As seen in delawareonline.com
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Twice as prevalent in females, diagnosis of condition usually made as children enter puberty
By HIRAN RATNAYAKE, The News Journal
Posted Tuesday, June 5, 2007
As a child, Denise Marandola could pinpoint the pain to her mid-back, on the right half, at the tips of her ribs. When she bent over, the bulge on that right side rose higher than on the left. Marandola was 12 when she learned she had scoliosis.
Not everyone experiences pain. Most people who have scoliosis, an abnormal curvature of the spine, don't. At its worst, scoliosis can interfere with the function of organs, causing people's posture to become the shape of a crescent moon. Marandola, now 36, said she was told that the "achy, annoying, burning" pain stemmed from scoliosis.
It is usually diagnosed when children are entering puberty, most often in females. Three-to-five out of every 1,000 children develop scoliosis. Rarely does it begin to occur in adults.
While thought to be hereditary, the cause of most cases of scoliosis is unknown, said Dr. Peter Gabos, co-director of Alfred I. duPont Hospital for Children's Center for Spine and Scoliosis Surgery.
"We don't know whether it's linked to the X chromosome, whether it's due to the ligaments or due to some hormonal issue," he said.
People with mild scoliosis may not need treatment. Those with severe cases could undergo surgery or be fitted for a brace.
Dr. G. Dean MacEwen at the former Alfred I. duPont Institute developed the Wilmington Brace almost four decades ago. The braces have been successful in treating teenagers with scoliosis.
But, as a preteen, Marandola worried about wearing a brace.
"It scared me to death," she said. "I remember it really shook me up."
Marandola was monitored by duPont doctors for a few years to see if the scoliosis would worsen. It got better, and she could feel her curvature improving. Only when she did a lot of hands-on work did that achy feeling return.
At 19, though, she fell off a horse and into a fence. In intense pain, she took muscle relaxers and medications for a month. The pain remained, and she went to a chiropractor for pinched nerves. She also had her back adjusted because of the scoliosis. Now, Marandola is treated by Dr. Scott Rosenthal and works as an account manager for his Wilmington practice, Rosenthal Chiropractic.
Rosenthal said Marandola's individual spinal segments are more prone to misalignment and malfunction than people without scoliosis.
"We're trying to manage the existing weakness that she has with the scoliosis," he said. "I'm helping her spine maintain its proper alignment."
Scoliosis affects girls twice as often as boys, while the ratio of severe curves from scoliosis in girls to boys is about 7 to 1, Gabos said. It is easier to diagnose as children enter puberty since they are hitting a tremendous growth spurt.
"Typically, a sixth-grade girl will have very long legs and a very short trunk," Gabos said. "After that, they basically grow into their trunk, and during that very rapid phase of spine growth, the spine grows basically to meet the [growth] of the lower half of the body."
Surgery is typically performed on children with a spine curvature that exceeds 50 degrees. The main goal is to stop the curve from increasing. A secondary goal, Gabos said, is to rebalance the spine toward a more common contour.
"We're taking a lot of little, crooked bones and turning them into one straight solid bone," he said. "We don't treat the entire spine, only the part that's curved. The part above the curve and below the curve is left untouched."
Surgeries also can be done on adults, but they carry more risk.
"As we get older, we get stiff," Gabos said. "The chance that the spine will fuse and the operation will actually work is much higher in teenagers than it is in adults."
As a youngster in the 1940s, when spine surgeries were less advanced, Carol Johnson's parents had to decide whether an operation was best for her. Her scoliosis was discovered when she was 12.
Her parents opted against surgery. Johnson was told she'd never walk again or be able to bear children. But six decades later, she is still walking and has given birth twice. Now 72, she credits Rosenthal and his father, Mel, who also ran a chiropractic practice before retiring a few years ago.
"At times, if I don't go to a chiropractor, I can be in constant pain," said Johnson, who lives in Wilmington.
Marandola said seeing a chiropractor has helped her back. But there is a lack of evidence in medical research that these methods prevent spinal curvature from progressing.
"There haven't been well-funded studies on this concept," Rosenthal said. "But there's critical case studies that I've seen where [people with scoliosis] have had curve reductions."