ADOLESCENT IDIOPATHIC

SCOLIOSIS (AIS)

CONTACT INFORMATION Clinical Research Coordinator

Orthopaedic Surgery The Hospital for Sick Children

555 University Ave, Toronto, Ontario, M5G 1X8

416-813-7654 Ext. 2959

DID YOU NOTICE A PHYSICAL CHANGE?

WHEN YOU CAME TO THE ORTHOPAEDIC CLINIC AND FOUND OUT ABOUT YOUR

DIAGNOSIS, HOW DID YOU FEEL?

HOW DOES THE BRACE FEEL NOW THAT YOU ARE WEARING

IT?

PATIENTS PARTICIPATING IN RESEARCH SHARE THEIR EXPERIENCES

HOW DID YOUR CURVE GET NOTICED? “I thought I broke my ribs

so I went to the doctor and he sent me for an X-ray...they discovered that there was a curve in my spine.”

“I didn’t notice my curve actually. My mom and dad noticed it.”

“I did not notice a change. Everyone kept telling me to stand up straight and I was standing as straight as I could. I also noticed

when I bent over I had a protrusion on my back.”

“I didn’t see any changes.”

“When I found out I had it, it didn’t bother me because I

was doing everything normal.”

“I felt kinda sad and confused. Also, I felt that

I might cry.”

“The measurements (for the brace fitting) felt kinda

awkward...most people still don’t notice (the brace) and my friends don’t even

know I have it. I told them that I have a bulletproof vest on and, well, they didn’t seem to care much.

The thing about it is that it is hard to bend down, tie my shoes and play sports.

But I was able to manage eventually. Nothing is wrong (with) my brace so far and

I feel fine about it.”

RISK FOR PROGRESSION

GROWTH

If you have a large curve and are still growing you are at the highest risk for progression.

AGE

If you are 10 to 12 years old, your curve is more likely to progress than if you are 15 to 16 years old.

MENSTRUATION

If scoliosis is detected before you experience menstruation for the first time, you have a higher risk of your curve getting bigger.

GENDER

If you are a boy your curve is less likely to progress than if you are a girl.

A quick guide about treatment

options and how you can

participate in research.

There are a few risk factors that are associated with curve progression. If you have these risk factors, there is a chance your curve will get bigger.

Have you had your

back checked lately?

We do not know why AIS develops, but it does sometimes run in families. Scoliosis causes the

spine to curve toward one side. The spine also twists, or rotates, causing the ribs to move with it. If the curve is small, it is usually not noticeable except on an X-ray.

We diagnose scoliosis by looking at an X-ray of the entire spine and the top of the hips. Scoliosis is measured in degrees. Scoliosis is present if there is a 10+ degree curve and if the spine is twisted or rotated. The spine is usually a straight line. If you have scoliosis the curve will be in the shape of a C or an S. S-shaped

curves are double curves. C-shaped curves are known as single curves. A small curve is less than 20 degrees. A moderate curve is between 20 and 50 degrees. A large curve is more than 50 degrees. If your curve is moderate to large you will be referred to the Orthopaedic Clinic. During each visit your height will be measured so that doctors can pinpoint when your growth is accelerating, slowing down or complete. The examination will involve the Adam’s test, reflex and sensory exam, strength test, leg length measurements and examination of shoulder and hip balance. If you are eligible, you will also be asked to participate in research. Research helps us better understand scoliosis and the most effective treatment options. Participating is voluntary.

WHAT IS

ADOLESCENT

IDIOPATHIC

SCOLIOSIS?

The girl in the photo above has a curve that measures 48 degrees. Notice that her right shoulder is lower than her left shoulder and her shoulder blades are not even.

The Adam’s test (below) is used to see if one side of the back is higher than the other. This position shows if there is rib prominence. The doctor may do the Adam’s test with a tool called the scoliometer (right). This tool is similar to the balance carpenters use to check if something is level. It measures the severity of the rib prominence in degrees.

PARTICIPATING IN RESEARCH

Currently SickKids is participating in a multi-centre trial called Bracing in Adolescent Idiopathic Scoliosis Trial (BrAIST) that involves 25 hospitals in North America. This trial will help to show how effective brace treatment is and for whom it is most effective. Patients who meet the criteria will be asked if they would like to participate. If you decide to participate in the trial your treatment option (watchful waiting vs. brace) will be either chosen at random or you may pick which treatment to take. If you decide to join the study you will fill out questionnaires that will let us know how you are feeling and doing. This is the best way to determine if the brace works and for whom it works. Visit www.uiortho.com/braist/index.htm to learn more!

WATCHFUL WAITING

This option consists of follow-up visits and X-rays on a regular basis to monitor the curve. There will be no braces or other things to wear that may interfere with the things you like to do. Six to 43 per cent of kids who wear a brace will need surgery. Doctors offer watchful waiting as an alternative because some research shows that patients do not benefit from wearing a brace.

BRACING

The brace looks like a clamshell made out of hard plastic custom-molded to fit your body. It is held in place by Velcro straps. The brace is usually worn for about three years or until your bones stop growing. Some people believe a brace can keep a curve from getting bigger. Others believe a curve will get bigger whether or not a brace is used.

SURGERY

Doctors will suggest surgery when a curve gets bigger than 50 degrees. Bone fusion is done to keep the spine in a straight position. By one year, when the fusion is healed, patients can go back to all their usual activities.

TREATMENT OPTIONS