2. Questions to Ponder What is Scoliosis? What is Adolescent Idiopathic Scoliosis (AIS)? How do I know if I have AIS? Is AIS caused by not drinking enough milk or poor posture? Are girls more likely to have scoliosis than boys? Is AIS hereditary? What are the treatment options for AIS?

3. by Tosha S. Rhea

4. Overview What is Scoliosis Prevalence of Scoliosis Adolescent Idiopathic Scoliosis (AIS) Pedigree Chart Symptoms of AIS AIS Testing AIS Treatment Observation Bracing Surgery Concluding Thoughts

5. What is Scoliosis? An abnormal lateral curve to the vertebral column greater than 10° Many different forms of scoliosis Straight Spine -has 0° curve Curvature of the Spine - has a curve that is between 0° and 10° Scoliosis of the Spine - has a curve that is greater than 10°

6. Prevalence of Curvature/Scoliosis Curves 10° or less, 3-5 out of 1,000 people Curves less than 20° is equal in males and females Overall, 2% of females and 0.5% of males are affected by scoliosis

7. Adolescent Idiopathic Scoliosis (AIS) Side-to-side curve Greater than 10° Twisting of the spinal column Spine resembles a “C” or “S” Patients are between 10 and 18 years Curve gets larger during rapid growth Otherwise, patients are healthy No known cause 30% have some family history Genetic connection

8. Pedigree Chart with Multiple Family Members affected with AIS Closed symbols represent affected individuals Squares - Males Circles - Females Suggests a dominant mode of inheritance

9. Symptoms of Scoliosis Waist may appear uneven or hips elevated One shoulder may appear higher One side of the rib cage may appear higher One leg may appear shorter than the other The body may tilt to one side

10. AIS Testing Adam’s Forward Bend X-ray This test involves the student bending forward with arms stretched downward toward the floor and knees straight. This angle most clearly shows any asymmetry in the spine and/or trunk. Often preformed in school starting in the fifth grade. This procedure is needed to confirm the AIS diagnosis, to check the magnitude of the curve, and to check the skeletal maturity of the patient. This will influence the treatment decisions.

11. AIS Treatment Observation Bracing Surgery

12. Observation Consider patient’s age (girls grow rapidly until age 14, boys until age 16) Consider status of females 1 st menstrual period (growth slows down) Consider x-ray of the spine and pelvis (shows skeletal maturity on a scale of 0 to 5)

13. Bracing Used with curves between 25° and 40° during the growth phase Designed to each patient’s shape Prevents curve progression Worn under clothes Worn all day or just at night Worn until growth of the spine has stopped

14. Surgery Treatment with Spinal Fusion Harrington Method Contrel-Dubousset Instrument Fusion with one rod hooked to the spine Obsolete “flatback” Increase wear and tear Early onset of arthritis Degeneration of discs Muscle stiffness Reliance of painkillers Further surgery required Disability Fusion with a combination of two rods, screws, hooks, and wires Modern Low rate of failure 5-7 Day hospital stay 3-4 Weeks out of school 6 Month recovery time For more information go to Scoliosis Research Society (SRS)

15. Concluding Thoughts Scoliosis occurs relatively frequently in the general population. Its frequency depends upon the magnitude of the curve of the spine. Scoliosis of greater than 25 degrees occurs in many people all around the world. However, 60% of curvatures in rapidly growing pre-pubertal children will progress. Screening for Adolescent Idiopathic Scoliosis (AIS) is not necessary until the fifth grade, and beyond that point, boys and girls should have an examination every 6-9 months. It is important to know what to do if a patient already has scoliosis, and what treatment options are available.

16. Resources www.srs.org www.ejbjs.org www.journals.lww.com/corr/Abstract/2000/03000 /Idiopathic_Scoliosis www.journals.lww.com/corr/Abstract/2000/03000 /Idiopathic_Scoliosis www.en.wikipedia.org/wiki/Scoliosis