up.

A structural curve is one due to the way the spine and skeleton develops. There can develop during different time frames

Some curves start inutero when the developing fetus is positioned in a way that allows for uneven development of the cranium and face (plagiocephaly and unilateral microcephaly), and eventually a torticollis. This is called infantile scoliosis and there is an increased risk for hip dysplasia in these infants. This left untreated can result in a scoliosis. Some infants, those in a breech position or facial or brow presentation at birth can have asymmetry between the front and the back of the body. They usually have the head in a strong position of extension (looking at the ceiling), arms back, difficulty lying on the stomach. Besides physical treatment of the joints, ligaments and muscles, it is critical for the parents to learn how to train with the infant. Babies that are asymmetric already inutero will usually develop a favorite side, often disregarding one side. In the breech baby this may present as not having contact with the front of the body, or with the top and bottom half of the body.Being asymmetric in infancy affects the integration of sight and balance with movement interfering with normal development of the core musculature.

The condition left untreated results in asymmetry in the developing child.

When we discuss scoliosis, there are two aspects to consider. One is that scoliosis develops and the other is the scoliosis that progresses. There are different theories as to why some children develop scoliosis; there is not a single cause. There are different theories why a scoliosis becomes aggressive and progresses into a more deforming condition. More to come on this.