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Scoliosis
Scoliosis is a lateral (toward the side) curvature in the normally straight vertical line of the spine. The normal spine curves gently backward in the upper back and gently inward in the lower back. When viewed from the side, the spine should show a mild roundness in the upper back and shows a degree of swayback (inward curvature) in the lower back. When a person with a normal spine is viewed from the front or back, the spine appears to be straight. When a person with scoliosis is viewed from the front or back, the spine appears to be curved.
What Causes Scoliosis?
There are many types and causes of scoliosis, including:
- Congenital scoliosis. A result of a bone abnormality present at birth.
- Neuromuscular scoliosis. A result of abnormal muscles or nerves, frequently seen in people with spina bifida or cerebral palsy or in those with various conditions that are accompanied by, or result in, paralysis.
- Degenerative scoliosis. This may result from traumatic (from an injury or illness) bone collapse, previous major back surgery or osteoporosis (thining of the bones).
- Idiopathic scoliosis. The most common type of scoliosis, idiopathic scoliosis, has no specific identifiable cause. There are many theories, but none have been found to be conclusive. There is, however, strong evidence that idiopathic scoliosis is inherited.
Who Gets Scoliosis?
Approximately 2% to 3% of Americans at age 16 has scoliosis. Less than 0.1% has curves measuring greater than 40 degrees, which is the point at which surgery becomes a consideration. Overall, girls are more likely to be affected than boys. Idiopathic scoliosis is most commonly a condition of adolescence affecting those ages 10 through 16. Idiopathic scoliosis may progress during the "growth spurt" years, but usually will not progress to adulthood.
How Is Scoliosis Diagnosed?
Most curves are initially detected on school screening exams, by a child's pediatrician or family doctor, or by a parent. Some clues that a child may have scoliosis include uneven shoulders, a prominent shoulder blade, uneven waist or leaning to one side. The diagnosis of scoliosis and the determination of the type of scoliosis are then made by a careful bone exam and an X-ray to evaluate the magnitude of the curve.
What Is the Treatment for Scoliosis?
The majority of adolescents with significant scoliosis with no known cause are observed at regular intervals (usually every four to six months), including a physical exam and a low radiation X-ray. Treatments include:
-
Braces. Bracing is the usual treatment choice for adolescents
who have a spinal curve between 25 to 40 degrees -- particularly if their bones
are still maturing and if they have at least two years of growth remaining.
The purpose of bracing is to halt progression of the curve. It may provide a temporary correction, but usually the curve will assume its original magnitude when bracing is eliminated.
-
Surgery. Those who have curves beyond 40 to 50 degrees are often
considered for scoliosis surgery. The goal is to make sure the curve does not
get worse, but surgery does not perfectly straighten the spine. During the
procedure, metallic implants are utilized to correct some of the curvature and
hold it in the correct position until a bone graft, placed at the time of
surgery, consolidates and creates a rigid fusion in the area of the curve.
Scoliosis surgery usually involves joining the vertebrae together permanently
-- called spinal fusion.
In young children, another technique that does not involve fusion may be used since fusion stops growth of the fused part of the spine. In this case, a brace must always be worn after surgery.
WebMD Medical Reference provided in collaboration with the Cleveland Clinic
ORENCIA® (abatacept) Important Safety Information
Indication and Usage
ORENCIA® (abatacept) is a prescription medicine that reduces signs and symptoms in adults with moderate to severe rheumatoid arthritis (RA), including those who have not been helped enough by other medicines for RA. ORENCIA may prevent further damage to your bones and joints and may help your ability to perform daily activities.
Important Safety Information About ORENCIA® (abatacept)
Before you receive treatment with ORENCIA, a lyophilized powder for intravenous infusion, you should tell your doctor about all your medical conditions, including if you:
- have any kind of infection even if it is small (such as an open cut or sore) or an infection that is in your whole body (such as the flu).
- have an infection that will not go away or a history of infections that keep coming back.
- have had tuberculosis (TB), a positive skin test for TB, or if you recently have been in close contact with someone who has had TB. If you get any of the symptoms of TB (a dry cough that doesn’t go away, weight loss, fever, night sweats), call your doctor right away. Before you start ORENCIA, your doctor may examine you for TB or perform a skin test.
- have or have had viral hepatitis. Before you use ORENCIA, your doctor may examine you for hepatitis.
- have a history of chronic obstructive pulmonary (lung) disease (COPD).
- are scheduled to have surgery.
- are allergic to any of the following ingredients in ORENCIA: abatacept, maltose, monobasic sodium phosphate, or sodium chloride for administration.
- recently received a vaccination or are scheduled for any vaccination.
- have diabetes and use a blood glucose monitor to check your sugar levels. The infusion of ORENCIA contains maltose, a sugar that can give falsely high blood glucose readings with some monitors on the day you receive your infusion. Your doctor may tell you to use a different way to monitor your blood sugar levels.
- are pregnant, planning to become pregnant, or are thinking about becoming pregnant. It is not known if ORENCIA can harm your unborn baby.
- are breast-feeding. You will need to decide to either breast-feed or receive treatment with ORENCIA, but not both.
- take any other kinds of medicine, including prescription and nonprescription medicines, vitamins, and herbal supplements.
- are taking other biologic medicines to treat RA such as: Enbrel® (etanercept), Humira® (adalimumab), Remicade® (infliximab), Kineret® (anakinra) or Rituxan® (rituximab). You may have a higher chance of getting a serious infection if you take ORENCIA with other biologic medicines.
Possible Side Effects of ORENCIA® (abatacept)
ORENCIA can cause serious side effects including:
- Serious infections. Patients receiving ORENCIA have a higher chance of getting infections including pneumonia, and other infections caused by viruses, bacteria, or fungi. Call your doctor immediately if you feel sick or get any of the following signs of infection: fever, feel very tired, cough, feel flu-like, or warm, red or painful skin.
- Allergic reactions. Allergic reactions can happen on the day of treatment or the day after receiving ORENCIA. Tell your doctor or get emergency medical help right away if you have hives, swollen face, eyelids, lips, tongue, throat, or trouble breathing.
- Cancer (malignancies). Certain kinds of cancer have been reported in patients receiving ORENCIA. It is not known if ORENCIA increases your chance of getting certain kinds of cancer.
- Vaccinations. You should not receive ORENCIA with certain types of vaccines. ORENCIA may cause some vaccinations to be less effective.
- Respiratory problems in patients with COPD. You may get certain respiratory problems more often if you receive ORENCIA and have COPD, including: worsened COPD, pneumonia, cough, or trouble breathing.
The more common side effects with ORENCIA are headache, upper respiratory tract infection, sore throat, and nausea.
Please read the Patient Information in the Full Prescribing Information below.
ORENCIA is a registered trademark of Bristol-Myers Squibb Company.
All other trademarks are property of their respective companies.
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